Recommendations for an interoperable health IT infrastructure

Meaningful Use (MU) has led to significant adoption of health IT but several barriers are preventing the U.S. from achieving a health IT infrastructure that supports interoperability and a successful move to value-based payment models.

That's the stance of a health policy brief from the Engelberg Center for Health Care Reform, “High Value Health IT: Policy Reforms for Better Care and Lower Costs." Peter Basch, MD, visiting scholar; Mark McClellan, MD, PhD, senior fellow; and co-authors argue that sweeping reforms will help build a stronger and more flexible national health IT infrastructure. This includes reengaging providers through financial incentives beyond MU, redesigning health IT systems with more user-friendly interfaces and data structure that are flexible across clinical areas, enabling the capture of real-time data that goes beyond regulatory standards, and instead, prioritizes key cost and quality measures.

Among the current challenges, MU and EHR certification programs have simplified requirements and process measures to a point that does not support the disparate needs of the various clinical practice area (e.g., the needs of primary care physicians, versus cardiologists, versus dermatologists). “The ‘informationalist’ clinician may feel the EHR is too underpowered for their patient management needs; whereas a proceduralist might feel the EHR is too cluttered,” they wrote. Also, many providers express dissatisfaction with current MU-certified products that they often describe the measures as “prescriptive and process-driven.” In turn, health professionals should call for systems that promote “user-centered design,” the authors wrote.

Current MU certification requirements do not include access to timely, accurate and actionable information on cost and health plan coverage of tests and treatments. Further, even where information is captured in the EHR and exportable using existing interoperability standards, health plans, insurance companies and employers typically do not accept information in these standard formats, and often require duplicative documentation.

To overcome these barriers, the authors offer nine ways to build a high value health system including removing the current requirement connecting EHR functionality to MU process measures, tie MU penalty avoidance and bonuses to reporting on relevant, outcome-oriented peformance measures, focus on identifying and disseminating interoperability standards that enable high-value care and increasing efforts to support standards and methods to enable reporting of outcome and value measures directly from EHRs.

Read the complete data brief.