From The Editor | February 4, 2015

The ONC's Olive Branch

Source: Health IT Outcomes
ken congdon

By Ken Congdon

Ken Congdon, Editor In Chief of Health IT Outcomes

Just when the Meaningful Use program was on life support, the ONC makes two key announcements that seem to have healthcare leaders rallying around the program (and the organization) once again.

The past year has been tough on the ONC and the Meaningful Use (MU) Incentive Program the organization shepherds. First, there was the clear lack of progress most healthcare providers were making toward achieving Stage 2 MU. As of September 2014, only 104 physicians and 4 hospitals had successfully attested for $86 million in Stage 2 MU incentive payments (compare this to the 264,000 eligible providers and 4,000 hospitals that collected nearly $25 billion in Stage 1 MU funds). The ONC didn’t help its cause any when it issued its finalized ‘modifications’ rule to the MU program back in September 2014. While the ONC touted this final rule as adding flexibility, healthcare providers lambasted it for failing to reduce the Stage 2 MU reporting period from one year to 90 days (a provision almost universally requested by key provider stakeholders). In the wake of this announcement, a survey by SERMO indicated that more than half (55 percent) of physicians surveyed had no plans to attest for Stage 2 MU in 2015.

Last week, the ONC and CMS finally acquiesced. In a blog post published on January 29, Dr. Patrick Conway, deputy administrator for innovation and chief medical officer for CMS said the agency will pursue rulemaking to reduce the Stage 2 MU reporting period to 90 days. CMS will also seek to realign MU to the calendar year, allowing hospitals more time to incorporate 2014 edition software into their workflows and to better align with other CMS quality programs.

As expected, this announcement came as welcome news to much of the healthcare provider community. For example, Russell Branzell, president and CEO of the College of Healthcare Information Management Executives (CHIME) views the announcement as much needed administrative relief for CHIME members who have struggled with the “burden of trying to maintain that level of reporting and data management for a year versus 90 days.” Furthermore, Branzell says the announcement is proof that the ONC and CMS are truly listening to healthcare providers.

While the announcement was praised, many healthcare leaders stressed the need to issue this new rule in a timely manner. “We hope the new rule will be issued expediently to provide the flexibility needed to allow more physicians to successfully participate in the MU program and better align MU with other quality reporting programs such as the Physician Quality Reporting System (PQRS) and the Value-Base Modifier (VBM),” says Dr. Steven Stack, president-elect of the American Medical Association (AMA).

A Big Step Towards Health IT Interoperability

In a statement issued on January 29, Stack also pressed the ONC to address “problems with interoperability and support technologies that provide the ability for information to be exchanged, incorporated and presented to a physician in a contextual and meaningful manner.” Little did he know that the ONC would respond to this issue a mere 18 hours later by releasing its draft for a nationwide health IT Interoperability Roadmap. The Roadmap, titled Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0, builds on a vision paper issued in June 2014 and calls for the ONC to identify the best available technical standards for core health IT interoperability functions.

The Roadmap also outlines a core set of building blocks that are necessary to achieve interoperability. They include:

  1. Core technical standards and functions;
  2. Certification to support adoption and optimization of health IT products and services;
  3. Privacy and security protections for health information;
  4. Supportive business, clinical, cultural, and regulatory environments; and
  5. Rules of engagement for governance.

The Roadmap is also linked with the administration’s Precision Medicine Initiative to improve care and speed the development of new treatments, as well as the Department-wide effort to achieve better care, smarter spending, and healthier people through improvements to our healthcare delivery system. As part of this work HHS and the ONC are focused on three key areas:

  1. Improving the way providers are paid;
  2. Improving and innovating in care delivery; and
  3. Sharing information more broadly to providers, consumers, and others to support better decisions while maintaining privacy.

The ONC was careful to stress that key decisions on health IT interoperability would not be made in a vacuum. “To realize better care and the vision of a learning health system, we [the ONC] will work together across public and private sectors to clearly define standards, motivate their use through clear incentives, and establish trust in the health IT ecosystem through defining the rules of engagement,” says Dr. Karen DeSalvo, national coordinator for health IT. “We look forward to working collaboratively and systematically with federal, state, and private sector partners to see that electronic health information is available when and where it matters.”

Not surprisingly, this long-awaited interoperability announcement was also met with praise by most healthcare providers. “This is a much-needed playbook for each and every health IT professional,” says CHIME’s Branzell. “Now, healthcare providers and health IT developers have a single source of truth, with an extensible process to align clinical standards towards improved interoperability, efficiency, and patient safety.”

The ONC appears to have the provider community back in its corner. Time will tell how long this harmony lasts. But for now, the infighting that derailed our health IT progress over the past several months is behind us and we can get back to focusing at the task at hand (achieving the Triple Aim).