“It’s not technology that’s holding us back. It’s business practice,” said Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), speaking at the Bipartisan Policy Center’s program on interoperability.

CMS’ commitment to having more than half of payments come from alternative payment models by 2018 means a tipping point is in sight. That gives physicians and others a reason other than incentives to want the technology, “because they need to connect and care for the patient. We cannot get there without information. The hope is we spend less time talking about how to manage and manipulate technology and more time talking to physicians about what they care about and how to support that. We want to get away from micromanaging every step of how someone uses technology.”

The federal government can do everything within its power but people still have to change the way they practice, he said. Until that happens there won’t be any progress but once that happens, “we’ll make fast progress.”

The government’s role is to level the playing field, Slavitt said. The reasoning behind open APIs is so that no one company has a lock on the physician workflow. Open APIs will get healthcare away from dominance of the field by a few players.

Another lever the government uses, he said, is incentives but that is changing as well. “I’m more interested in incentives that reward physicians for coordinating care…not rewarding people for the mode but for achieving the means.”

Slavitt talked about meeting with about one dozen hospital CEOs to talk about the Shared Savings Program, a form of an accountable care organization. The CEOs provided feedback and one said that if the rules weren’t changed in several ways, he would leave the program. “We’re going to be in sad shape if people wait for CMS to set up the perfect system to make them do the right thing. I will gladly reward physicians and hospitals but I can’t do it for them. Nobody wants the federal government to play that role.”

When Slavitt came into his position, he said, there was a goal to speak with a clearer voice. “We don’t want to make people decipher our regulations to figure out what’s important. Technology and interoperability are really important and there’s a moral component to the issue.”