The American Medical Association (AMA) and 36 other medical associations sent a letter to CMS and ONC to encourage them to change the way EHR interoperability is measured. The associations think the metric is too focused on the quantity of records and not enough on the relevance of the data exchanges.

This letter is a response to CMS’ and ONC’s request for information assessing interoperability for the Medicare Access and CHIP Reauthorization Act (MACRA), a bipartisan payment reform bill that was made law last year.

CMS proposed to carry the current measures over to proposed MACRA regulations in the Advancing Care Information category. But that would insufficiently measure interoperability, provide no incentive for health IT developers to make changes and even encourage developers to develop EHRs that meet federal reporting requirements that only focus on data exchange, according to the letter.

"Measurement is a key issue, and one worth exploring. However, we need to step away from measurement and look at what's driving the exchange of data and what's happening now between EHRs," Dr. Steven J. Stack, president of AMA, told HCB News.

Many EHR vendors claim that their products are interoperable, but the majority of them only exchange data in a way that meets a minimum amount of Meaningful Use (MU) requirements.

In December, AMA released a set of recommendations to improve the program so that it accommodates the real-world needs of physicians and patients while focusing on promoting interoperability. The recommendations were included in comments the AMA sent to CMS on Meaningful Use Stage 3.

One of the things that AMA proposed is to simplify the program to provide more flexibility — there are eight different requirements with multiple measures — and eliminate the all-or-none to succeed metric. It also suggests that it focus more on the desire for outcomes, according to an HCB News feature on EHRs.

"The main issues are the actual measure requirements in Meaningful Use (now Advancing Care Information), which EHR vendors follow to a 'T'," said Stack. "Their products support 'interoperability' by way of moving large PDF files back and forth, which is not meaningful interoperability."

Instead of using data exchange as the measurement of interoperability, the letter suggests that CMS should focus on the usefulness, timeliness, correctness and completeness of data, as well as the ease and cost of information access. Not only will that benefit patients, but it may also help to promote greater competition in the health IT market.

"These new objectives should be less about measuring the process or path a physician takes. Rather, they should focus on how health IT can best support patient goals and better outcomes," said Stack.

For example, instead of just making sure a summary of a care record is sent around, tools should be in place that allow the care teams to co-author, edit and support care plans, he added. Patients should also have the ability to communicate with their care team using the methods they choose.

The associations also urge CMS and ONC to focus on specialty-specific interoperability use cases. That would relieve the burden on physicians as well as ONC because the agency wouldn’t have to find additional data sources for interoperability evaluation.

"Interoperability can mean different things to different audiences," Michael Peters, director of regulatory and legislative affairs at the American College of Radiology, told HCB News.

For example, ACR advocates for seamless, bidirectional connectivity between radiologists and referring providers, including the abilities to send and receive orders electronically, share reports and associated imaging data with referring providers regardless of system and business affiliation, and provide e-access to patients.

"Other specialties have their own uses and priorities related to interoperability and exchange," added Peters.

A few of the other associations that signed the letter are the American College of Cardiology, the American Society for Radiation Oncology, the American Academy of Family Physicians and the American College of Surgeons.