SPEECH: Remarks by Administrator Seema Verma at the ONC Interoperability Forum in Washington, DC
Thank you Dr. Rucker. It’s been a pleasure to partner with an innovative medical leader on the path to achieving true interoperability.
You just heard from Dr. Rucker that CMS and ONC are working together to realize our shared vision for a health ecosystem where data can flow easily between patient, provider, caregivers, researchers, innovators, and payers.
Today, I want to talk about the vision of CMS, working in conjunction with ONC, to transform patient care through interoperability as well as opportunities for innovation and digital health.
Let’s first take a step back to consider the times we live in. We are in an age of wonder…where we can roam the surface of Mars, explore the depths of the ocean, and unlock the mysteries of the human body.
We can even track our every move. So let me ask you, how many steps did it take you to get here today? I bet many of you in this room know the answer just by looking at the devices you carry with you each day. For me, I’m at 2,000 steps.
Its innovations, such as this, that have allowed technology to transform our society, and the United States is a leader across the world with many of our advancements in medical technology.
The examples are many. Precision medicine has opened the door to a new world of therapies specifically tailored to a patient’s unique genetic code.
We can now treat retinal disease that causes blindness.
3D training tools are enabling doctors to learn anatomy without a cadaver.
And who hasn’t been on online and seen the story of a toddler in her mother’s arm gain the power of hearing for the first time due to a Cochlear implant?
But while medical technology is leading to breakthrough therapies and procedures to save and extend human life, the professionals in this room are intimately familiar with the fact that health care information technology remains far behind all other major industries.
Now in one sense we have come a long way. For instance, in 2008, adoption of health IT was limited to 17% of doctors and 9% of hospitals. Today, 78% of doctors and 96% of hospitals use certified health IT.
But despite the best efforts of innovators like many of the individuals in this room, health care providers are in a 1990’s time warp…where doctors are faxing patient records, medical staff are manually entering results into EHRs, and hospitals are handing out data on a CD-ROM while the rest of the economy is functioning on fully digitized, integrated data that informs decision-making instantaneously.
Consider on an average day in the life of the American consumer. They can withdraw money at one of millions of ATMs around the world that can instantly access their bank account, or use a banking app to make an electronic payment to their credit card company.
Credit card companies, based on an algorithm of spending habits, can notify us almost immediately about fraudulent purchases.
We can go online and book our travel…not just our airlines ticket, but a rental car and hotel…from a single aggregator site. It’s a one-stop shop!
All these examples lead me to ask the question, “Why don’t we have the same expectations for our health care?”
The federal government spent over $35 billion on the effort to get doctors to use Electronic Health Records…new technology that is making their work more difficult, not less – causing more physician burden and burnout. Because of it, doctors today are still recording their notes on paper, and they are still faxing patient records.
If I could challenge the developers in this room here today to achieve one mission, it would be this: help us make every doctor’s office in America a fax free zone by 2020!
What we have today is a technological Tower of Babel ...where systems speak different languages…information is not communicated…records are not interoperable… and patients and providers don’t have access to the information they need to make the best decisions.
I have personally experienced the fallout of our inefficient Health IT system.
Many of you have heard me tell my story of my husband’s cardiac event. Let me fast-forward to the end: he survived!
That’s the incredibly good news. But here is the rest of the story:
As we were leaving the hospital, they handed me a few sheets of paper and CD-ROM of my husband’s records from his stay. I felt like we had taken a time machine to the 1980’s…in addition to his EKGs, would they include the best hits from Duran Duran?
But there were no songs from Duran Duran…and on top of that, there was no MRI. Other test results were missing. And all of the data from the machines that were monitoring him during his stay were also missing.
But this isn’t just happening to me – it is happening to millions of families across the nation.
As patients, we are used to showing up early for doctors’ appointments and waiting 30 minutes because…that’s just the way it is. We are used to our primary care doctor not having all our records from our last PCP and asking us…instead of us asking them…when was the last time we had a tetanus booster.
Now, if my phone knows what podcast I might want to listen to next based on my purchase history, shouldn’t our medical decisions be fully informed by our medical history?
As we look to the future, imagine a world in which your health data follows you wherever you go and you can share it with your doctor, all at the push of a button. Imagine if, in turn, your doctor didn’t have to spend so much time faxing records and staring at a computer during an appointment. Imagine if you could track your medical history from your birth throughout your life, aggregating information from each health visit, your claims data, and the health information created every second through wearable technology.
Imagine if our health records weren’t just used by our doctors in their workflow, but rather if EHRs allowed third-party applications to access and leverage that data in innovative ways for both the patient and doctor.
Imagine if that data could then be used to not only treat illnesses, but also predict and prevent illnesses.
Imagine if patients could authorize access to their records to researchers from all over the country who could not only develop specific treatments for their needs, but the researchers could also use that information to develop cures that could save millions of lives, like what the National Institutes of Health and ONC, are doing with their Sync for Science program.
The reality is that once information is freely flowing from the patient to the provider, the advances in coordinated, value-based and patient-centric care will be even greater than anything we can imagine today.
As the head of CMS, one of my main missions is to break down any and all barriers to interoperability, and create that one-stop shop for health data that will help inform our health care decisions with a complete picture of our medical history.
