Help Inform the Department of Health and Human Services’ (HHS) Measurement of Interoperability

Today, we are asking for your input on ways to measure the progress toward a future where health information is flowing between providers and patients to supports a health system that provides better care, smarter spending, and healthier people. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) declares it a national objective to achieve the widespread exchange of health information through the use of interoperable certified electronic health records and directs HHS to establish metrics in consultation with you – the health IT community – to see if that objective has been met.

Ensuring health data flows seamlessly and securely to create a learning, person-centered health system is a common theme of the Federal Health IT Strategic Plan, a collaboration with over 35 federal partners and the public that focuses federal offices that use or influence the use of health information technology on person-centered care, advancement of science, and overall health. Similarly, the Nationwide Interoperability Roadmap was an effort by the Office of the National Coordinator for Health Information Technology (ONC) in collaboration with the private sector, states, and federal partners to identify near-term actions to advance an interoperable health system. Combined with other recent announcements, including the pledges made by private sector market leaders to make electronic health information flow better and the challenges issued to spur innovation of market-ready, user-friendly apps for consumers and providers, these efforts all help to support the flow of health information when and where it is needed for patient care.

We are issuing a request for information for your thoughts for how to measure interoperability and ensure HHS is keeping pace with the objectives we laid out in the Roadmap and the Federal Health IT Strategic plan to measure the broad health information ecosystem, including individuals and non-health settings. Specifically, we are asking for input on:

  1. What populations and elements of information flow should we measure?
  2. How can we use current data sources and associated metrics to address the MACRA requirements?
  3. What other data sources and metrics should HHS consider to measure interoperability more broadly?

We look forward to your feedback and to our continued collaboration to advance an interoperable, learning health system. The public comment period closes on June 3, 2016. View and download the request for information.

Request for Information MS Word Version [Docx – 49KB]

ONC Comment Submission Form [xlsx – 10KB]

7 Comments

  1. Constanze Rayhrer says:

    Previous operative complications
    Number of comorbitities
    Poor nutrition
    Level of anti coagulation
    Short life expectancy

  2. Teresa Lesley says:

    In response to Health Information exchange:

    I handle Physicians Support for Allscripts EHR for 3 Family Practice, 1 Surgical and 1 Orthopedic office located in Pickens County, South Carolina affiliated with Cannon Memorial Hospital.
    I handle all of the reporting for MU, PQRS, Patient Portal and oversee our users in Allscripts EHR.

    Currently, I am using Follow My Health Patient Portal that is powered by Allscripts. Prior to Follow My Health Patient Portal, I used Relay Health which was developed for Hospitals, but lacking significantly on the Physician Practice side. I was unable to make Relay work for our Patient Population.
    There has to be more regulations on Patient Portals. Someone needs to look at what the portals are capable of receiving and sending. Portals should be simple to sign into, and navigate. Patients want to see their lab and x ray results for the most part, renew a prescription and make an appointment.
    I survey our patients on our patient portal once a month. The reviews are very good, however, there are many patients that are unable to have internet coverage due to the rural communities and lack of resources.
    Most patients do have a cell phone and it appears that this is the best way for them to access their patient portal.

    Another issue I have is being able to exchange records with other providers. We have had to obtain direct addresses from other providers to build into our database for exchange of medical records. It would be nice to have a national database with all providers having a uniform electronic exchange address.
    This database should be easy to access and should be a requirement of all providers to have an address. A lot of providers we have called confuse fax with electronic and they don’t have a clue what you are talking about. I am still having a hard time trying to send records electronically for referrals. One issue is each provider has “their own” referral form they want completed. There has to be one cover sheet that is standard in order for records to be sent electronic.
    IT is extra work to fax “their own” form and then send the records electronically.

    One of our locations is a rural health facility. Our community is comprised of Medicare and Medicaid patients.

    I hope this will provide some ideas as you strive toward a better HI exchange of records!

    Best Regards,

    Teresa Lesley
    Physician Support Analyst
    Cannon Physician Practices
    Office – 864-843-8507
    Fax – 864-843-5939

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  3. Connie High says:

    1.) Populations and elements: With the Meaningful Use Transitions of Care measures, this was very helpful to be able to generate a summary of care document for transitions. Of course transitions include other physicians, surgery centers, hospitals, nursing homes. It would be helpful if the History and Physical Exam (H&P) information from an encounter was as easy to generate from an EHR and send to another provider. Some EHR systems had this capability and for other systems, it was not so easy.
    2.) a. Make it an additional EHR certification requirement that H&P be as easily generated as the Summary of Care document. This would be helpful to get more surgery centers to purchase EHR technology. Currently, many surgery centers do have this technology. b. Make secure Direct email a program requirement or somehow tied to reimbursement. I have worked with many healthcare organizations that do not see any value in Direct email. If it is not mandatory or tied to reimbursement, it won’t happen.
    3.) Regional or Statewide Information Exchanges should also have the same credit as having Direct Secure Email technology.

  4. Michael Banks says:

    What I do not understand is that you are not listening to front line providers. We do NOT want to be burdened with even more regulatory action from ONC. If you want to measure interop, then speak to vendors. Do NOT make providers “show” interop when we have NO ability to program, customize or even influence the small numbers of vendors left. You seem to penalize providers for actions that we have NO ability to control. So here’s a thought, require VENDORS to show their abilities to you. NOT us. Audit THEM not us. Penalize THEM not us. Please STOP and listen to what we are saying.
    1. Measure if providers can click ONE button to view information from other EHRs , if not penalize vendors not providers.
    2. Forget MACRA its dead to front line providers before it has even started.
    3. First define what you mean by interop, I don’t even think you understand it from OUR perspective. If I cannot view records from another institution or provider with ONE click of a button, in 5 seconds or less with little to no typing then its USELESS to me. Further to PENALIZE me for not participating makes me even more likely to quit medicine or Medicare completely.
    Please stop making our jobs harder and harder we are begging you at this point.

  5. Daniel Stein says:

    Let’s remember to include the social determinants (human services contributors) to the overall measurement of interoperability otherwise we risk missing a substantial and important contributor to overall health and wellness. Big Tent Time!

  6. Joseph M Smith, MD, PhD says:

    It is essential that information from “smart” medical devices flow seamlessly into the medical record, and that medical devices have real-time access to pertinent information from other devices involved in the care of the same patient. We need open-standards based medical device interoperability.

  7. V. Katherine Gray says:

    As a vendor who needs to integrate to EHRs, I believe it would be helpful if there was a tally that ONC kept for each different “application” type (e.g. imaging Clinical decision support) of how many different vendors does the EHR have set up and operating as interoperable. This would give an index of the real “total interoperability” not just the potential for it with specifications, etc. To be really considered interoperable, the EHRs would need to be aware of their success by counting how many applications that they have actually interoperating in each application category.

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