Acting Assistant Secretary for Health Karen DeSalvo and Centers for Medicare & Medicaid Services' acting administrator Andy Slavitt offer contrasting outlooks when it comes to the future of healthcare.
Speaking at a panel discussion at the 2016 HIMSS conference on electronic health records and interoperability, Slavitt described how DeSalvo's upbeat disposition counters his Eeyore-style realism.
"She works with the technology community, which is making tons of progress," he joked. "I've been spending the last few months hearing from physicians trying to use technology, I think they affect my mood just a little bit."
The gulf in the two executives' perspective isn't the result of personal foibles, but is instead representative of the gaps in user-centered IT in the healthcare sphere.
DeSalvo and Slavitt have teamed to craft policies that provide for the free flow of electronic health records across an ocean of IT systems. The challenge has been trying to get the expansive private sector to design systems that can share the data across platforms.
"We are still at a stage where technology often hurts rather than helps physicians providing better care," Slavitt said. "We are committed to taking a page out of the consumer technology playbook at CMS and using a user-centered approach to design a policy.
"Understanding what we want from technology first means understanding how we provide care and receive care in America, where the consumer is more diverse, more mobile and more demanding than ever before."
Citing CMS's work to change physicians' payment structures to a merit-based payment system under 2015's Medicare Access and CHIP Reauthorization Act, Slavitt said doctors in eight focus groups told him they were hamstrung when using current EHR software.
"Physicians are hampered and frustrated by the lack of interoperability," he said, "but it's more practical than that. I don't think anybody but we policy people actually use the word interoperability regularly. It's usually, 'I can't track my patient's referral' or 'I sent them to the hospital and I don't know what happened.'"
So in comes DeSalvo and the Office of the National Coordinator for Health Information Technology, which has just released a rule that expands its certification powers for EHR programs, as well as new challenge grants for app funding. DeSalvo said that the private sector has to step up in its role as an interoperability collaborator.
"We're working to see that as federal partners, we are giving clear signals to the private sector that we really want to see this new open, connected community of health," she said. "That we expect the health IT system to get on the same language. We want to get over that artificial barrier and always want to keep putting the consumer at the center."
The goal has helped inspire an interoperability pledge from several private sector stakeholders, announced by Secretary for Health and Human Services Sylvia Burwell.
Both Slavitt and DeSalvo said the pledge was integral to ensuring that providers shift the proprietary ownership of information from the private sector to the patient, but companies need to take bigger collaborative role make sure the data gets through.
"There has to be a private sector commitment to a greater good," Slavitt said. "Regulations like those that require open [application program interface] can help and they're vital. But frankly, there are just too many ways to step in the way of true interoperability. No regulation can anticipate all of them."
