Last summer, President Donald Trump stood at the White House and promised healthcare providers would soon be able to “kill the clipboard” — no more having patients fill out the same paperwork at every appointment, no more chasing down records between doctors.
CMS built the pledge into what it calls the Health Technology Ecosystem, a voluntary framework that has since drawn commitments from dozens of health systems, EHR vendors and technology companies. A year in, the leaders living with the results are not in agreement about how much has actually changed.
For some health systems, the progress is concrete and countable. Salt Lake City-based Intermountain Health spent 2025 consolidating nine disparate EHR systems into a single platform, moving more than 60,000 caregivers onto it in one coordinated activation. The system also launched a single mobile app powered by MyChart that has logged 769,000 activations since the new EHR went live, and online scheduling reached 55,424 appointments in December — about 56% above Intermountain’s 2024 monthly average.
“Those are tangible signs that more patients are using a unified digital front door,” Intermountain Health Chief Strategy Officer Dan Liljenquist told Becker’s. “Although I would not claim that we have eliminated every form or clipboard without measuring the specific workflows involved.”
Intermountain has also struck an EHR-sharing agreement that lets Salt Lake City-based University of Utah pediatric subspecialists use its Epic platform to preserve longitudinal pediatric records, and it completed 22 outreach-hospital telehealth go-lives in 2025, its highest single-year total. On the administrative side, the system said flowsheet macros saved nurses 24.8 million clicks and freed up about 8,200 hours for patient care in the fourth quarter alone.
“Installing technology is not the same as proving its value,” Mr. Liljenquist said. “The next phase is measuring whether these capabilities consistently reduce repeated work for patients, give caregivers a more complete picture at the point of care, and help care teams coordinate decisions more quickly.”
CMS said it has added eight more workgroups to the initiative since it began: price transparency; real-time benefit checks; modern scheduling; clinical trial matching; bulk FHIR; pharmacies and pharmacy systems; access provider; and diagnostic imaging, which the agency has nicknamed “Ditch the Disk.” A CMS spokesperson told Becker’s the additions build on the ecosystem’s “voluntary, standards-based approach to improving health information exchange and reducing administrative burden.”
The agency also pointed to progress on one of the thornier technical problems: matching patients to their own records. CMS said it has defined more than 30 patient-matching combinations that participating organizations are now testing against. It acknowledged that smaller and rural providers face resource and infrastructure hurdles, pointing to the separate Rural Health Transformation Program as a complementary source of support.
Because participation in the Health Technology Ecosystem remains voluntary, the spokesperson said, CMS’ approach centers on publishing criteria, tracking implementation milestones and highlighting organizations as they move from pledges to operational use — though the agency has yet to publish the public-facing data it says will show that progress.
Other health systems reported smaller but tangible wins. Cleveland Clinic has launched QR code-based patient intake at one pilot location and is preparing to expand it, according to a spokesperson, who said the organization is “optimistic about work on electronic prior authorization as well as image exchange, which would allow patients to stop having to bring imaging studies on CDs to healthcare providers.”
At New York City-based Mount Sinai Health System, the focus has been on moving work that used to be done on paper into MyChart. “From completing previsit questionnaires online to booking appointments, and communicating with their care team, patients can move through their care more easily, without unnecessary paperwork or repeated requests for information,” said Lisa Stump, executive vice president and chief digital information officer at Mount Sinai.
At Wellstar Health System, based in Marietta, Ga., that shift has taken the form of digital check-in built on facial recognition technology from CLEAR — the same identity-verification company CMS tapped in December to help secure Medicare.gov logins as part of the broader Health Technology Ecosystem push.
“Digital check-in that includes CLEAR facial recognition technology, MyChart, virtual care and digital communication have further improved patient experience at key points in their journey,” said Richard Freeman, MD, executive vice president and chief physician executive at Wellstar. “As a result, our patients are reporting greater convenience, transparency and control while our care teams [are able] to spend more time focused on meaningful human connection.”
Not everyone is convinced anything fundamental has shifted. Curtis Cole, MD, chief global information officer of Ithaca, N.Y.-based Cornell University, said the voluntary structure of the pledge is the core problem.
“We have known since the Carter administration how ineffective that is,” he said.
Dr. Cole said the initiative sidesteps the harder work of getting data to actually mean the same thing across systems. “I don’t think the people who framed the problem as ‘Killing the Clipboard’ actually understand either EHR interoperability or why we use clipboards,” he said. “We need far deeper standard-making if data is going to move from system to system in a semantically robust way. The data inside an echocardiogram doesn’t map itself magically to all the other data in the records.”
Just because a record arrives from another site, he said, doesn’t take away a physician’s responsibility to verify it with the patient. “My own record at other centers has allergies I don’t have and medications I don’t take,” he said. “I want my doctor to give me a chance to correct that.”
Dr. Cole said the deepest problem — the lack of a national patient identifier — is not something CMS can solve on its own. “But deeper data standards could be led by the agencies,” he said. “But only if they hire serious people with a mandate to actually solve the problem, rather than generate ephemeral headlines.”
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