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DirectTrust to ONC: Broaden interoperability measurements


HIT coalition says the medical field must measure all forms of information sharing today so it can accurately assess interoperability successes moving forward.

As the healthcare industry continues its drive toward interoperability, one health IT-focused organization wants to get a better handle on how clinicians currently share information.

“Let’s start with asking what’s happening now. What’s the amount of information being handled by fax and mail,” said David Kibbe, MD, MBA, founding president and CEO of DirectTrust, a nonprofit association of 145 health IT and healthcare provider organizations working to support secure, interoperable health information exchange.

Kibbe told Medical Economics healthcare providers still exchange much information in traditional, non-electronic formats (including via millions of faxes daily). And while he said data from his organization, healthcare institutions, vendors and others show that clinicians are sharing increasing amounts of information electronically, it’s unclear whether those electronic exchanges are replacing or just supplementing those paper-based modes of sharing.

DirectTrust expressed its viewpoint in a June letter to the Office of the National Coordinator of Health Information Technology (ONC), which in April requested feedback about the specific metrics it should use to measure the healthcare industry’s progress on interoperability

 DirectTrust further stated in that letter that “[r]eliance upon fax and mail is a source of inertia within many health care organizations and one of the primary reasons adoption of electronic exchange methods is occurring at a slower than desired pace.”

ONC in early July announced the two metrics it will use to measure interoperability, a task it was charged with undertaking as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

ONC listed its first metric as the “proportion of healthcare providers who are electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding (querying); and integrating information received from outside sources.” Its second metric is the “proportion of healthcare providers who report using the information they electronically receive from outside providers and sources for clinical decision-making.”


When asked by Medical Economics to comment on DirectTrust’s letter, an ONC spokesman said officials were not addressing additional questions on the topic and pointed to a July 5 ONC online post. In it, ONC said the organization received nearly 100 comments from health and health IT organizations and businesses, with many conveying concerns that additional reporting requirements could burden healthcare providers. Many also spoke about the need to broaden the scope of measurements to include individuals and providers not eligible for the Medicare and Medicaid EHR Incentive Programs; to examine the usage and usefulness of the information that is exchanged as well as the impact of exchange on health outcomes; and to recognize the complexity of measuring interoperability.

Although ONC’s plans for measuring interoperability do not seem to include DirectTrust’s recommendations, Kibbe said he still sees value in having brought the idea to the attention of ONC and the broader medical community.

“We want ONC to do a good job of measuring interoperability and set some benchmarks,” he said, “so we can compare in several years whether we’re really doing a better job.”


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