Guest Commentary | Michael Joseph Mirro, MD, FACC

It’s been a roller coaster year for health information technology (IT) policy. From congressional hearings to the release of numerous rules, several recent developments are sure to shape the future of health IT.

Last week, the Centers for Medicare and Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) released two final rules that align all three stages of Meaningful Use. The joint rule release was a twist in events given that the House of Medicine, including the ACC, has been pushing the agencies to delay Meaningful Use Stage 3 and the finalizing of 2015 Electronic Health Record (EHR) Certification criteria due to concerns that implementation is moving too quickly. However, CMS and ONC decided to finalize program requirements for the 2015-2017 reporting periods and combine Meaningful Use into one single stage. According to the agencies, the alignment aims “to advance electronic health records with added simplicity and flexibility.” The current enterprise health IT systems suffer from lack of fluid clinical usability and interoperability because the systems are designed to primarily focus on administrative data capture. This supports charge capture but also requires clinician documentation to support Meaningful Use compliance. The current final rule may help to some degree yet much work needs to occur to support the evolution of the systems so that clinicians can focus on the patient interaction and not clerical work during routine visits.

“We cannot establish a long-term health care program that does not take into account what we can feasibly attain in the short-term, transitional period,” said ACC President Kim Allan Williams Sr., MD, FACC, in response to the rules. Given that many of the Stage 2 requirements have been unattainable for providers, it is alarming that CMS and ONC decided not to pause the program to figure out a successful path forward. Additionally, it is unclear how Meaningful Use will align with the new Merit-Based Incentive Payment System, which is slated to start in 2017. We will hopefully know more in the coming weeks and months and the ACC will be weighing in during the 60-day comment period.

It’s not just the federal agencies who have been focused on health IT this year. Senate Committee on Health, Education, Labor and Pensions (HELP) Chairman Lamar Alexander (R-TN), and Ranking Member Patty Murray (D-WA) have been working to accomplish five items related to interoperability of EHRs by the end of 2015—whether through legislative means or an administrative fix. As part of this effort, the HELP Committee held a hearing in July on health information blocking where I testified about unforeseen problems that have been created by EHRs and possible solutions to help improve care.

To help guide collaboration amongst stakeholders who build and use health IT products, ONC released a Shared Nationwide Interoperability Roadmap as part of National Health IT Week. According to ONC, “The collaborative efforts of stakeholders is crucial to achieving the vision of a learning health system where individuals are at the center of their care; providers have a seamless ability to securely access and use health information from different sources; an individual’s health information is not limited to what is stored in EHRs, but includes information from many different sources and portrays a longitudinal picture of their health, not just episodes of care; and where public health agencies and researchers can rapidly learn, develop, and deliver cutting edge treatments.”

Moving forward, ACC Advocacy will continue to leverage policy opportunities to advance the interoperability of health IT; actively engage in shaping the Meaningful Use program towards improving and advancing cardiovascular care quality and outcomes; establish and advance telemedicine principles allowing the cardiovascular care team to champion innovative services without sacrificing quality and safety; and shape and promote streamlined health IT certification, including leading discussions to adopt federal cardiovascular data vocabularies and standards.

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Michael Joseph Mirro, MD, FACC, a member of the ACC’s Informatics and Health Information Technology Task Force, CQC FOCUS Committee, and NCDR Value Work Group. Dr. Mirro is a cardiologist affiliated with Parkview Hospital in Fort Wayne, IN. See more at: blog.acc.org

Keywords: CardioSource WorldNews, Centers for Medicare and Medicaid Services, U.S., Certification, Electronic Health Records, Health Information Systems, Medicaid, Medicare

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