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What Does EHR Interoperability Mean for MACRA Implementation?

CMS continues to place the burden of EHR interoperability on EHR vendors, but eligible clinicians still have a role to play under MACRA.

By Kyle Murphy, PhD

In recent remarks to the American Osteopathic Association, the head of the Centers for Medicare & Medicaid Services (CMS) put the onus for EHR interoperability squarely on the shoulders of EHR vendors and not end-users.

“The burden needs to be on the technology, not the user. EHR vendors and hospitals that use them will now be required to open their APIs — so data can move in and out of an application safely and securely — and technology can become plug and play,” said CMS Acting Administrator Andy Slavitt (via the CMS blog).

“Today’s data silos are more a function of business practices than technology capability and we cannot tolerate it any longer,” he continued. “This will not only help you track referrals, but serve another purpose — to eliminate the ‘desktop lock’ that occurred based on early EHR purchases.”

Those remarks absolve healthcare organizations and providers of the technical obstacles to EHR interoperability. However, the propose rule for MACRA implementation makes clear that eligible clinicians (and hospitals) participating in the Quality Payment Program have an important role to play in advancing EHR interoperability and information sharing.

As part of the Merit-based Incentive Payment System (MIPS), CMS has proposed an attestation process for eligible clinicians under a provision to support information exchange and the prevention of health information as well as to cooperate with authorized surveillance of certified EHR technology.

As proposed, eligible clinicians would be required to attest to the following three statements:

(A) Did not knowingly and willfully take action (such as to disable functionality) to limit or restrict the compatibility or interoperability of CEHRT.

(B) Implemented technologies, standards, policies, practices, and agreements reasonably calculated to ensure, to the greatest extent practicable and permitted by law, that the CEHRT was, at all relevant times—

(1) Connected in accordance with applicable law;

(2) Compliant with all standards applicable to the exchange of information, including the standards, implementation specifications, and certification criteria adopted at 45 CFR part 170;

(3) Implemented in a manner that allowed for timely access by patients to their electronic health information; and

(4) Implemented in a manner that allowed for the timely, secure, and trusted bi-directional exchange of structured electronic health information with other health care providers (as defined by 42 U.S.C. 300jj(3)), including unaffiliated providers, and with disparate CEHRT and health IT vendors.

(c) Good faith and timely responses. Responded in good faith and in a timely manner to requests to retrieve or exchange electronic health information, including from patients, health care providers (as defined by 42 U.S.C. 300jj(3)), and other persons, regardless of the requestor's affiliation or health IT vendor.

According to the proposed rule, the support for health information exchange and prevention of information blocking is a carryover from meaningful use requirements relative to meaningful EHR use. In the rule, CMS explained the rationale behind these MIPS requirements for eligible clinicians:

We believe that, at a minimum, such a demonstration would need to provide substantial assurance not only that the certified EHR technology was connected in accordance with applicable standards during the relevant EHR reporting period, but that the eligible clinician, EP, eligible hospital, or CAH acted in good faith to implement and use the certified EHR technology in a manner that supported and did not interfere with the electronic exchange of health information among health care providers and with patients to improve quality and promote care coordination.

The final rule for MACRA implementation and the Quality Payment Program is expected this fall and is likely to bear a number of changes in response to feedback from industry stakeholders. Chief among them are potential changes to the program’s start date and the duration of reporting periods, which Slavitt said the federal agency was open to at a recent Senate hearing.

Dig Deeper:

Reexamining the Progress of Health Data, EHR Interoperability
ONC Addresses MACRA Health Data Interoperability, HIE Measures




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