6 questions about the CMS health tech 'pledge'
My inbox is overflowing with companies bragging about how on Wednesday they were included in the very exclusive group over over 60 health and tech organizations that signed on to a health tech pledge at the White House. By doing so, they agree to work collaboratively to make progress on a broad set of goals by the first quarter of next year. Signers include some of the biggest names in tech and health care: Amazon, Apple, Google, OpenAI, Epic, Microsoft, CVS Health, and UnitedHealth Group. What the companies agreed to depends on what category of entity they are, but the overall goal is to promote modern health data sharing standards that will make tech progress and innovation in health care easier. Some companies have committed to creating new tools for patients.
Brittany Trang and I covered the announcement yesterday
We have seen these kinds of commitments before, including in 2018 and 2016, and interoperability was not fixed. I'll be watching for actual demonstrable progress on promised innovations like QR codes that make it easier to share my medical history and not needing a different MyChart login for every health system I have ever been to. The administration and companies got their photo op. Time to put up!
So I have some questions:
What if everybody doesn't adopt FHIR fast enough?
The most concrete piece of the pledge creates a new category of "CMS Aligned Networks," including health record vendors and health data exchanges, that agree to abide by two-dozen interoperability framework criteria. Specifically, though, by July 4th, 2026, they have committed to "provide or facilitate access to data using FHIR," a modern data sharing standard. This costs money and will require some players to speed up development.
And what if they don't really want to do other stuff?
The framework criteria are expansive and some of them, like the ability of providers to use "any application or delegated technology" to access the network may ruffle the feathers of some companies that want to guard data under their care for both selfish and privacy reasons. Everybody smiled for the camera but EHR vendors and other health IT companies are in a fight to the death, so let's see how nice they play in working groups.
What about a carrot, CMS?
CMS is wielding its power as a payer to convene lots of players to see if they can't make progress without regulation. But forget the CMS stick — where's the carrot? In my reporting earlier this year it was suggested to me that CMS might dangle incentives like faster payments for organizations that abide by certain standards. No mention, yet.
OpenAI committed to do what?
The commitments for data networks are clearer, but the pledges made by some tech and health tech companies seem both unusually specific and imprecise, and I'm very curious how exactly some are going to show they've made progress. For example, large language model developer OpenAI pledged to build conversational agents for health care? Its technology might enable such tools, but it would be odd if OpenAI actually did this itself. (OpenAI declined to provide any details.) Maybe this is clumsy language that's the byproduct of a speedy agreement, but it underscores the fuzziness about what everybody is really signing up to accomplish.
Where are the health systems?
CMS secured pledges from a handful of big health systems like Intermountain, Providence, Cleveland Clinic and Sanford Health, but the list seems pretty paltry given their importance.
Where is the patient voice?
CMS signed up dozens of health and tech companies to make improvements in the interest of patients. Where are the entities representing patients on topics like privacy and what the various working groups will choose to prioritize? CMS and other entities, like the health department's Office of Civil Rights, represent patients to an extent, but if there's a systematic effort to include patient perspectives here, it's not obvious to me.
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