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National Coordinator Rucker Urges CMIOs to Participate in Helping to Improve Interoperability, Usability

March 5, 2018
by Mark Hagland
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National Coordinator Donald Rucker, M.D. urged CMIOs to participate actively in reshaping U.S. healthcare towards the improved interoperability and usability of clinical IS

Donald Rucker, M.D., National Coordinator for Health Information Technology, told the medical informaticists gathered at the AMDIS/HIMSS Physician Executive Symposium on Monday morning that CMIOs and other medical informaticists that they can be instrumental players in helping move healthcare computing to improved usability and interoperability going forward. Dr. Rucker presented the opening keynote address at that preconference symposium, one of numerous preconference symposia being held Monday during the annual HIMSS Conference, currently taking place at the Sands Convention Center in Las Vegas this week. The symposium is being cosponsored by AMDIS (the Association of Medical Directors of Information Systems) and HIMSS (the Chicago-based Healthcare Information and Management Systems Society). The Symposium is being held at the Wynn Hotel and Resort, across the street from the Sands.

Rucker cited increasing consumer empowerment—which he made clear that he supports—and advances in information technology, as elements that will stimulate enhanced interoperability in healthcare going forward, with interoperability being one of the key goals of federal healthcare officials.

“If you look at the computers we have today, they’ve really grown up in an environment where they weren’t really about computing for automation,” but rather primarily for billing. “Our computers today are deeply grounded in documentation and billing. We’ve just had a little bit of elimination of unnecessary workflow. But computers in healthcare look very different from computers in other industries—manufacturing, even service industries,” partly because of the complexity of healthcare delivery processes. Fundamentally, Rucker said, the shift in the health insurance market towards high-deductible health plans will compel consumers forward to search for greater value from the healthcare services they consume, which will in turn force innovation among providers.

Rucker urged the CMIOs and other medical informaticists in his audience to take things into their own hands and participate in pushing their own patient care organizations towards greater usability on behalf of their fellow physicians. “It doesn’t have to be just someone in IT who ‘does it to you,’” he said, referring to internal efforts to improve physicians’ workflow. “You have as much power as anybody in the hospital administration, when it comes down to it. Doctors are noisy, but we don’t use our powers. So take that user-group meeting, figure out how to build a better order system, how you can label things with labels that make common sense to folks. There’s a lot of stuff you can do to advance your work. And with just a little bit more work, you can really dive into these systems.”


Donald Rucker, M.D., at the sympoisum Monday morning

Moving on to the federal healthcare IT policy level, Rucker said, “Now, as we look at things that make more sense for the government to be more involved in today in the healthcare IT space, two things stand out. We have the electronic medical record, in large part because of the HITECH [Health Information Technology for Economic and Clinical Health] Act. And everybody intuitively thought they would automatically hook up with each other. But that didn’t happen. And that’s just the case everywhere. Windows didn’t have an Internet IP stack in it until the early 90s. So one issue is the raw usability. When clinicians are spending four or five hours a day on the computer—an hour of which has been described in our listening sessions as ‘pajama time’… usability and interoperability are massive issues. And there’s really a national consensus to work on those things.”

Further, he said, “Congress in December 2016 passed the 21st Century Cures Act, with an entire section on usability and interoperability. That was passed with 390-plus votes in the House, and over 90 votes in the Senate, and that’s pretty rare in U.S. politics these days. And it was signed into law by President Obama, after the election. And President Trump has made consumer empowerment a major campaign issue and issue for his organization, and has charged Secretary Azar at HHS[Health and Human Services Secretary Alex Azar] to really be working on consumer empowerment.”

Speaking further about consumer empowerment, Rucker said, “Drilling down into these two issues, that’s a complicated stack. The usability issue has a number of components to it. Often, people will say, they didn’t design the user interface well. You can argue back and forth on that. Some of it is the nature of tools, the nature of incentives. Sometimes, we as docs give bad advice to developers. But there are a number of things on the policy side—I would stay tuned for Administrator Verma’s talk on meaningful use tomorrow. A number of things that make sense in a paper world but don’t make sense in an electronic world. The E & M codes were actually requested by our colleagues in the 1990s in lieu of having time stamp codes. But we have to think about that entire burden. We’re working very closely with CMS [the Centers for Medicare and Medicaid Services] on putting together an entire program on that. John Fleming [M.D.] of ONC is working with Kate Goodrich at CMS to put that together.”

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