Interoperability crucial to MACRA, value-based care, experts say

Kerry McDermott, vice president of public policy and communication at the Center for Medical Interoperability

The rule on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be released early this fall. But even before it hits the street, the hefty law is having an impact.

MACRA, designed to overhaul how physicians are paid under Medicare and how they must use health IT to achieve value-based care, relies on a definition of interoperability written in 1990 by the Institute for Electrical and Electronics Engineering (IEEE), which calls for "the ability of two or more systems or components to exchange information and to use the information that has been exchanged."

Under the Merit-Based Incentive Payment System (MIPS) portion of MACRA, an eligible clinician must allow a single unique patient to view, download or transmit their patient record, within a performance period, or allow them to use an application programming interface (API) to access their record--or a combination of both.

[Also: Cardiologist: New bundled payment program 'adds another click,' real interoperability needed]

Indeed, value-based care cannot be achieved without the interoperable exchange of data and the analysis of the data, to improve care and lower costs.

Todd Cooper, principal of Breakthrough Solutions Foundry, a member of the IEEE Personal Devices Workgroup, said that when trying to implement HIT architectures and solutions, it helps to have a definition.

But he concedes that it would help to have one "with a bit more flesh on the bones to help direct roadmap and development planning" than the one ONC has been using. Whereas ONC has been using the IEEE definition, Cooper recommended a new one by The Center for Medical Interoperability.

[Also: Health information exchanges, interoperability crucial in change to value-based payments]

The Center, which defines itself as "a united a group of industry leaders to change the status quo," in fact, recently published an Interoperability Maturity Model.

The model includes five dimensions focusing on infrastructure, syntactic information exchange, terminology semantics, orchestration and the dynamic contextual ability of apps and devices to share patient data based on clinical workflow.

Kerry McDermott, vice president of public policy and communication at the Center said the model can currently be useful to assess progress toward interoperability.

Healthcare IT News parent Health Information Management and Systems Society (HIMSS), meanwhile, earlier this summer encouraged officials from the Office of the National Coordinator for Health Information Technology (ONC) to expand its view of interoperability.

[Also: ACOs held back by poor interoperability]

"To simply focus on technical interoperability is not enough," HIMSS said in its comments to ONC.

ONC should look at how much information is flowing and the extent to which clinicians make decisions by incorporating exchanged data, HIMSS said. That kind of analysis and guidance "could have a greater impact on care delivery than simply looking at the technical capabilities between interoperable systems."

All of these dimensions, Breakthrough's Cooper said, "should be addressed in parallel if you want the interoperability tide to raise all ships." 

This article first appeared in Healthcare IT News.

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