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An Interoperability Crossroads: As Feds Continue the Push, Health IT Stakeholders Push Back for Faster Results

October 22, 2015
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When the federal government (CMS) released the final rules for both meaningful use Stage 2 modifications and Stage 3 earlier this month, and at the same time, the final version the Office of the National Coordinator of Health IT (ONC) Roadmap, there were a few loud messages that it was clearly trying to convey: the need for a “person-centered” healthcare and a commitment to interoperability.

For those who have been following the words and actions of senior-level leadership at ONC and CMS throughout the last year, this should come as no surprise. At this year’s Healthcare Information and Management Systems Society (HIMSS) conference in Chicago, in her annual meeting with the press, Karen DeSalvo, M.D., National Coordinator for Health IT, said that its time to advance ideas beyond electronic health records (EHRs), with the push towards a more interoperable healthcare. "The EHR is one of major drivers to advance care, but the world has evolved and advanced, and now the ecosystem is much broader than EHRs. To provide person-centered care, you need a model that's beyond episodic visits, and we need to make certain that we're allowing technology to evolve. EHRs only tell one part of story," DeSalvo said at HIMSS15. Indeed, with the release of the MU rules, CMS released a statement that similarly said, “By 2018, these rules move us beyond the staged approach of ‘meaningful use’ and focus on broader delivery system reform.”

Additionally, in its final Interoperability Roadmap, ONC outlined three-, six- and 10-year goals for the flow of data between consumers and providers and between different segments of the nation's healthcare system. According to HCI Assistant Editor Heather Landi’s report on the Roadmap, by the end of 2017, the ONC intends for the majority of health providers and consumers to be able to send, receive, find and use a common set of clinical information in order to improve healthcare quality and outcomes. In six years, by the end of 2020, ONC intends to expand data sources and users in the interoperable health IT ecosystem to improve health and lower costs. The ultimate goal, to be achieved by 2024, is nationwide interoperability that enables a learning health system, “with the person at the center of a system that can continuously improve care, public health and science through real-time data access.”

Nonetheless, while the vocal words and written rules from the feds are as clear as day, industry stakeholders are still wondering if enough is being done to truly advance interoperability. Regarding the meaningful use program, some say if anything, it’s a barrier to interoperability. Leslie Kriegstein, interim vice president of public policy, at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), recently told me, “We want a complete overhaul of the program, focusing on interoperability and security. CIOs have pointed to that for a while. What are other ways we can show that we are meaningfully using health IT that isn’t the ‘checking the box’ mentality of meaningful use? How else can we tangibly show outcomes?”

Then there is of course the push from the Hill, namely Sen. Lamar Alexander (R-TN), who has repeatedly shown his distaste for the EHR incentive program, most recently citing a Government Accountability Office report which, after interviewing leaders from various health information exchange (HIE) initiatives, concluded that changes to the meaningful use program would be needed to better promote interoperability. Specifically, the report noted that efforts to meet the programs’ requirements divert resources and attention from other efforts to enable interoperability. For example, initiative representatives explained that the EHR programs’ criteria require EHR vendors to incorporate messaging capabilities into EHR systems, but this capability generally does not enable interoperability at this time.

What’s more, an American Hospital Association (AHA) report recently cited how the lack of interoperability in healthcare is especially troublesome given the amount of dollars the nation has spent on health IT. Similarly, the American Academy of Family Physicians (AAFP) recently wrote a letter to ONC citing “inadequate” technology. AAFP Board Chair Robert Wergin, M.D, called for “more than a roadmap. We need action,” he said.