Electronic Health Records

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SGR Repeal Aims to Require Widespread EHR Interoperability

By Kyle Murphy, PhD

The latest attempt to address the Medicare sustainable growth rate (SGR) and improve Medicare payments to providers also includes requirements for achieving widespread EHR interoperability in less than three years.

Introduced by Representative Michael C. Burgess, MD, (R-TX), the House bill — HR 1470: SGR Repeal and Medicare Provider Payment Modernization Act of 2015 — includes a section reducing administrative burden and other provisions requiring activities on the part of the Department of Health & Human Services and providers toward promoting interoperability of EHR systems.

The proposed bill sets out recommendations for achieving widespread interoperability by first declaring this to be a "national objective" to be realized via interoperable certified EHR technology (CEHRT) by December 31, 2018.

The bill provides a definition of widespread interoperability that requires the exchange of health information "between certified EHR technology systems employed by meaningful EHR users under the Medicare and Medicaid EHR incentive programs and other clinicians and health care providers" — that is, both meaningful and non-meaningful users.

Interoperability itself denotes the exchange and use of exchanged data that is enabled by common standards in order to ensure provider access to longitudinal health information for the purposes of effective care coordination and improve patient outcomes.

In the pursuit of realizing these definitions of interoperability, the bill calls on the Secretary of the Department of Health & Human Services to establish metrics no later than July 1, 2016, to assess whether the healthcare industry meet the objective of widespread EHR interoperability by the close of 2018.

If the objective is not met, then the HHS Secretary would be tasked with reporting on the barriers in the way of widespread interoperability and providing recommendations for achieving that end, such as payment adjustments for Medicare EHR Incentive Program participants and the decertified of CEHRT products, by the end of 2019.

In terms of enforcement on the provider side, the proposed legislation would hold both eligible professionals and hospitals responsible for instances of "knowingly" and "willingly" restricting the exchange of data between end-users of CEHRT. Also, HHS would be required to assess the feasibility of  providing a mechanism for providers to compare CEHRT products (e.g., website).

Unlike Burgess's discussion draft submitted to the House Energy & Commerce Committee earlier this month, the most recent bill does not provide details about the form enforcement would take when decertifying CEHRT products.

Earlier this month, the discussion draft laid out penalties for non-compliance in the certification and use of qualified EHR technology. The criteria for EHR certification would require EHR developers to complete three activities:

(I) provide to the Secretary an attestation that the entity, unless for a legitimate purpose specified by the Secretary, has not knowingly and will-fully taken any action, including through any financial, administrative, or technological barrier, to limit or re-strict the exchange of information or to prevent or disincentivize widespread interoperability between any providers using such records or other qualified electronic health records in connection with such records;

(II) publish application programming interfaces, with respect to such records, for medical records data, search and indexing, semantic harmonization and vocabulary translation, and user interface applications; and

(III) demonstrate to the satisfaction of the Secretary that data from such records is able to be ex-changed through the use of application programming interfaces and used in a manner that allows for exchange and everyday use of such records by authorized users.

The bill currently sits with the Committees on Energy and Commerce and Ways and Means and the Judiciary.




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