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ONC Issues RFI on Defining Interoperability Under MACRA

ONC's request for information seeks input on interoperability in context of the Medicare Access and CHIP Reauthorization Act (MACRA).

By Sara Heath

- The Office of the National Coordinator for Health Information Technology (ONC) has released a request for information (RFI) aimed at reconciling interoperability definitions with the Medicare Access and CHIP Reauthorization Act (MACRA).

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The RFI, published today in the Federal Register, seeks information on interoperability under the following three categories: "measurement population and key components of interoperability that should be measured; current data sources and potential metrics that address section 106(b)(1) of the MACRA; other data sources and metrics ONC should consider with respect to section 106(b)(1) of the MACRA or interoperability measurement more broadly."

Under MACRA, interoperability is defined as the ability for two or more disparate health technologies to exchange clinical information and to use that information under a standard set of guidelines to coordinate patient care, ultimately improving patient outcomes.

ONC plans on examining interoperability in the context of the various populations using health technologies to understand how they meet the definition of interoperability under MACRA.

“Thus, ONC plans to assess interoperability among ‘meaningful EHR users’ and clinicians and health care providers with whom they exchange clinical and other information—their exchange partners,” ONC explains. “Note that the exchange partners do not have to be ‘meaningful EHR users’ themselves.”

Specifically, ONC plans to look at both the exchange of health information between two systems and the way in which users utilize the information.

“ONC seeks to measure the interoperable exchange and use of information by examining the following: electronically sending; receiving; finding (e.g., request or querying); integrating (e.g., incorporating) information received into a patient’s medical record; and the subsequent use of information received electronically from outside sources,” the agency says.

As of present, ONC has two data sources to investigate interoperability – national survey data from stakeholder organizations, and meaningful use data from the Center for Medicare & Medicaid Services (CMS).

The agency explains that this seriously limits their data collection, as most of the information they will gain from these two sources are from eligible professionals, eligible hospitals, and critical access hospitals participating in the meaningful use program.

Despite these limitations, ONC spells out the particular measures it will investigate:

  • Proportion of health care providers who are electronically sending, receiving, finding, and easily integrating key health information, such as summary of care records. This can be a composite measure (engaging in all four aspects of interoperable exchange) or separate, individual measures.
  • Proportion of health care providers who use the information that they electronically receive from outside providers and sources for clinical decision-making.
  • Proportion of health care providers who electronically perform reconciliation of clinical information (e.g. medications).

The agency also listed measures it will investigate using meaningful use data:

  • Proportion of transitions of care or referrals where a summary of care record was created using certified EHR technology and exchanged or transmitted electronically.
  • For 2017 and subsequent years, the proportion of transitions or referrals and patient encounters in which the health care provider is the recipient of a transition or referral or has never before encountered the patient, and where the health care provider (e.g., eligible professional, eligible hospital, or CAH) receives, requests or queries for an electronic summary of care document to incorporate into the patient's record.
  • Proportion of transitions of care where medication reconciliation is performed.
  • For 2017 and subsequent years, the proportion of transitions or referrals received and patient encounters in which the health care provider is the recipient of a transition or referral or has never before encountered the patient, and the health care provider performs clinical information reconciliation for medications, medication allergies, and problem lists.

ONC has requested comments by June 3 by 5 p.m. by either written or electronic mail.

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