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."