More Health IT Isn’t Always Better, Says HHS Digital Service Director

For decades, healthcare providers have doubled down on technology to improve the way they treat patients, but Shannon Sartin worries the industry’s expansive IT ecosystem is getting in the way of better care.

As executive director of the Digital Service at the Health and Human Services Department, Sartin is on the front lines of the government’s efforts to revamp healthcare for the 21st century. In recent years, much of the battle has played out at the Centers for Medicare and Medicaid Services, which oversees the care of more than 100 million people across the country.

Like other U.S. Digital Service outposts, she and her team work to bring tech industry best practices—like agile development, cloud services and user testing—to federal IT shops that are sometimes far behind the times. But while many digital services branches focus on modernizing processes unique to their respective agencies, Sartin sees the potential for her work to reach far beyond the borders of HHS, and even the government itself.

“We want to be in a place where our technology and the choices that we're making are actually the ones that are impacting the way you and I receive healthcare,” Sartin said in a conversation with Nextgov. “That's how much economic force CMS has. It could slow down or speed up the entire healthcare industry.”

HHS Digital Service’s efforts have been so successful that the Partnership for Public Service nominated Sartin and her team for one of its annual Service to America awards.

In Sartin’s eyes, technology can work both for and against patient care. If used correctly, IT can give people more control over their own health and allow doctors to focus more energy on treating patients. But incorporating too many different systems can overburden providers with administrative tasks, leading to impersonal, inefficient and expensive care.

Unfortunately, Sartin said, the modern healthcare industry seems to more closely resemble the second model than the first. But by overhauling its outdated infrastructure and making healthcare data more readily accessible, she said, CMS could free up more resources for treating patients ultimately drive change across the broader industry.

Last year, Sartin and her team launched an application programming interface called Blue Button 2.0, which contained detailed health information on some 53 million Medicare recipients. The API, which originated from an earlier CMS program, allows patients to connect their medical records to the numerous health-centric applications and services that have popped up in recent years. They can also opt to donate their data to inform medical research efforts around the globe.

So far, more than 1,800 developers have signed up for the platform and dozens of apps are already using the API to give patients a better handle on their healthcare.

Before Blue Button, Medicare claims data was only available to recipients in a PDF format, something “none of us really want” in the age of smartphones and wearable tech, Sartin said. Future, tech-savvier generations of beneficiaries will want to pay bills, access data and manage healthcare through their devices, and according to Sartin, APIs like Blue Button are laying the groundwork for that reality, she said.

“I think it's really about ... empowering innovators and entrepreneurs with the data,” she said. “How do we make sure it's available in a way that not only aligns with what industry is already doing but actually sets the standard” for where it goes in the future.

On the provider side of the equation, Sartin and her team also launched a tool that sped up payments to doctors and offers rapid feedback on their treatment of patients. The platform came as part of a governmentwide effort to promote “value-based” care—the concept of paying doctors based on performance instead of the specific services they provide—and incentivizes doctors to take “a broader, holistic” approach to treating patients, according to Sartin.

When developing the tool, she and her team conducted extensive testing with doctors who would ultimately be using the system, a practice common in industry but not at CMS, Sartin said. Their feedback played a large role in shaping the platform, she said, and since its launch, the Quality Payment Program has been embraced throughout the medical community.

The system “ended up being one that doctors not only didn't hate but were giving praise to, which is a rarity at CMS,” she said. “Our team really believes that partnership is how we achieve success.”

Looking ahead, Sartin said she expects her team to continue improving the platform and modernizing the backend payment system, which is still running on outdated COBOL software. While there won’t be “crazy, flashy launches” every few months, she said, incremental improvements to CMS’ payment processes will have significant impacts on both providers and patients.

Sartin said her team also plans to explore ways to make it easier to share patients’ data among HIPAA-covered entities like doctors and insurers.