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DirectTrust: Add More HIE, Interoperability Measures to MACRA

ONC needs to focus on alternative interoperability measures, like health information exchange, to enhance the MACRA legislation, DirectTrust says.

By Sara Heath

DirectTrust has thrown its hat into the ring, adding to the discussion of interoperability measures under the MACRA legislation.

In a letter written to the Office of the National Coordinator for Health Information Technology (ONC), DirectTrust commended the agency for taking on such an important and complicated issue within the healthcare industry.

However, the organization stated that ONC should refocus and take a simpler approach to interoperability measures under MACRA.

Agreeing with ONC’s measures of sending, receiving, and integrating health data, DirectTrust’s president and CEO David C. Kibbe also noted that the agency should be taking into account other ways in which interoperability is advancing, specifically how interoperability is replacing outdated methods of data exchange.

“The interoperability of electronic exchange of clinical information is a relatively new and highly innovative phenomenon in an industry historically dependent on fax, mail and courier services for transports of most clinical information,” Kibbe said in the letter. “Additionally, the infrastructure standards that make it possible for the electronic exchange are also relatively new and are unfamiliar to many providers.”

Fax and courier mail, for example, are long relied upon methods for exchanging health data, but will ideally become obsolete in the wake of better technology interoperability. However, ONC needs to measure the methods that are replacing fax and mail as a means to start pushing them out of practice.

It would be very useful to have some baseline of understanding about usage of non-electronic and non-interoperable methods currently in place for health information exchange; e.g., fax, e-fax, mail and courier. These largely paper-based methods of health information exchange remain the predominant means of moving health information within the health care industry, and are relied upon very heavily in most medical practices and hospitals, in effect competing with electronic messaging and other forms of electronic transport on a daily basis. Reliance upon fax and mail is a source of inertia within many health care organizations and one of the primary reasons adoption of electronic exchange methods is occurring at a slower than desired pace.

Further, Kibbe explained that interoperability under MACRA must measure all forms of health information exchange, rather than just the exchanges occurring between meaningful EHR users. This includes users of state and regional HIEs, and members of organizations like DirectTrust, who use direct message to exchange health data.

“It is important to measure activity by any and all exchange partners, notwithstanding that ONC plans to assess interoperability primarily among ‘meaningful EHR users,’” Kibbe noted. “The reason for our preference is that there are significant numbers of exchange partners outside the population of providers using certified EHR technology, for example, home health agencies and social service agencies.”

According to Kibbe, taking into account these alternative health data exchange methods is vital because they are quickly growing in number. As more and more healthcare professionals use regional HIEs or secure direct messaging for data exchange, the more important it will become to include these methods in measures of interoperability.

“These exchange partners are growing in number, especially as Accountable Care Organizations take hold, and in many instances have the opportunity to significantly improve care coordination by participating in interoperable exchanges of health information with EHR users,” DirectTrust maintained.

DirectTrust is not the only healthcare entity calling for an expanded measure of interoperability under MACRA. In previous responses to ONC’s request for information on the subject, organizations have called on the agency to look past meaningful use data to measure interoperability.

The American Hospital Association, for instance, asked ONC to consider shared data systems, stating that these alternative HIE methods are more efficient than regular data exchange.

“Hospitals and health systems are sharing information with clinicians and post-acute care providers by offering access to shared data systems,” AHA’s Ashley Thompson explained. “This type of sharing can be more efficient and effective than exchange, as the latest data are always available and clinicians with appropriate access rights may access it whenever needed.”

Other organizations, like the National Association for Women & Families, asked ONC to take a more patient centric approach and consider the data exchange between patients and their providers when measuring interoperability.

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