ONC must take 'multi-pronged approach' to measuring interoperability, AMIA says

The American Medical Informatics Association says measuring interoperability will require a "multi-pronged approach" from the Office of the National Coordinator for Health IT in a letter to agency head Karen DeSalvo.

The letter is in response to a request for information from ONC on how it can meet a requirement in the Medicare Access and CHIP Reauthorization Act of 2015 that aims to achieve interoperability by the end of 2018.

ONC's measurement strategy, according to AMIA, must be patient-centric and must be open to adjustments over time.

"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," AMIA says in the letter.

AMIA adds that its approach seeks to understand where interoperability is necessary and investigate whether it is occurring.

In its info request, ONC asked for response to a slew of questions on this matter. Some of AMIA's recommendations in response to those questions include:

  • Should the focus of measurement be limited to "meaningful EHR users" and their exchange partners? In the near term, AMIA says ONC should do so, but also must create plans that expand the scope to include "other cohorts identified in the Interoperability Roadmap."
  • How should eligible professionals under the Merit-Based Incentive Payment System and eligible professionals who participate in the alternative payment models be addressed? AMIA says eligible clinicians (ECs) participating in the payment system "should be treated as 'meaningful EHR users' for the purposes of measurement scope." In addition, qualified professionals should be treated similarly to ECs.
  • Should the focus of measurement be limited to use of certified EHR technology? Yes, ONC should initially focus on certified EHR technology, AMIA says. But the authors add that certification of tech is not as important as making sure the data is available and used for the right purpose.
  • If ONC seeks to limit the number of measures selected, which are the highest priority measures to include? Measures that capture interoperability across providers should be the biggest focus, according to AMIA. "While interoperability within organizations is important, exchange across organizations is the larger policy concern," the authors note.

"We urge ONC to work closely with organizations such as AMIA that can convene clinicians and technology developers to identify expected data sharing patterns and measurement instruments that indicate to what degree we have achieved nationwide interoperability, while avoiding the pitfalls of past approaches," the association says. 

To learn more:
- here's the letter (.pdf)