The inability to exchange health information on a large scale is one of the most significant limitations of today’s electronic health records (EHR). However, interoperability may become a reality as soon as 2017, according to a draft roadmap published by the Office of the National Coordinator (ONC) in January. The document, titled Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap, includes several steps that will ultimately allow the “majority of individuals and providers across the care continuum to send, receive, find and use a common set of electronic clinical information at the nationwide level.”
The roadmap outlines these key ingredients for interoperability: Core technical standards; certification of health IT products; privacy and security protections for health information; supportive business, clinical, cultural and regulatory environments; and rules of engagement and governance.
By 2020, the ONC hopes that providers will expand the use of interoperable health IT to improve health and lower costs. By 2024, the goal is to achieve a nationwide learning health system. Such a system would enable longitudinal records, precision medicine, and more efficient and targeted care.
What does all of this mean for the average physician practice?
Interoperability allows physicians to recommend treatments that are better tailored to an individual’s preferences, genetics and concurrent treatments. That’s because physicians will be able to access important information from a variety of providers at any given time. Interoperability can also help reduce potential readmissions. For example, knowing that a discharged patient with congestive heart failure is gaining weight the week after they are discharged can trigger home-based interventions that can help prevent the patient from being readmitted.
Notable is the fact that CMS announced in January that it would tie 30% of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016. In an increasingly quality-driven healthcare environment, the ability to tailor treatments can enhance outcomes that may be directly linked to payment.
Another important recent policy that demonstrates CMS’ commitment to the use of health IT in the provider setting is the separately billable payment for chronic care management that the agency finalized under the 2015 Physician Fee Schedule. In order to bill for these services, physicians will be required to utilize certified health IT to furnish certain services to beneficiaries.
One of the many goals of health IT is to empower patients to participate in their own healthcare. The ONC says that this empowerment will only occur when there is a cultural shift at both the individual and provider levels. Physicians must work together with patients to routinely assess and incorporate patient preferences into care plans. This includes identifying ways in which physicians can make the most of patient-generated health data.
With true interoperability, physicians not only have easier access to information, but they’re also less likely to duplicate certain tests (e.g., labs and imaging). By allowing providers to share test results, patients receive treatment more quickly and without placing an unnecessary burden on the healthcare system.
Interoperability and data liquidity could allow physicians to change health IT vendors more easily, thus increasing the competition among vendors.
Several states have already begun to advance interoperability via their Medicaid managed care contracts. States can require payers to ensure that provider networks use interoperable health IT or that they electronically report data to support care coordination as a condition of participation. States also emphasize the use of health IT and information exchange as part of quality strategies for managed care plans.
Payers increasingly participate with provider networks that ensure members have access to high value, coordinated care. Some commercial payers can make the adoption of certified health IT systems or demonstration of interoperability a condition of participation. Payers may also incentivize consumers to choose providers within these interoperable networks. In addition, commercial payers may include interoperability requirements as part of the credentialing process for providers within their networks.
This post was made possible via considerations from RevenueXL. To learn more about their PrognoCIS Meaningful Use EHR Software, visit their website.
Alok Prasad is the President of RevenueXL Inc. which is a leading provider of healthcare solutions and Electronic Medical Records software, providing ONC-ATCB Certified Electronic Health Records Software to small and mid-sized practices. RevenueXL offers free EMR Software in conjunction with its medical billing services.
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