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Interoperability Under MACRA Must Provide Standard HIE Tools

According to Dr. Larry Garber, HHS must define interoperability under MACRA in such a way that individual providers would have access to standardized HIE tools.

By Sara Heath

National interoperability frameworks are necessary before providers can fully improve electronic health information exchange (HIE) in support of federal regulations, including the upcoming Medicare Access and CHIP Reauthorization Act (MACRA), says Dr. Larry Garber, medical director for informatics at Reliant Medical Group.

Republished in a blog post by Beth Israel Deaconess’s CIO John D. Halamka, MD, Garber urges the Department of Health & Human Services (HHS) to reconsider the framework for health IT interoperability, saying that in order for all members of the healthcare industry to fully support interoperability, they must have access to a national framework.

Specifically, Garber says that all healthcare professionals need access to key interoperability tools in order to facilitate seamless health IT interoperability.

“It is my firm belief that our goal is ‘Hassle-Free HIE,’” Garber wrote to HHS. “In order to achieve that goal, it is not only important to measure progress towards that goal, but also to ensure that all of the tools necessary to achieve that goal are readily available.”

Overall, Garber says interoperability must be measured on three basic tenets:

  • What the holder or sender of health information had to do for seamless HIE
  • What the receiver of the data had to do
  • What the patient had to do, specifically with regard to giving authorization for data exchange

According to Garber, these interoperability measures do not reflect the efforts of one individual stakeholder or policy – not the provider, EHR vendor, EHR infrastructure or use, the available standards, or local, state, or federal interoperability and HIE laws.

Instead, interoperability success is dependent upon all of those factors combined.

As a result, individual providers cannot and should not be held liable for interoperability success alone. Often, Garber says, the shortcomings of providers are due to a lack of national interoperability policies or standards.

“I do not believe that you can force Hassle-Free HIE by measuring and penalizing providers for things that are out of the control of the providers,” Garber wrote.

Instead, HHS and other government agencies must establish a standard national policy for interoperability, or a common set of tools providers can use to better and more seamlessly exchange health information.

“You first need to create the national infrastructure to give the providers the opportunity to be successful,” Garber explained. “Only then can you use positive incentives to encourage interoperability; but it’s still not fair to impose punitive payment withholds. While I recognize those are essentially the same, the difference is the message that you send when you market this…”

In order to facilitate Hassle-Free HIE, Garber says the industry needs these seven national standards and policies:

  • National federated Master Patient Index (MPI) network
  • Relationship Listing Services affiliated with MPIs
  • National federated Provider Directory network
  • Standard consents and authorizations
  • Standard vocabulary set for orderable procedures and tests
  • Standard application programming interfaces
  • Support for free text summaries of problems and encounters

Garber’s comments come as a response to HHS and the Office of the National Coordinator for Health Information Technology (ONC’s) call for suggestions for measuring interoperability under MACRA.

In the request for information, ONC stated that it seeks suggestions for ways to measure interoperability and data sources for those measurements. As of present, the agency is considering meaningful use data as a data source. Other potential data sources include Medicare fee-for-service data and electronically-generated data from certified EHR technology and other health systems engaging in HIE.




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