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The problems illustrate why the bipartisan push toward interoperability is important.
Don Rucker, M.D., probably hears the word “interoperability” 500 times per day. And given his role, that makes sense. As the national coordinator for health information technology (IT), Rucker is charged with helping the nation’s healthcare system achieve interoperability, the much-heralded state in which providers, payers and patients may seamlessly exchange medical data.
But the constant use of the word “interoperability” can obscure what’s at stake. It’s not just another buzzword, and its ramifications could very well change healthcare for the better, Rucker said yesterday during the ONC Interoperability Forum in Washington, D.C.
“Interoperability, as we know, is a very, very hard thing to do,” he told the audience of healthcare leaders and developers. “It’s very important, and it’s very nuanced.”
After $35 billion in federal investments in electronic health record (EHR) system adoption, many providers have gone digital, but problems remain. The industrywide campaign to achieve interoperability is an attempt to solve two major issues, which Rucker detailed in his speech.
As government officials surveyed healthcare decision makers and providers, they repeatedly heard stories of doctors and other clinicians facing burdensome documentation requirements. Physicians spend anywhere from 5 to 15 percent of their day performing “no-value-add” documentation to satisfy the demands of a complicated payment system, Rucker said, and these inefficiencies sometimes result in provider burnout.
In response, the Centers for Medicare & Medicaid Services (CMS) has proposed changes to physician fee scheduling for reimbursement. Government leaders claim that the overhaul could save individual physicians an average of 51 hours of paperwork per year.
The challenge, of course, is requiring less bureaucratic effort from busy providers while maintaining fiscal integrity, Rucker said. But other countries accomplish this with a smaller emphasis on boilerplate text.
“U.S. office notes are four times as long as the rest of the world,” he said. “We pay for that as a country.”
The CMS proposal would install a blended payment rate for specialties, with add-on codes for more complex cases. Rucker claimed the rule — which is still in feedback mode — would not only save time and foster proper payments but also make EHRs more usable by eliminating loads of boilerplate text that would serve little purpose to patients.
And the patient element represents the second problem stemming from widespread EHR adoption with little to no interoperability. One reason why Congress took up interoperability, through its passage of the 21st Century Cures Act, is not because of providers but patients. There are two issues at play here: data control and ownership and the ability for EHRs to follow a patient from one provider to another.
“If we are going to have empowered patients who are going to be able to control their medical care, it is hard to imagine that it isn’t going to happen through the tools and fruits of interoperability,” Rucker said.
Right now, federal officials are trying to solve the problem of information blocking, which negatively affects this goal. In some cases, information blocking is clear, but barriers often crop up because of technical complexities, Rucker said. The challenge at hand is distilling genuine information blocking from low-tech road bumps. Still, government leaders are trying to come up with a solution to the problem.
Rucker and his colleagues are also working on uniting healthcare stakeholders to support the interoperability cause, patient identification, open application programming interfaces, population-level query tools and any other number of technical challenges. But the road ahead will be neither easy nor without cost.
“There’s a lot of interoperability now,” he added, “but most clinicians, most patients would not describe it as something you can rely on.”
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