By Michael Burger, Practice Lead, EHRs and EDI
The Centers for Medicare and Medicaid Services (CMS) wants to know if the agency should revise the Medicare Conditions of Participation (CoP) to require hospitals to share clinical data — if “possible” with other community providers, hospitals and patients under the banner of interoperability. The proposal came in a recently issued Request for Information (RFI), which is buried in a voluminous draft regulation related to hospital payment.
The comment period ended recently, and I have seen glimpses of some of the responses. A number of organizations filed opinions strongly opposed to the proposal. Those giving it a thumbs down include the College of Health Information Management Executives (CHIME), the American Medical Informatics Association (AMIA) and the American Hospital Association (AHA).
This opposition seems to bolster my long-held perspective that interoperability is more of a business issue than a technical issue.
In its response, the AHA cites its 2016 survey showing that 96% of hospitals have a certified electronic health record (EHR), and that “many physician practices” have implemented certified EHRs related to achieving Meaningful Use. Despite this widespread adoption of EHR technology, the AHA believes that it is “premature” to consider a CoP interoperability requirement because:
- The uptake of EHRs in other parts of health care is less robust
- The information sent is not useful to the recipients
- The workflow required to enter and send information from their EHR is cumbersome
- Identifying the correct patient between systems is difficult
- Exchanging information across different vendor platforms is difficult
These are all very real issues. Yes, not all providers across the continuum of care have EHRs. Yes, the information is often so voluminous that it’s not useful without reconciliation. And yes, EHR workflows can be cumbersome. And yes, identifying patients and connectivity across multiple platforms is difficult.
No one debates the public health value of shared clinical data – the positive effect on outcomes when data is shared is well documented. The challenge of clinical data sharing is a business challenge. Medicine, after all, is a business.
Yet these challenges are surmountable, if there is a business incentive to address them. However, this depends on two factors: whether (as a health system) you’re exchanging data with providers outside your system (that is, your competition) and whether, as a health system, you have a business incentive to invest time and money to share the data with competitors.
Despite its flaws, the CMS EHR Incentive Program (Meaningful Use) did accomplish CMS’s strategic goal – to have a standardized infrastructure in place for the digitization of clinical information. As a result of Meaningful Use, the vast majority of hospitals and practices have EHRs in place. And these EHRs have all been certified to be able to create and consume a variety of standardized, interoperable data, and between disparate systems. While the standards are imperfect and the process has room for improvement, it IS possible to share all kinds of clinical data among all kinds of providers.
Seldom do I find myself defending CMS. In this case, though, I think that CMS is approaching the question of interoperability in a logical fashion. By recognizing that resistance to interoperability is a business issue and not a technology challenge, CMS is applying business leverage (allowing hospitals to participate in Medicare) to solve the interoperability dilemma.
And, as noted by the AHA, “today’s health information exchange landscape is comprised of a complex set of existing networks.” From the CMS perspective, this is problematic because to achieve interoperability nationwide, the networks need to be interconnected, and today they are not. The reality, though, is that most healthcare is delivered locally. As a result, a regional network fits the bill for the majority of data sharing.
I applaud CMS for taking the initiative to pull the available levers to prod the business of healthcare to share clinical data. I also applaud those organizations who have taken the time to provide exhaustive commentary to CMS’s RFI. The comments bring the challenges to light, although I don’t believe that those challenges are a reason not to mandate interoperability.