With so much data available to us, from our medical records, claims history, wearable devices and medical monitoring, we should have everything we need to make informed decisions about our health care and the cost of that care.
Recognizing we must transform Health IT as we have all other sectors of the economy, The White House Office of American Innovation, led by Jared Kushner, launched the MyHealthEData initiative this past March.
MyHealthEData aims to empower patients by ensuring that they control their healthcare data and can decide how their data is going to be used, all the while keeping that information safe and secure.
The MyHealthEData initiative is based on the premise that information is power, and patients should be fully informed and empowered to make the best decisions for their own health.
But, MyHealthEData, is more than just patients and doctors getting health care records. It’s about driving a new era of digital health, one that will unleash data to trigger innovation, and advance research to cure diseases and provide more evidence-based treatment guidelines that ultimately will drive down costs and improve health outcomes.
Liberating data will drive innovation throughout the entire health care system and create new tools and solutions that will allow the system to deliver value to patients.
To further spur innovation in this era of digital health, CMS has recently released Medicare Advantage data sets and next year we expect to make Medicaid and CHIP data available. These data sets will provide researchers and innovators with data on a new population of 74 million beneficiaries.
Once all this data becomes available, advancements in artificial intelligence will make it possible to analyze the data at the speed of light, and the possibilities are endless.
Machine interoperability is just as important as the interoperability of EHR systems. As you know, a huge amount of health care information comes to us from devices such as heart monitors and CT scans. It is vital that those devices share data and be interoperable…just as much as we need doctors’ notes and medication lists to be interoperable.
Earlier this year, I visited the Center for Medical Interoperability in Nashville and heard about doctors still having to put EKG results into a patient’s EHR. We have to get the electronic health record and all medical devices to connect seamlessly to the EHR.
I am committed to removing any and all bureaucratic and legal obstacles to machine, device and EHR system interoperability.
CMS believes that the future of interoperability centers on digital health and the implementation of open APIs.
Let me be clear, we will not shrink from this vision or delay its implementation: we are committed to requiring that providers begin using 2015 Edition certified EHR technology starting in 2019 because this version opens APIs.
By committing to the 2015 Edition of EHR certified technology, we are opening the door to innovators in this room to solve our most confounding challenges.
And this is important because it will finally put patients in control of their data and their health care, as MyHealthEData was intended to do.
As the largest payer in the system, CMS has a critical role in driving interoperability. We want to leverage technological innovation to deliver value to patients and hold healthcare vendors accountable.
With 130 million Americans served by CMS, we have the power to transform the delivery and value of care across the country. That is why we are taking a lead role to advance Health IT and interoperability with an API-first approach for the sharing of data.
To advance the cause of interoperability under MyHealthEData, CMS recently announced the creation of a CMS Chief Health Informatics Officer…or CHIO. The CHIO’s job is to accelerate the pace of innovation in health IT at CMS, and we are excited about filling this position very soon.
This is just the one of many actions that we are taking to promote interoperability and innovation. We have also been examining our payment rules for more opportunities to advance interoperability.
Recently, CMS overhauled the Meaningful Use programs to the “Promoting Interoperability” programs…which was much more than a name change, it is a change in direction for the programs – from programs that support the adoption of health IT, to programs that promote interoperability and patient access to data.
To avoid payment reductions and gain incentives, doctors and hospitals will have to give patients electronic access to their health records. We are also considering whether CMS should require, as a condition of participation in the Medicare program, that providers share data with patients in a universal electronic format, and hope to share more information on that soon.
When we announced MyHeathEData, we also unveiled Blue Button 2.0. -- a developer-friendly, standards based API, which will allow a majority of Medicare beneficiaries to connect their claims data to third party applications, services, and research programs.
There are now 600 developers signed up to experiment with this API, more than doubling participation since March of this year. And next week, we are hosting the 1st Blue Button 2.0 Developer Conference. And while the conference is at capacity, you can still participate online.
With Blue Button 2.0, CMS is doing its part to support the MyHealthEData initiative.
CMS is leading to support MyHealthEData by releasing more data and taking action to drive interoperability and patient control of their data. We are calling on industry to follow our lead and step up to the challenge.
It’s time for the rest of the industry to do its part. I have called on insurers to begin releasing claims data as we did with Blue Button 2.0, and make data available to patients.
Soon CMS will release policies to move insurers down a new path, where sharing health information is part of everyday business. Where health information is no longer locked in silo’ed systems, but is securely exchanged with patients, providers and other payers for the purposes of care coordination and treatment.
We are also looking at our innovative payment models to identify ways in which we can require and incentivize interoperability among participants.
Too often, patients are told their data can’t be shared with another provider “for their security.”
But patient security should not be a ruse for what is really happening: patient profiteering.
Systems too often refuse to share data because they fear their patients will be poached. This mentality has to be changed because it endangers the health of millions of Americans.
We can keep patient data private, safe and secure, while also making it available to patients working on leading edge innovations that can transform American medicine.
At CMS, we are thinking about ways to encourage the market through innovation and investment to advance digital health and encourage new companies and entrepreneurs to use data that we can make available that will help change the expectations of the health care delivery system.
And now is the time to do so.
As patients, we demand a health IT system that is as advanced as the medical technology that saves lives. As regulators, policy-makers, developers and IT specialists, it is our charge to make that vision a reality.
Let’s get to work!