Brookings Report Finds Significant Gaps in EHR Interoperability
While the meaningful use program has spurred adoption of electronic health records, significant gaps in interoperability remain, according to a data brief released by the Brookings Institution, Clinical Innovation & Technology reports.
Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.
Details of Interoperability Challenges
The brief identified several barriers to achieving an interoperable health IT infrastructure, including that:
- Certification requirements for meaningful use do not include access to accurate, timely and actionable cost and coverage data for treatments and tests;
- Insurers and employers tend to be unable to accept data captured in EHRs -- even when it can be exported using current interoperability standards -- and can typically need duplicative documentation;
- Meaningful use-certified EHR systems are too "prescriptive and process-driven," rather than having a more "user-centered design"; and
- Meaningful use requirements and process measures are overly simplified, resulting in EHRs not being adequately responsive to the varying needs of different providers (Walsh, Clinical Innovation & Technology, 3/16).
The authors recommended addressing barriers to interoperability by modifying "meaningful use payment incentives to focus on value and outcomes rather than mandated health IT processes."
To accomplish this goal, the brief suggested:
- Further supporting methods and standards to allow outcome and value-measure reporting from EHR data;
- Identifying opportunities for vendors to introduce user-centered design into intuitive care workflows;
- Linking meaningful use bonuses and penalty avoidance to reporting on outcome-oriented performance metrics; and
- Removing the requirement for EHR functionality to be connected to meaningful use process measures.
The authors also recommended increased support for "value-based payment reform by shifting federal efforts to promote interoperability from process-oriented mandates to real business cases for data exchange that increase value."
To that end, they suggested:
- Developing more flexible health IT structures so that the technology could further evolve to be specialty-specific and meet scope of practice needs;
- Identifying and circulating interoperability standards that support high-value care;
- Implementing the Office of the National Coordinator for Health IT's Interoperability Roadmap;
- Increasing support for methods to enable outcome and value reporting directly from EHRs; and
- Promoting the capture of timely data beyond current regulatory standards by prioritizing key quality and cost metrics (Brookings data brief, March 2015).
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