Slavitt, DeSalvo: Health IT has to work better for doctors
LAS VEGAS – In a co-presentation with National Coordinator Karen DeSalvo, MD, at HIMSS16 Tuesday evening, Acting Centers for Medicare and Medicaid Services Administrator Andy Slavitt said physicians "want better technology."
From both a policy and an innovation perspective, it's time to give it to them, he said.
Before their dual appearance, Slavitt said, he and DeSalvo read each other's speeches; the audience laughed when he said she took issue with the tone of his prepared remarks.
"I think your speech comes across as very negative," DeSalvo told him. "Why don't you re-read through that lens?"
[Also: See photos from Day 1 of HIMSS16]
It was a light moment, but Slavitt had a serious point to make: "She works with the technology community," he said, which is making tons of progress and, to judge from HIMSS16 so far, "generally pretty happy."
On the other hand, "I've been spending last months with physicians trying to use technology," said Slavitt. "That may affect my mood just a bit."
Indeed, health IT has made hugely impressive strides over the past five years, said DeSalvo. U.S. providers have tripled the adoption of EHRs, and the industry continues to build on those early incentives.
On one hand, healthcare is getting better at spending smarter and having healthier patients. But there are challenges, she said, emphasizing that data needs to flow more freely.
"On the supply side, we have built up an amazing amount of health information," said DeSalvo. "We have to set it free."
HHS Secretary Sylvia Burwell Monday evening announced that a who's-who of private-sector vendors, providers and health organizations have committed to more open sharing of data, which DeSalvo called a step in the right direction.
"I couldn't be more thankful," said the ONC chief.
But Slavitt – who said he and DeSalvo have "been working together for months" on some of these new policy initiatives, to the point where they can finish each other's sentences – said still more was needed.
"I'm certainly not bashful about what we need to do better, and I'm not going to be bashful here, even in the face of some very good reasons for optimism, about ways we need to take our game up across the board – all of us," he said.
The health IT industry has made a great start, said Slavitt. "But we're still at the stage where technology often hurts rather than helps physicians providing better care."
CMS is committed to taking a user-centered approach to designing policy, he said.
"I'm asking you to do the same. Step back and look at what you don't think is working, and make it work better."
Slavitt said CMS has recently undertaken its most concerted effort ever to listen to physician feedback, working with those on the front lines to understand their pain points.
He read a number of physician quotes that should sound familiar to many: Meaningful use has become "too much of a burden," said one doc. "Most of what I'm doing during the day is entering data into the EHR," said another. One joked (or half-joked) that "to order aspirin takes eight clicks; to order full-strength aspirin takes 16."
Physicians feel hampered and frustrated by lack of interoperability, said Slavitt. They think federal regulations in their current form slow them down and distract from care. They also find EHR technology hard to use and cumbersome.
The good news, he said, is that doctors are "not describing problems we don't know how to solve. That makes Karen and me optimistic."
CMS is "still a few months away from having details available on the proposed MACRA rule," said Slavitt. But he did share some principles of the agency's policy approach in the near future.
"Job one is to bridge the gulf between our public policy work and what's actually happening with patient care," he said. "That has to become an integral part of how we do things."
Second, he said CMS would hear physicians' requests to "stop measuring our clicks" and "give us more flexibility to suit our practice needs and, ultimately, more control."
Third, providers wherever possible "favor a pull, versus a push for incentives" that lets "outcomes, rather than activities, drive the agenda," said Slavitt, indicating that CMS has received that message.
Meanwhile, he said the agency would continue to use what levers it could to spread interoperability.
"We're announcing funding to connect many of the remaining parts of the system that are not part of the EHR incentive programs but serve our neediest patients every day," said Slavitt. "Finally, we are going to wire up long-term care, behavioral health, and substance abuse providers."
But in the private sector there are still too many barriers to interoperability, he said, from legal clauses to commercial impediments to intellectual property. That's not an excuse, said Slavitt.
"The companies that live up to their commitments here will be recognized and applauded," he said. "And I strongly encourage you to recognize those that don't."
This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.