Interoperability Explained For Healthcare ProvidersLearn what interoperability means to you and your healthcare organization By: Secureworks
Medicare and Medicaid healthcare providers that participate in Centers for Medicare and Medicaid Services (CMS) are expected to achieve interoperability by the end of 2017. Healthcare providers who don’t will see a reduction in their Medicare and Medicaid payments, according to the Office of the National Center for Health Information Technology (ONC).
The ultimate goal of the government is for doctors, hospitals, clinical researchers, payers, technology developers, individuals, and pharmacies to all be able to share medical information with each other as well as patients and their caretakers, such as nursing homes. But at this time there are no requirements for anyone to achieve interoperability except for those entities that participate in CMS.
Interoperability describes the extent to which systems and devices can exchange and interpret data. Often two different types of medical information systems can’t communicate with another. ONC follows the Institute of Electrical and Electronics Engineers (IEEE) definition of interoperability as the ability of systems to exchange and use electronic health information from other systems without special effort on the part of the user. IEEE is the world’s largest technical professional organization for the advancement of technology.
The Health Information Technology for Economic and Clinical Health (HITECH) program requires providers to demonstrate “Meaningful Use” of an electronic health record. Meaningful use is a CMS Medicare and Medicaid program that awards incentives for using certified electronic health records (EHRs) to improve patient care. To achieve Meaningful Use, providers must follow a set of criteria that serve as a roadmap for effectively using an EHR. To demonstrate Meaningful Use, providers have previously had to attest through certified electronic health record software to show they comply with federal meaningful use regulations and thus qualify for monetary incentives. However, ONC spokesperson Peter Ashkenaz told SecureWorks in April that to meet the Meaningful Use requirements, healthcare providers and other professionals who earn Medicare and Medicaid incentive payments for the electronic capture of clinical data must be able to show that they could be interoperable.
In 2018, all providers will be required to participate in Stage 3 of Meaningful Use regardless of their prior participation. Previously there was a tiered approach to obtaining Meaningful Use. Healthcare providers could start off meeting Stage 1 requirements, then move to Stage 2 and finally to Stage 3. Moving all participants to a single stage of Meaningful Use aims to reduce the program’s complexity and simplify reporting requirements. The latest Stage 3 objectives include Public Health Reporting, which states the Eligible Professional is in active engagement with a public health agency or clinical data registry to submit electronic public health data in a meaningful way using certified EHR technology.
Epic Systems and Cerner Corporation are the most popular certified EHR technology (CEHRT) vendors among ambulatory providers and hospitals successfully attesting to meaningful use, according to the ONC. Reporting on ONC data from 2016, EHR Intelligence reports an array of CEHRT vendors being used by ambulatory providers and eligible hospitals.
The ultimate goal of interoperability is to build a learning health system by 2024. Healthcare records shared among doctors, researchers, clinical trials and pharmacists will help each segment learn from the other to better understand and treat patients and illnesses.
The ONC, a position within HHS was created by Executive Order in 2004 and was written into legislation by the Health Information Technology for Economic and Clinical Health (HITECH) Act to promote a national health Information Technology infrastructure and oversee its development. The HITECH Act legislation was created in 2009 to stimulate the adoption of electronic health records (EHRs). By 2024, ONC believes individuals, care providers, communities, and researchers should have an array of interoperable health IT products and services that allow the healthcare system to continuously learn and improve patient care.
Exceptions can be made for Eligible Professionals (EPs) that are not meaningful users of Certified Electronic Health Record (EHR) Technology under the Medicare EHR Incentive Program. If a provider is eligible to participate in the Medicare EHR Incentive Program as an Eligible Professional, Eligible Hospital, or Critical Access Hospital (CAH) it may be exempt from Medicare penalties if it can show that demonstrating Meaningful Use would result in a significant hardship. To be considered for an exemption (to avoid a payment adjustment), the eligible entity must complete a Hardship Exception application along with the proof of the hardship. If approved, the hardship exemption will be valid for only one payment year and the entity would need to submit a new application for subsequent years. In no case may a provider be granted an exemption for more than five years.