For many patients, the clipboard remains one of healthcare’s most familiar frustrations.
At nearly every visit, patients are asked to provide information they have already supplied elsewhere, including their insurance coverage, medications, family history and previous surgeries. This repetitious hassle—even if managed on tablets as in recent years—frustrates patients, increases the risk of incomplete or inaccurate information entering the record, and takes unnecessary staff time to reconcile.
The Centers for Medicare & Medicaid Services’ Health Technology Ecosystem initiative offers a compelling alternative through the Kill the Clipboard pledge. The effort is focused on moving technology and care practices forward so that patients can more easily retrieve and share their health information through personal health records or other health apps, removing the need for their data to be reconstructed at every encounter.
That shift could conclusively improve the patient experience. Reaching that goal, however, will require more than voluntary commitments from individual technology developers. This multi-stakeholder initiative needs work based on consensus-based standards, reliable infrastructure, clear data governance and careful attention to how new capabilities affect clinical work.
A connected ecosystem, from many moving parts
Patients often assume that health data interoperability is happening more than it is, and certainly more easily. In some cases, a person opens an app and shares their information with a provider themselves; in others, the exchange is initiated by their clinical care team. Behind that process, though, is a complex chain of care organizations, electronic health records (EHRs), identity verification services, intermediaries, standards development organizations, application developers and networks.
Consider, for example, real-time prescription benefit information. Giving patients cost and coverage options during an encounter—and ensuring that the information is accurate all the way to the point of sale—could help increase affordability and medication adherence. Yet the experience depends on pharmacy networks, price comparison apps and other third parties delivering complete, timely information into the clinician’s prescribing workflow, all while the patient is there in the exam room or awaiting discharge from the hospital. Every participant in the chain is fundamental to the increasingly complex web of health information exchange.
A 2025 study of more than 8,100 family physicians published in JAMA Network Open underscores just how much work around data-sharing remains. Depending on the type of clinical information, only 8% to 19% of survey respondents reported that outside data were routinely available, easy to find and easy to use within their EHRs.
Pledges like Kill the Clipboard can establish a valuable direction for the industry and encourage momentum. They will face challenges with adoption and impact, however, if sufficient effort doesn’t go into resolving dependencies across the country’s health tech ecosystem. Clear technical standards, realistic implementation timelines and ways to verify that promised capabilities work in practice are essential.
While the goals of increasing patient control over their own data, tackling inefficiencies, and increasing affordable care delivery are laudable and things no one would argue with, it is also true that moving quickly without those foundations could create expensive rework down the road or inadvertently widen the digital divide. If any or all pledge criteria eventually become certification requirements, as Dr. Tom Keane, the National Coordinator for Health IT, has intimated could be a possibility, the variability in readiness among different companies could become a problematic gap.
Patient control requires patient protection
Expanding digital access also raises important questions about how patient data will be used once it leaves a regulated clinical environment.
There has been a huge proliferation of health apps in recent years intended to help patients more actively manage their own health while also better managing their medical records. Many can deliver meaningful value, but patients who are considering use of such an app need clearer information about whether an application may retain, combine, share or sell their data. Consent language should be understandable, with governance expectations following the information across the digital ecosystem, but the current legal and regulatory system needs modernization to ensure sufficient patient awareness.
Patient matching presents another safety concern. A larger volume of exchanged data is useful only when organizations can confidently connect each record to the correct person. Striking the right balance between the stringency of matching criteria and the goal of increasing data exchange is critical, as a clinician could make a prescribing or treatment decision based on another person’s medications, allergies, diagnoses or laboratory results with damaging consequences. Strong identity verification and thoughtful matching practices therefore belong at the center of any effort to make health data more portable, ensuring that patient safety protections are inherent to the matching process.
The potential consequences have recently been measured. A 2026 BMJ Quality & Safety study found that hospitalized patients with duplicate charts had 3.5 times the odds of requiring intensive care, 4.7 times the odds of inpatient death and hospital stays that were 32% longer than those of matched patients without duplicate charts. Although the observational study does not establish causation, it underscores the clinical risks associated with fragmented patient information.
New capabilities—intelligently planned
For virtually any initiative focused on the patient, program vision and software design must also account for the people delivering care.
Primary care clinicians often have only a few minutes to review a patient’s record, conduct their initial assessment of the problem, complete documentation of the encounter, place orders and determine any necessary follow-up. While unquestionably helpful, adding review of new extensive patient data that has been sent from a patient’s medical record aggregation app adds another step that takes time. Then, needing to build in time to consider prescription cost comparisons, scheduling stemming from referrals, discussions of patient consent preferences, or record reconciliation further consumes part of a tightly constrained visit.
The impact on the provider and staff workflows in no way diminishes the value to the patient. These changes benefit all of us as patients and/or caregivers ourselves—but the implications for that workflow cannot be an afterthought.
The strongest implementations will embed new capabilities directly into existing workflows and surface information exactly when it is most useful. Software developers should also involve practicing clinicians in design, testing and governance so that any improvements support better care without introducing avoidable friction. In fact, prioritizing the efficient implementation of these new functionalities will increase adoption and user satisfaction, moving us all closer to our collective goals.
Turning the pledge into progress
Eliminating the clipboard is the correct ambition, as are the goals of the other Health Tech Ecosystem pledges. They would serve patients nationwide and represent broader industry change in how we move and manage information. Patients should not have to recount their histories every time they seek care, and clinicians should have dependable data available whenever decisions must be made.
With mature standards, real-time connectivity, responsible governance, reliable patient matching and thoughtful workflow design, we can collectively turn the pledge’s aims into a new reality: more trusted digital experiences that give patients greater control and help everyone involved in their care act with greater confidence.
Leigh Burchell is vice president of policy and public affairs at Altera Digital Health, as well as chair of the Electronic Health Record Association.