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GAO Report: MU Requirements Impede EHR Interoperability

October 1, 2015
by Rajiv Leventhal
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Sen. Lamar Alexander references report in his latest push for a Stage 3 delay

A new report from the Government Accountability Office has outlined five key factors—in addition to meaningful use program requirements—that are slowing down the progress of electronic health record (EHR) interoperability.

For the report, GAO was asked to review the status of efforts by entities other than the federal government to develop infrastructure that could lead to nationwide interoperability of health information. Stakeholders and initiative representatives GAO interviewed described five key challenges to achieving EHR interoperability, which are consistent with challenges described in past GAO work. Specifically, the challenges they described are (1) insufficiencies in health data standards, (2) variation in state privacy rules, (3) accurately matching patients’ health records, (4) costs associated with interoperability, and (5) the need for governance and trust among entities, such as agreements to facilitate the sharing of information among all participants in an initiative.

 Representatives from the 18 initiatives GAO reviewed said they are working to address these key challenges using different approaches. Each key challenge is in the process of being addressed by some initiatives. To move interoperability forward, initiative representatives noted, among other issues, that providers need to see an EHR system as a valuable tool for improving clinical care.

What’s more, the report found that changes to the Centers for Medicare & Medicaid Services (CMS’s) Medicare and Medicaid EHR Incentive Programs would also help move nationwide interoperability forward. Specifically, it said representatives from 10 of the initiatives 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. Representatives from 10 of the initiatives said that the criteria currently used to certify EHR systems under the EHR Incentive Programs are not sufficient for achieving interoperability, and representatives from three initiatives suggested amending the criteria to focus on testing systems’ ability to interoperate.

To this end, during an Oct. 1 Senate meeting on achieving the promise of health IT, Sen. Lamar Alexander (R-TN), Chairman of the Senate Health Education Labor and Pensions (HELP) Committee, referenced the GAO report as one of his five reasons to hold off on publishing the final rule for Stage 3 of the meaningful use program. Alexander, who has been urging federal officials for months to delay Stage 3 of the program, said in the meeting, “The whole purpose of this program is to benefit patients, so that they and their healthcare providers have quicker and better access to their health histories and their doctors and hospitals and pharmacists can provide them with better care. There is no reason not to take time to do it right, and there are plenty of reasons to do this.”

This was the Senate HELP’s committee’s sixth meeting this year on EHRs. Alexander’s other four reasons for a Stage 3 delay were: Stage 2 requirements are so complex that only 12 percent of physicians and 40 percent of hospitals have been able to comply, and rushing a Stage 3 rule would make it harder to comply; the administration’s new Medicare payment system pays out penalties and bonuses based in part on meaningful use compliance; some of the nation’s leading medical institutions with the best electronic health records systems recommended taking more time; the committee’s work with the administration to develop seven areas of agreement for legislation to achieve interoperability. “It would make the most sense to make the final rule consistent with the goals of that legislation,” Alexander said.

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