It was a skit worthy of an Agatha Christie whodunit reveal: Against the perhaps-too-joyous strains of a jazzy “When The Saints Go Marching In,” a gaggle of health IT professionals and Medicare staffers accompanied a Spirit Halloween-style coffin prop onstage at Health and Human Services headquarters on Monday. Some wore black veils, some held white roses.
The coffin read, “RIP CLIPBOARD,” referring to the decades-old information-gathering staple of health care provider waiting rooms.
“So who killed the clipboard?” asked Zac Jiwa, a federal Medicare official. Health IT officials and experts, reading from cue cards, denied that it was standards implementation, health information exchange networks, electronic health records, or apps — all parts of the various health data initiatives that private industry promised Medicare a year ago that it would improve.
“Nobody killed the clipboard. All of us had to do it together,” declared Amy Gleason, a top Centers for Medicaid and Medicare Services official and leader of the Health Tech Ecosystem initiative.
One year after launching the CMS Health Tech Ecosystem, officials convened in Washington to celebrate the Trump administration modernizing health technology without instituting a single regulation. But the event also acknowledged the real hurdles in instituting AI and technology in a fractured health care system, and launched eight new initiatives aimed at leveraging technology to end what Gleason called “the runaround” — work that patients typically must do to advocate for themselves in scheduling appointments, getting into clinical trials, or shuttling their MRIs and CT scans from one provider to another.
HHS Secretary Robert F. Kennedy Jr. and chief adviser Chris Klomp touted one new statistic at the event: Today, they said, 60% of people can import their health record into an app of their choice. “12 months ago it was 5%. We think it’ll be 80% by October,” Klomp said.
That statistic is important because one of the cornerstone goals of the health tech ecosystem initiative is to give patients more power over their health records — ideally, skipping the “clipboard” when arriving to a doctor’s office and instead showing the intake staffer a QR code that leads to all the patient’s information and medical records.
But in his eulogy for the clipboard, Jiwa cautioned, “Here’s the truth about the clipboard. It isn’t fully dead. If patients don’t know they can share their record and providers don’t know what to do with the QR code, this thing will climb right out of the casket.”
One of Medicare’s big pushes is to make sure that providers know what to do with the QR code and can ingest the information. It’s standing up a new website with instructions from major electronic health record companies on how to enable the QR code medical record feature, partially possible because the government got the major EHR vendors to be part of the modernization initiative.
But there are still larger problems that the government needs to address to make sure technology actually decreases the cost of care instead of inflating it. “If we allow technology-based solutions like AI to work within the current billing system, it will be inflationary,” said CMS administrator Mehmet Oz in a fireside interview at the event.
He pointed to the risks of AI letting providers see more patients without giving them better care, or the possibility of AI identifying “every small, little irrelevant problem a patient has and collect[ing] more money because of that,” offering value-based arrangements such as accountable care organizations and the outcomes-based ACCESS pilot as ways to curb this phenomenon.
An event this spring commemorated the early launch of many of the industry solutions for the problems CMS raised. Monday’s event marked the general availability of the rest of the apps and data transfer pathways, though Gleason said that CMS is still working with industry on some of its goals from last year. “There’s still continuing work to happen on the interoperability work; we haven’t quite gotten FHIR subscriptions all the way going, our trusted delegate model, so we have some things we’re still working on to close out year one, but we are ready to start our next effort,” she said.
But at the event Monday, she announced the future of the pledge: Eight new initiatives under the moniker “The End of the Runaround.”
“We are going to take the friction out of health care so patients spend less time chasing the system and more time getting care,” Gleason said.
The initiatives include:
- Price transparency: Getting patients personalized estimates of their charges based on their actual insurance plans
- Real-time benefits: Instituting health data standards that will eliminate the need to call insurance plans to figure out what it covers
- Modern scheduling: Letting patients book and reschedule appointments through an app of their choice rather than a portal or over the phone
- Clinical trials matching: Using claims data and HHS’ new Operation TrialBlazer to reduce dependency on physician knowledge of trials when enrolling patients
- Bulk FHIR: Enabling population health data sharing for public health, quality measurement, care management, and research reasons, as well as AI insights
- Pharmacy systems: Strengthening the data exchange between pharmacies, providers, and insurers so that patients do not have to carry prescriptions to their pharmacy
- ACCESS: Providers committed to identifying patients to enroll in the ACCESS program and providing the data support to manage their care through the program
The eighth category is a work group (not yet a pledge category, officials clarified) focused on diagnostic imaging and “ditching the disk” — i.e., eliminating the need to carry scans from one doctor to another on a CD.