Michael McCoy, M.D. is best known as` the Chief Health Information Officer in the Office of the National Coordinator for Health IT, a role in which he served from January 2015 through January 2016. Meanwhile, Dr. McCoy, who spent 25 years in obstetrics and gynecology practice, has played a number of roles in the healthcare IT world, including as a senior executive at the former Eclipsys Corporation, CMIO at DigiChart, and CMIO, between 2010 and 2013, at the Catholic Health East health system, now a part of the Trinity Health system.
Dr. McCoy currently runs his own consulting firm, Physician Technology Services, and is board co-chair of IHE International (Integrating the Healthcare Enterprise), a not-for-profit initiative by healthcare professionals and industry to improve data- and information-sharing processes in healthcare, via the coordinated use of established standards, including DICOM and HL7.
Dr. McCoy, who is based in Lawrenceville, Georgia, spoke with Healthcare Informatics Editor-in-Chief Mark Hagland, following the conclusion of the annual HIMSS Conference, which took place last week at the Sands Convention Center in Las Vegas. Below are excerpts from that interview.
We were both at HIMSS18, and were able to converse at the CMIO Roundtable. Looking back at HIMSS18, as well as considering all the recent conversations you’ve been having with fellow healthcare IT leaders, how does this moment in healthcare and healthcare IT look to you, broadly speaking?
On the political side, the policymakers [in the current administration] are trying to wind back some of the policies and regulations that have been put in place [including via the MIPS/MACRA law—the Merit-based Payment System, and the Medicare Access and CHIP Reauthorization Act of 2015]. The challenge will be in actually making that happen. Many of those things are baked into law, and you can’t just easily wave your hands and make the law go away. Given that there has been widespread support for many of the elements that have gone into recent lawmaking… it’s difficult to imagine that all of the desired actions would take place.
Michael McCoy, M.D.
At the HIMSS Conference, the federal healthcare officials who spoke, talked fairly extensively about deregulation, either explicitly or implicitly. Do you have any thoughts on that?
Yes; some of those comments were specifically related to payment reform—MIPS/MACRA—and also to the issue of physician burden. Considering that many of the requirements embedded in MIPS/MACRA were written into law [as passed by Congress], it would take another law to undo them, unless you go the route of not ticketing people for slightly speeding—that concept—that idea that you can perhaps allow for [the regulatory path to softening certain requirements]. If the goal is to make sure the public gets something for the dollars spent on health IT, both in terms of hospitals and physicians—and healthcare IT spending—it’s difficult to do some hand-waving stuff and make that [the regulatory requirements embedded in laws like MACRA] go away. So there’s a gap between intentions and the ability to actually make those intentions happen. So that’s one of the concerns. There are similar concerns around balance for things like TEFCA [the federal Trusted Exchange Framework].
You’ve seen the comments from various trade groups and professional associations. I think the concept is good; the problem is in the execution, and how much can get done without pointed regulation. So it’s that balance.
I noted in my HIMSS18 reporting that that CMS Administrator Seema Verma, in her speech last Tuesday, called for empowering patients by giving them control over their data. Still, this administration remains at least nominally committed to repealing the Affordable Care Act, which would cause some loss of health insurance coverage. Can sufficient patient empowerment occur in the absence of health insurance coverage, or might that be an uphill proposition?
With regard to that, I’ll just say that there’s a major disconnect between words and actions there; I’ll just leave it like that.
Meanwhile, what about federal healthcare officials’ potential interventionism around EHR and other healthcare IT vendors? Administrator Verma and HHS Secretary Alex Azar both said last week that they want the free market to lead in helping move us forward on interoperability and patient empowerment. To what extent, though, might a more interventionist stance be necessary on their part?
This is my personal viewpoint, of course; as you may know, I am the co-chair of board of IHE International, the standards development organization, endorsed by the European Commission for a number of interoperability elements. There comes a time when you have to be more forceful. As a matter of policy, the U.S. government does not endorse specific standards. But the development of standards can advance things. Thus far, we have some alignment of incentives in the healthcare IT space, but not complete alignment; there’s still not a good reason yet for patients to move freely between and among different hospitals, for example.