Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy & Regulation News

ONC Addresses MACRA Health Data Interoperability, HIE Measures

An ONC blog post discusses health data interoperability under MACRA, sharing two measure approaches for the new law.

- After a slew of industry feedback, the Office of the National Coordinator for Health Information Technology (ONC) has made adjustments for how it will measure interoperability and health information exchange (HIE) under MACRA.


In an ONC blog post, Seth Pazinski, ONC’s director of the Office of Planning, Evaluation, and Analysis, and Talisha Searcy, director of research and evaluation in that same office, addressed the nearly 100 industry comments made in May and June.

A majority of the comments identified issues that fell into one of four categories – burden, scope, outcomes, and complexity.

Several experts explained to ONC that MACRA’s interoperability measures should not increase reporting burden on the provider, should be wide in scope, should focus on health outcomes, and should consider the complexity of measures health IT interoperability, the pair wrote.

Taking that feedback into consideration, Searcy and Pazinksi said they developed two measures:

  • Measure #1: Proportion of health care providers who are electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding (querying); and integrating information received from outside sources.
  • Measure #2: Proportion of health care providers who report using the information they electronically receive from outside providers and sources for clinical decision-making.

In an effort to address comments about provider reporting burden, ONC has decided to use the results of other, pre-existing industry surveys about health IT interoperability and HIE to collect their data.

In using the American Hospital Association’s AHA Information Technology Supplement Survey and the Center for Disease Control and Prevention’s annual National Electronic Health Record survey, ONC hopes to obtain the necessary data for measuring interoperability without asking providers to report the same health data to multiple different sources.

Searcy and Pazinksi also said ONC plans on expanding the breadth of their interoperability measurements, stating that in the near term it would focus on populations along the care continuum, and look at care outcomes in the long term. The agency reportedly draws much of this strategy from its previously published Interoperability Roadmap.

Further, the pair explained that ONC’s MACRA interoperability measures will work seamlessly with other industry efforts to boost health data interoperability:

  • The pledges made earlier this year by many private sector market leaders to make electronic health information flow better by not blocking data, implementing and using federally recognized standards, and helping consumers easily and securely access, use and share their electronic health information;
  • Updated information from health IT developers about potential costs and implementation issues that is posted online for providers to use when purchasing health IT, and
  • Recent challenges we have issued to spur innovation of market-ready, user-friendly apps for consumers and providers and to make it easier for individuals to send their data where they wish.

This latest message from ONC addresses several industry responses to the agency’s request for information on how to measure health data interoperability under MACRA.

Notable industry leaders such as the American Hospital Association (AHA) and the Healthcare Information and Management Systems Society (HIMSS) responded to the RFI, stating that interoperability under MACRA needs to be wide-ranging in scope.

“The AHA recommends that ONC consider developing measures about the extent to which we have the standards, technology and infrastructure in place to facilitate exchange,” wrote AHA’s Ashley Thompson, senior vice president for public policy analysis. “Without those building blocks in place, providers are challenged to efficiently and effectively exchange and use health information.”

Further, industry experts stated that interoperability under the new law must be patient-centric.

“We observed that the patient perspective, and their ability to access their health information, is missed in this definition and should be considered in any metrics that assess interoperability,” wrote HIMSS’ president and CEO H. Stephen Lieber, CAE, and vice president Dana Alexander, RN, MSN, MBA, FAAN, FHIMSS.

“In our healthcare system’s continued shift to a value-based payment system, patients and the care they receive should be at the forefront and fully considered in assessing overall interoperability and health information exchange.”

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