For those of you who are sports fans and who watch a lot of games, you probably can appreciate how important it is to have good broadcasters working the game on TV. Most of the time, there are two broadcasters in the booth— the “play-by-play” person who usually has announcing expertise; and the “color” commentator who is often an ex-athlete. Having a former athlete on the broadcast makes for a better viewing since that person has been in the trenches before, and can explain many of the detailed nuances of the game that would simply be too tough for someone without that game experience. What’s more, current athletes are often more comfortable talking to and being interviewed by ex-players. That camaraderie in the professional athlete world creates somewhat of a fraternity among players.
I bring this up because it reminds me of what we’re seeing in federal health IT policy right now. In recent months, and perhaps even longer, one of the main narratives in this industry has been how doctors around the country have become increasingly frustrated with electronic health record (EHR) usability. This frustration has gained significant momentum of late; just this week in a press briefing, ONC (Office of the National Coordinator for Health IT) leadership once again affirmed that reducing the burden that health IT puts on doctors will be a core emphasis for the agency going forward. Said Donald Rucker, M.D., National Coordinator for Health IT, in the call with media, “[EHRs] are right now about documentation and billing, but every other industry uses its enterprise computer software to do automation to become more efficient. We are the only business to use computers to become less efficient.”
Headlining that briefing was Rucker and John Fleming, M.D., deputy assistant secretary for health technology reform. The two of them, along with Health and Human Services (HHS) Secretary Tom Price, M.D., together bring a wealth of physician practice experience that the new administration hopes will have a profound impact on how health IT usability could be improved.
Notably, a position inside the government was created for Fleming, a former Navy physician who then opened his own private independent practice in the 1980s, signaling the importance the feds are placing on helping out small practices with technology. And Price, the HHS Secretary appointed by President Trump, is actually the first in his position with a medical degree since Dr. Louis Sullivan who served under the elder President Bush some 25 years ago.
Indeed, there seems to be a sense of camaraderie here, too, as current practicing physicians hope that these trio of MD leaders in the government, along with others as well, will lead to easier days ahead in regard to technology use.
When it was confirmed that Rucker and Fleming would be hired to team up with Price, Farzad Mostashari, M.D., former ONC chief in the Obama administration, told me, “The administration seems to taking [health IT] seriously and seems to be appointing someone serious with longstanding experience who is qualified to lead this next phase of the work of the office. And that’s a relief.” Added Arien Malec, vice president of data platform and acquisition tools for RelayHealth (an Alpharetta, Ga.-based McKesson business unit), and formerly an ONC staffer, “In aggregate [with Fleming and Rucker], what you have in this administration is a solid health IT leadership team that covers the basis of understanding the needs of providers, the perspective of vendors, and also the needs of policymakers, both at the Centers for Medicare and Medicaid Services [CMS] and on the Hill. And in general, that’s a strong set of assets to bring to bear on this challenge.”
Have We Reached a Tipping Point?
There have been a few turning points that one can look back on and see how this narrative of “reducing the burden” has evolved into what it is today (To be realistic, the broader theme of burdens on practicing physicians has been around for decades going to back to at least the introduction of Medicare and Medicaid in the 1960s).
For one, it was actually the CMS Administrator in the previous administration—Andy Slavitt (not an MD himself, but absolutely an advocate for helping physicians) who said during a conference early on in 2016 that due to the complexities involved with federal mandates such as the meaningful use program, “We have to get the hearts and minds of physicians back. I think we’ve lost them.”
In the year following those comments until his time as CMS head was up, Slavitt doubled and tripled down on this sentiment, making trip after trip to physician practices all over the U.S. in an attempt to see first-hand how technology was burdening them, and how CMS regulations could be better structured for them. At HIMSS 17, Slavitt again made headlines, saying that vendors should stop spending $2 million on exhibitor booths at HIMSS until they have "thrilled their customers."
Another turning point was a study published last fall in the Annals of Internal Medicine that got a massive amount of attention in health IT circles. Researchers for this study concluded that for every hour physicians provide direct clinical face time to patients, nearly two additional hours is spent on EHR and desk work within the clinic day, And, outside office hours, physicians spend another one to two hours of personal time each night doing additional computer and other clerical work. Federal health IT administrators have referenced this study numerous times since it was released, using it as tangible proof that technology must work better for physicians going forward.
What Can Be Done?
Of course, the million dollar question (or $30 billion question, if you count what the government has invested in health IT via HITECH) has become what can the various stakeholders involved do to solve this compounding issue? In the briefing this week, Rucker said that the agency is looking at documentation requirements for physicians as well as the whole quality framework around value-based purchasing, and other regulations related to how systems are architected. “For a lot of practices, this has become a challenge in that we have to think about what the win is for them. The expense that [comes with] complying with the quality measures [compared with] the innate value [gained] needs to be analyzed at some point,” he said.
This also brings up another core point, which is will MACRA/MIPS reporting requirements further burden clinicians as meaningful use directives have in the past? Doctors seem to be growing quite tired of “checking boxes” and being data entry clerks just so that they can meet these federal reporting mandates. For the most part, they appear to believe in the shifting landscape that will reimburse them for quality outcomes, but they don’t feel like it’s necessary for the government to check up on them every step of the way.
And therein lies the hope that has been presented in front of the industry—the trio of Price, Rucker and Fleming, MDs who will try to help lead physicians out of this messy situation. One thing we are sure of is that there will be no turning back to paper medical records, so it’s up to these federal leaders, the vendor community, and yes, doctors, too, to work together for an improved solution. But I do have hope that better days are ahead of us—and just like seeing ex-athletes helping us answer sports’ toughest questions, I think MDs at the helm of key healthcare agencies will turn out to be a positive for the health IT industry.
Have any thoughts or questions? Feel free to tweet at @RajivLeventhal or comment in the section below.