Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

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ONC Needs New Approach for MACRA Interoperability Standards

According to the American Medical Informatics Association, ONC should take a retrospective approach to developing interoperability standards.

- ONC needs to take a new approach to how it implements health data interoperability standards under the Medicare and CHIP Reauthorization Act (MACRA), says the American Medical Informatics Association (AMIA).


In a letter signed by AMIA president and CEO Douglas B. Fridsma, MD, PhD, FACP, and AMIA board chair Thomas H. Payne, MD, FACP, the organization told ONC that it should look at interoperability retrospectively as a means to develop future standards.

As of right now, the ONC has interoperability standards which measure, primarily using EHR Incentive Program measures, the extent to which healthcare professionals are meeting interoperability requirements.

“Thus, ONC plans to assess interoperability among ‘meaningful EHR users’ and clinicians and health care providers with whom they exchange clinical and other information—their exchange partners,” ONC explained in the request for information. “Note that the exchange partners do not have to be ‘meaningful EHR users’ themselves.”

However, Fridsma and Payne stated that ONC should be looking at interoperability standards retrospectively.

“Rather than try to develop measures for the myriad of ways interoperability may be occurring, we recommend an approach that looks to understand where interoperability is needed, and then assess whether or not it is occurring,” the pair wrote in the letter.

This approach should not only help ONC develop future interoperability standards, but should also help them better assess the current state of interoperability.

Using a retrospective review would also enable an assessment of why expected interoperable data sharing did not occur. If the sampling is representative, such an approach should offer insight into the level of interoperability across the nation, and address whether interoperability was in place among providers who share a high volume of patients. This approach would help ONC assess the availability of data and the impact of interoperability where it is likely to influence the care of patients most – among the clinicians and organizations that treat them routinely.

To take this retrospective approach, Fridsma and Payne suggest ONC utilize claims data and statistical samples that are representative of all practices across the nation.

In addition to suggesting a retrospective interoperability standards development approach, AMIA cautioned ONC against putting too much emphasis on the volume of data exchange, stating that the data sources on which ONC claimed it would rely are not going to be sufficient to make this a feasible measure.

However, due to the time constraints – ONC has until July 2016 to publish the interoperability standards for Congress – AMIA understands it may need to utilize the data sources it has already identified. As a result, the organization suggests ONC create a plan to expand their data sources as soon as possible following the issue of the rule.

Last, AMIA suggested that ONC not develop more interoperability standards, particularly ones that will create a further burden on healthcare providers, and stated that their suggested retrospective approach will reduce that burden.

“We note that the measurement paradigm developed through the EHR Incentive Program has affected development and usability of health IT, and impacted care workflows in unintended, negative ways,” Fridsma and Payne wrote. “The strength of our recommended approach, based on retrospective reviews, is that it would only require reporting by a very small subset of providers.”

Going forward, AMIA suggested that ONC continue to consult with industry groups such as themselves to better develop workable solutions to interoperability standards development.

“We urge ONC to work closely with organizations such as AMIA that can convene clinicians and technology developers to identify expected data sharing patterns and measurement instruments that indicate to what degree we have achieved nationwide interoperability, while avoiding the pitfalls of past approaches.”

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