Interoperability: The Latest Buzzword Defined

The Office of the National Coordinator for Health IT recently released defined interoperability measures as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). These measures intend to clarify what exactly it means to, “achieve widespread exchange of health information through interoperable certified EHR technology nationwide.” As the Department of Health and Human Services received nearly 100 Comments regarding the definition and implementation of MACRA’s Interoperable measurements, many of the comments fall into one of the following four topics:

Burden Above all else, most clinicians demand MACRA does not create significantly additional reporting responsibilities that reduce time available for patient-care.

Complexity Interoperability itself is inherently complex, the measurable definition of such must be fully recognized if measurements are to properly compare the differing necessities and demands of aggregate systems, localities, and specialties.

Outcomes Identify USEFUL uses of Health Information Exchange (HIE). Although measuring capability of exchange is important, it is critical to measure the transition from “Can we exchange PHI?” to “How are you improving patient-care through HIE?”

Scope Broaden the scope of measurements to include clinicians and providers that are not eligible for Medicare EHR Incentive programs.

Widespread Interoperability Defined

The ONC interpreted these comments with two identified measures:

Measure #1: Proportion of health care providers who are electronically engaging in the following core domains of interoperable exchange of health information:

• Sending
• Receiving
• Querying
• Integrating information received from outside sources into internally useful formats

Measure #2: Proportion of health care providers who report using the information they electronically receive from outside providers and sources for clinical decision-making

These metrics largely reflect similar aspirations built within the MIPS-scoring framework, signaling a collective momentum swing towards data aggregation and expanding population health infrastructures.  As this daunting process unfolds, several provider-based or led organizations continue to lobby further clarity to allow physicians to practically prepare for this so-called reduction in reporting via actionable data exchange.  The American Hospital Association recommends the ONC broadens the scope of interoperability while imposing stricter definitions as to the “usage” of HIE to reflect practical, actionable, and relevant measurements rather than generally obscure yet easily definable metrics.  Though this may seem vaguely out-of-reach for many clinicians and administrators alike, it is imperative to ensure IT decisions and strategic partnerships reflect this overarching trend.