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ONC Identifies Interoperability Measures as Required by MACRA

July 5, 2016
by Rajiv Leventhal
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The federal agency will rely on industry surveys that convey providers’ perspectives on exchange and interoperability

Following up on a request for healthcare stakeholder feedback in April to appropriately measure interoperability, the Office of the National Coordinator for Health IT (ONC) has identified two measures that the agency feels fits under the parameters of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

In an April blog post, ONC officials wrote, “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 the U.S. Department of Health and Human Services (HHS) to establish metrics in consultation with you—the health IT community—to see if that objective has been met.”

These metrics are separate from the provisions that HHS has proposed to implement through the Quality Payment Program for payment of office-based Medicare physicians. MACRA specifically calls on HHS to establish metrics for the exchange and use of clinical information to facilitate coordinated care and improve patient outcomes between participants in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and others nationwide.

Since then, ONC has received nearly 100 comments from organizations and businesses all across the health and health IT landscape in response to its Request for Information (RFI), and found that many of the comments related to four topics, according to a July 1 blog post from Seth Pazinski, director of ONC’s Office of Planning, Evaluation and Analysis and Talisha Searcy, director of research and evaluation at OPEA:

  • Burden: Do not create significant additional reporting burdens for clinicians and other healthcare providers.
  • Scope: Broaden the scope of measurement to include individuals and providers that are not eligible for the Medicare and Medicaid EHR Incentive Programs.
  • Outcomes: Identify measures that go beyond exchange of health information. Although measuring the flow of information is important, it is also critical to examine the usage and usefulness of the information that is exchanged as well as the impact of exchange on health outcomes.
  • Complexity: Recognize the complexity of measuring interoperability. Multiple data sources and more discussions are needed to measure interoperability fully.

What’s more, based on internal analysis, external feedback, and MACRA’s specific definitions of “widespread interoperability” and the relevant population to be measured, ONC has identified two measures in particular that satisfy both the feedback the agency received and MACRA’s specific parameters:

  • Measure #1: Proportion of healthcare 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 healthcare providers who report using the information they electronically receive from outside providers and sources for clinical decision-making.

The measures come from existing national surveys of hospitals and office-based physicians, including the American Hospital Association’s AHA Information Technology Supplement Survey and the Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics’ annual National Electronic Health Record Survey of office-based physicians. Both surveys have relatively high response rates and convey healthcare providers’ perspectives on exchange and interoperability. As these surveys touch providers across the country in a variety of practices, they are not limited to the Medicare and Medicaid EHR Incentive Programs, ONC officials noted.

“Although the MACRA requirement for measuring interoperability largely focuses on ‘meaningful users,’ we are committed to advancing interoperability of health information more broadly. We will be expanding our measurement efforts to include populations across the care continuum in the near-term, as well as an increased focus on outcomes in the longer-term,” the blog post read.



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