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Interoperability and Data Exchange as Health System Reform Enablers

May 30, 2014
by John DeGaspari
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Next steps in scaling up payment reforms, according to one ONC official

Interoperability, data sharing and reporting—and the IT infrastructure to support them—will be crucial components of payment reform as it gains traction across the entire care continuum nationwide, according to Kelly Cronin, health reform coordinator in the Office of the National Coordinator for Health Information Technology (ONC). Her remarks were delivered in April at the New York State HIMSS Chapter conference in New York. The group is a state chapter of the national Health Information and Management Systems Society (HIMSS), which is headquartered in Chicago.

Cronin said that in the last year, there has been a commitment among federal agencies within the Department of Health and Human Services (HHS), including the ONC, to go beyond meaningful use and make interoperability and data exchange a critical part of Affordable Care Act implementation and care delivery reform. She presented an overview of how data should be shared and reported as value-based purchasing rewards quality of care through payment incentives.

For that to happen, the infrastructure needs to be in place to make sure that all data “can be moving across the system and that we are enabling advanced levels of interoperability over time,” Cronin said. She noted that this is a critical time as value-based payment becomes more prevalent, while opportunities are arising from the Health Information Technology for Economic and Clinical Health (HITECH) Act, such as the Medicare EHR Incentive programs, Pioneer accountable care organizations (ACOs), and regional health information organizations (RHIOs). She said that federal and state agencies need to work together in scaling up these initiatives so that they become permanent.

Cronin also noted that, generally, market penetration has lagged over the last 10 years in consumer applications, because, so far, consumers have not been empowered to exchange data across many points in the healthcare system.

That may now be changing, she said, citing as one local example, the Statewide Health Information Network for New York (SHIN-NY), which is building a health IT infrastructure in the state. This year, the group received $55 million in state funding for the purpose. “SHIN-NY presents an awesome opportunity for apps to be built on top of the longitudinal record,” she said. “This is one area where we are going to see a lot of transformation in the next decade.”

Cronin said that New York state has done reasonably well with electronic health record adoption and meaningful use attainment, but there is still work to be done. She noted that good uptake has not occurred across the board for initiatives such as patient-centered medical homes and various forms of accountable care. There needs to be a focus on areas where adoption has been lagging, and bringing the providers up to speed as quickly as possible, she said.

“There is a proof of principle in New York that is leading to real results, and it should fuel adoption across the country,” she said. She added that there is a need for more transparency and communication about what is working, and what are the demonstrated improvements in the quality of care and the costs.

From a federal perspective, Cronin said National Coordinator for Health Information Technology Karen DeSalvo, M.D., is bringing a renewed focus on interoperability and data exchange over the next decade. “We are actively working with CMS [Centers for Medicare and Medicaid Services] and other federal partners to think through how we can come up with a comprehensive health information exchange acceleration program,” she said.

The federal strategy is comprehensive in scope, she said. “They are trying to get every  provider across the care continuum, not just eligible professionals and hospitals, but long-term care, behavioral health, home health, visiting nurses—everybody who touches the patient—and it means being part of the care process across the care continuum.”

She explained the federal strategy in terms of a national policy lifecycle, starting with incentives and evolving over time to payment adjustments, with the expectation of meeting clinical quality requirements as criteria for participation. “We want to make sure, as we pursue all of these federal and state projects, that we are thinking about the policy levers together on a federal and state level that have consistent requirements across providers,” she said.

One example of such a policy lever is Medicare’s proposed multiple chronic care management fee, which will be available to physicians caring for patients with two or more chronic conditions, starting in 2015. Cronin said the scope of the initiative is still being worked out, and there will be a comment period on potential requirements for participation, such as a summary of care record exchange or an electronic shared care plan.

Cronin described a healthcare scenario where there will be a need to align core sets of quality measures for value-based purchasing, particularly as more multi-payer based forms of accountable care get implemented. She noted that a strong IT infrastructure will be critical component to support the development and implementation of measures.

She added that there will also be a need for better reporting tools. “One of the key themes CMS is focusing on is to report [only] once, so if you have a set of measures, your reporting is part of PQRS [physician quality reporting measures] or meaningful use. You should be able to use that to account for other programs,” she said.

Cronin called for what she termed a more rational infrastructure for sharing and reporting information. “We are going to have to come up with something that is more scalable, real-time, based on high-quality data, and not just a lot of different claims feeds that don’t really come together in a reliable data set,” she said.

To make the vision of interoperability and data sharing a reality, a collaborative effort that reaches across the federal and state sectors will be necessary, Cronin said, adding that there is a need to think about how federal programs can enable this and reinforce it. “This is a tough nut to crack but an important one over the next several years,” she said. Ideally, the goal should be to get clinical, and ultimately claims data, that allows reporting not just across CMS programs but across all payers, particularly as healthcare moves toward multi-payer reform in accountable care, she said.

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