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Utilizing Value-Based Reimbursement to Promote EHR Interoperability
By Craig Schmidt

The US health care landscape is on the precipice of some major changes. Fueled by policies implemented by the federal government and supported by the health care community, the elemental way we pay for health care services is transitioning from the defunct fee-for-service model to a more contemporary standard, where monetary reimbursement is based on demonstrated value.

Over the past two decades, the traditional Medicare payment policy has become an outmoded and archaic model, hindering the medical profession for years by limiting expenditures on physician services. The original algorithm was altered to offset budgetary anomalies, and inevitably became unsalvageable. This culminated with the Medicare Sustainable Growth Rate payment formula being repealed on April 14, 2015. This ushered in a value-based reimbursement schedule, where providers can see bonuses for adopting technologies and techniques that focus on adding value and quality to the continuum of care.

One of the fundamental steps providers can take to show that they are providing a valued service is to show that they are meaningful use compliant by adopting an appropriate EHR platform. Unfortunately, most EHRs have yet to fulfill their obligation of making it easier for doctors to transfer medical records to colleagues outside of their own network. This has led to a void in the market for an EHR platform that will genuinely help providers add more value to the care they give.

Most EHR platforms were developed under the old fee-for-service climate. This has severely limited the potential functionality where providers used EHRs as more of an internal streamlining process. Now, with the focus being on value added services, providers are looking to EHR platforms for their actual intended use: collaboration. This means that EHR platforms must be developed with the latest federal regulations and HIT standards in mind to promote interoperability.

In March 2015, the Office of the National Coordinator for Health Information Technology proposed a new 2015 Edition Health IT Certification Criteria rule that aligns with the data exchange goals put forth in its Nationwide Interoperability Roadmap. The proposed rule includes new and updated IT functionality and provisions that support care improvement, cost reduction, and patient safety across the health system.

To ensure platforms remain compliant, it is important for health care industry software providers to look for partners that have HIT expertise that includes knowledge of, and experience with, federal regulations such as the new ruling, along with ARRA, meaningful use, the Accountable Care Act, etc. These partners must also be proficient with HIT standards, including the Physician Quality Reporting System, Health Level 7 (HL7), Electronic Data Interchange, and Continuity of Care. And it's also essential that a software partner understands the provider's workflows, both clinical (look for a vendor with clinical practitioners, ie, MD, RN in the C-suite) and financial.

Furthermore, Fast Healthcare Interoperability Resources (FHIR) is a common-ground strategy for electronic health information exchange. With the industry digitizing records and patients moving fluidly throughout the health care system, it is obligatory for a common structure of data. HL7 has been addressing these challenges for years but over time technology trends have changed and new standards have emerged. FHIR targets these new trends and leverages them without complicating the integrity of the HL7 models.

All of the aforementioned standards are imperative to take into account when developing an EHR platform. But what about standards that should be implemented into existing EHR technology—standards that ensure better harmonization between systems, stronger security, and increased accessibility?

Interoperability is seen as the ultimate goal, but proprietary software systems are built in a way that impedes communication between the numerous platforms available. This is what ultimately creates the interoperability chasm. To improve on a system that seems as if it was built to fail, offering open Application Programming Interfaces (API) for each proprietary EHR platform may close the gap.

APIs are a set of programming languages and coding standards for software-to-software integrations. They allow developers to use established protocols for an applications feature base to communicate with another application. Ultimately, an API is a list of commands that the application or program sends to another to get a desired outcome. These protocols and routines will give developers the assets necessary to develop fully functional, interoperable EHRs.

These APIs will be necessary to help legacy EHR systems be interoperable, strengthening the overall infrastructure. Having an open API system in place will broaden the range of health information exchange.

Overcoming the hurdle of full interoperability can give way to amazing advancements in the health care system. Hopefully, in the near future, the industry can shift the focus to other areas that will bring value to the continuum of care that piggybacks on the EHR network.

— Craig Schmidt is the director of sales for health care at Chetu.