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Interoperability is more than just a buzz word. It’s akin to the holy grail of health information technology, and it has remained just as elusive.

This may sound familiar to regular readers of this column, as I have addressed this issue often during the past few years. Yet here we go again.

Interoperability 2.0

Interoperability is defined as the extent to which systems and devices can exchange data and interpret that shared data, according to the Healthcare Information and Management Systems Society (HIMSS). The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, focuses on “interoperability” of electronic health records (EHRs) software and systems, but later iterations aim to put the power back in the people’s hands—with patient health records.

There are some strong signals that we are getting closer to these goals. For starters, tremendous progress has been made in the adoption of EHRs by health care systems. But in a speech made at the 2018 HIMSS meeting, Centers for Medicare & Medicaid Services Administrator Seema Verma said that the issue at hand is not the technology, per se, but the fact that many of the big players don’t play nicely in the sandbox and are engaging in data blocking.

“The technology for data sharing has advanced, and data is often shared effectively within a given healthcare system, with inpatient and outpatient doctors in the same provider system able to share and edit the same clinical record,” she said. “Despite this progress, it is extremely rare for different provider systems to be able to share data. In most cases there is not yet a business case for doing that—it’s in the financial interest of the provider systems to hold on to the data for their patients.”

During the speech, Ms. Verma announced plans to prioritize efforts that promote EHR interoperability. The EHR Incentive Program has been re-christened as the Promoting Interoperability (PI) Programs, and the Merit-Based Incentive Payment System (MIPS) track of the Quality Payment Program (QPP) formerly known as the Advancing Care Information performance category is now the Promoting Interoperability performance category.

CMS also launched MyHealthEData to get healthcare information into the hands of patients more quickly. (See sidebar.) The initiative will ensure that patients receive a copy of their entire health record electronically.

Another sign that CMS means business this time around is the recent appointment of founder and former CEO of Landmark Health Adam Boehler as the head of the CMS Innovation Center. Choosing a tech entrepreneur shows that CMS is looking for outside-of-the-box solutions to these vexing issues.

The Pressure Is On

Yes, the administration is serious, again, but will it make a difference? The jury is still out, but the pressure is on and I am cautiously optimistic that we are getting closer to the holy grail.

Mark D. Kaufmann, MD is an associate Clinical Professor of Dermatology, Dept. of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City.


According to CMS, the MyHealthEData initiative, “aims to empower patients by ensuring that they control their healthcare data and can decide how their data is going to be used, all while keeping that information safe and secure…MyHealthEData will help to break down the barriers that prevent patients from having electronic access and true control of their own health records from the device or application of their choice.”

Among key aspects of the program are:

Giving Medicare Beneficiaries Their Data Through Medicare’s Blue Button 2.0

Medicare’s Blue Button 2.0 is intended to provide beneficiaries with their claims data in a universal and secure digital format. Medicare first launched Blue Button in 2010 to give patients access to their claims data in a downloadable PDF file. Now, with Blue Button 2.0, beneficiaries will be able to take their data and use it on applications designed to help them manage their health, or share it with their doctors to improve clinical decision-making. Medicare’s Blue Button 2.0 contains four years of Medicare Part A, B, and D data for 53 million Medicare beneficiaries and provides multiple types of information including prescriptions and primary care treatments.

Calling on Private Plans to Provide Patients Their Data

CMS will re-examine its expectations for Medicare Advantage plans and qualified health plans (QHPs) offered through the federally facilitated exchanges, and is calling on all health insurers to release their data.

Encouraging Patient Access Through CMS Programs 

CMS is streamlining the Medicare and Medicaid EHR Incentive Programs for eligible hospitals and critical access hospitals (commonly referred to as the Meaningful Use programs)and the Quality Payment Program (QPP) for clinicians (part of MACRA) to increase the programs’ focus on interoperability and to reduce the time and cost required to comply with them. (Read more in the main article.)

Prioritizing Quality Measures That Lead to Interoperability Preventing Information Blocking

CMS is also taking steps against information blocking (a practice in which providers prevent patients from getting their data), as required by law by requiring hospitals and clinicians under some CMS programs to show they have not engaged in data blocking activities.

Provider Requirements

CMS also says as part of MyHealthEData that it is modernizing provider requirements with a “focus on value-based care”:

CMS has finalized for some its programs the requirement for health care providers to use 2015 Edition certified EHR technology (CEHRT) beginning in 2019, which is capable of giving data to patients in a usable and secure electronic format. Additionally, CMS says it intends to specify what types of information—ideally in electronic format—must be shared by hospitals with a patient’s receiving facility or post-acute care provider. The agency also says that it will further assess the impact of not sharing data on duplicate testing and associated costs.

Of note, CMS states that it is seeking to streamline documentation and billing requirements:

“To make sure that clinicians will spend less time inputting codes and information into EHR systems, and more time with their patients, CMS is considering stakeholder feedback and looking into streamlining its policies around documentation guidelines for Evaluation & Management E&M codes (the codes that doctors use to bill Medicare for patient visits) to modernize documentation requirements and reduce clinician burden.”

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