Healthcare Analytics, Population Health Management, Healthcare Big Data

Quality & Governance News

ONC Needs Input on MACRA Interoperability Measurement Program

Measuring health data interoperability across the care continuum is a tricky task for federal regulators looking to meet MACRA requirements for systemic improvement.

By Jennifer Bresnick

- The Department of Health and Human Services is still in search of the right strategies to make seamless health data interoperability a reality across the care continuum, and the Office of the National Coordinator is hoping that the stakeholders with the most skin in the game will be able to come up with a new crop of bright ideas.

Health data interoperability and MACRA

In a request for information (RFI) published last week, ONC officials asked the industry for input about how to improve interoperability, destroy lingering data siloes, eliminate the threat of information blocking, and better measure the health system’s progress towards achieving defined and measurable goals.

“The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) declares it a national objective to achieve the widespread exchange of health information through the use of interoperable certified electronic health records and directs HHS to establish metrics in consultation with you – the health IT community – to see if that objective has been met,” wrote Seth Pazinski, Director of the Office of Planning, Evaluation and Analysis at the ONC, and Talisha Searcy, Director of Research and Evaluation in a blog post on HealthITBuzz.

Interoperability, a foundational technical competency for population health management and big data analytics, is at the top of the federal health IT agenda, they added, and features prominently in a number of recent documents outlining the nation’s path towards better patient care.

The ONC’s Nationwide Interoperability Roadmap, a core piece of the Federal Health IT Strategic Plan, lays out a series of long-term goals for the industry’s ability to adopt standards-based data exchange protocols that will support improved patient care. 

READ MORE: Are Health Data Interoperability Standards the Same in Theory as Practice?

But neither the Roadmap nor the recent series of private industry interoperability pledges contain actionable strategies for creating a series of widely accepted metrics to gauge whether or not stakeholders have achieved the milestones laid out by federal authorities and industry leaders.

“We are issuing a request for information for your thoughts for how to measure interoperability and ensure HHS is keeping pace with the objectives we laid out in the Roadmap and the Federal Health IT Strategic plan to measure the broad health information ecosystem, including individuals and non-health settings.” Searcy and Pazinski said.

In addition to overhauling the scope and function of quality reporting programs like PQRS and the EHR Incentive Programs, MACRA focuses sharply on health data interoperability. 

According to the RFI, MACRA defines interoperability as “the ability of two or more health information systems or components to exchange clinical and other information and use the information that has been exchanged using common standards to provide access to longitudinal information for health care providers in order to facilitate coordinated care and improve patient outcomes.”

While the ONC hopes to bring this type of free and seamless data exchange to every healthcare provider, officials will start by developing a series of metrics and assessments applicable to meaningful users under the EHR Incentive Programs. 

READ MORE: FHIR Finally Brings the Internet to Bear on Healthcare’s Big Data

To kick off this effort, the ONC suggests that it should limit its initial activities to “assessing the extent to which meaningful EHR users are electronically sending, receiving, finding, integrating information that has been received within an EHR, and subsequently using information they receive electronically from outside sources.”

The EHR Incentive Programs have produced one of the only standardized data sets about technology use and EHR capabilities, the ONC states, which has led officials to believe that a narrower focus on meaningful users may be the most effective way to proceed with this program. 

The ONC recognizes that more work needs to be done in order to collect broader data from more members of the care continuum – and admits that data generated by the EHR Incentive Programs is not adequate to fully measure every critical aspect of interoperability – but MACRA does not give the industry must time to develop these additional datasets.

That being said, the agency is asking the healthcare community whether this limited approach is the best technique, or if the ONC should take on the challenge of measuring interoperability across more settings, data types, and population groups than MACRA initially requires.

The ONC is also unsure whether or not its activities should be focused only on certified EHR technology, or if non-certified technology tools should also fall under the scope of the program.

READ MORE: Physician Portal Aids Data Exchange for Stand-Alone Hospital

Additionally, the ONC wants to ensure that it has identified the most pertinent aspects of health data interoperability before it moves forward with crafting measurement metrics. 

Currently, the ONC is planning to measure “electronically sending, receiving, finding and integrating data from outside sources, and subsequent use of information electronically received from outside sources,” but hopes industry experts will confirm that these aspects of data exchange adequately address the MACRA requirements and cover and appropriate portion of the interoperability conundrum.

Members of the healthcare community have until June 3, 2016 to comment on these issues and other questions posed in the request for information.  To read the entire RFI and learn more about how to submit commentary, please download the full document by clicking here.


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