AMIA Urges Patient-centered Approach to Measure Interoperability

Wednesday, May 25, 2016

Nation’s biomedical and health informatics professionals say federal officials must think differently to understand our national state of interoperability

(BETHESDA, MD) – The American Medical Informatics Association (AMIA) responded to a request for information (RFI) issued by the Office of the National Coordinator for Health IT (ONC) outlining a measurement approach to interoperability that focuses on the patient experience, and determines if clinically relevant data were available when and where it was needed. The organization of health informatics professionals said a focus on volume-based national measures, such as the number of summary care records exchanged, and surveys will be insufficient to understand the national state of interoperability.

As part of a requirement of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress declared it a national objective to achieve widespread interoperability by December 31, 2018. Section 106(b)(1)(C) of the MACRA requires that by July 1, 2016, and in consultation with stakeholders, the Secretary of Health and Human Services shall establish metrics to determine if, and to the extent, this objective has been met. ONC issued the RFI to gain feedback on how such a measurement should be developed.

In response, AMIA recommended ONC develop a multi-pronged approach to measuring interoperability that:

  1. Satisfies congressional deadlines;
  2. Avoids the unintended measurement consequences of the EHR Incentive Program; and
  3. Enables policymakers and stakeholders to gauge how interoperable our health system is through the point of view that matters most: the patient.

"AMIA strongly recommends that ONC develop a measurement strategy that is patient-centric, and one that can be expanded and refined over time,” the organization said in comments.  “Our approach would enable ONC to contextualize transaction- and provider-focused data to better understand if clinically relevant data were available to the clinician when and where they were needed. Rather than try to develop measures for the myriad of ways interoperability may be occurring, we recommend an approach that looks to understand where interoperability is needed, and then assess whether or not it is occurring."

AMIA's recommended method to measuring interoperability would rely on claims data and statistical samples to conduct retrospective reviews, examining if expected interoperable data sharing occurred for patients with health conditions that necessitated receiving care from multiple providers. Further, it would help ONC assess the availability of data and the impact of interoperability where it is likely to influence the care of patients most – among the clinicians and organizations that treat them routinely.

"We need federal officials to think differently about how to measure interoperability," said AMIA Board Chair and Medical Director of IT Services at the University of Washington’s UW Medicine, Thomas H. Payne, MD. "The issue of ‘Do we have interoperability?’ is a complex and dynamic question, but a vitally important one. We must answer with certainty, and in a way that does so from both a clinician’s and a patient’s perspective."

AMIA provided responses to ONC's questions, which indicate federal officials are focused on existing national surveys and administrative data from the EHR Incentive Program, known as meaningful use, as a way to measure interoperability. AMIA suggested several enhancements to existing surveys, and discussed the limitations of focusing on transactions, such as summary of care records sent during transitions of care or using medication reconciliation as a means to measure interoperability.

AMIA issued a word of caution against the development of new national measures that further burden clinicians as they deliver patient care and divert vendor focus from meeting provider and patient needs. “We note that the measurement paradigm developed through the EHR Incentive Program has affected development and usability of health IT, and impacted care workflows in unintended, negative ways,” said AMIA.

"Interoperability is hard in the concrete and impossible in the abstract," said AMIA President and CEO Douglas H. Fridsma, MD, PhD.  “We will make the best progress toward measuring interoperability when we can clearly define what we want to do with the information that is exchanged. Focusing on specific ways in which we can support clinicians and improve the health and healthcare of patients is the best hope we have to make substantive and measurable progress towards widespread interoperability."

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AMIA, the leading professional association for informatics professionals, is the center of action for 5,000 informatics professionals from more than 65 countries. As the voice of the nation’s top biomedical and health informatics professionals, AMIA and its members play a leading role in assessing the effect of health innovations on health policy, and advancing the field of informatics. AMIA actively supports five domains in informatics: translational bioinformatics, clinical research informatics, clinical informatics, consumer health informatics, and public health informatics.