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Interoperability Plan Underwhelms, Mostashari Resigns: Now What?

Scott Mace, for HealthLeaders Media, August 13, 2013

In seven weeks, providers are supposed to be implementing stage 2 of Meaningful Use. The government's interoperability plans are lacking. And a key Washington player says he's leaving the scene. It's starting to look like a calamity.

As if the turbulence of July 2013 on healthcare IT wasn't bad enough, last week things got arguably worse.

First, Farzad Mostashari, director of the Office of the National Coordinator (ONC) for Health IT at the Department of Health and Human Services, announced he is resigning, staying on just long enough for a replacement to be found.

Then, one of ONC's major projects of 2013, a strategy by CMS and ONC to promote interoperability in an industry that desperately needs it, made its underwhelming debut, overshadowed as it was by Mostashari's resignation, which hit during the same 24-hour news cycle.

How underwhelming was the ONC/CMS plan, itself a response to comments on an earlier request for information? Highlights of the initiative related to health information exchange tell the story:

  • Accelerating Interoperability and Electronic HIE through Payment Models Require electronic HIE in all advanced payment models and Medicaid waivers
  • Extend Center for Medicare & Medicaid Innovation (CMMI) efforts
  • Include Long-term care and post-acute care (LTPAC) and Behavioral Health (BH) in State Innovation Models (SIM) grants
  • Direct incentives for LTPAC and BH providers
  • Explore additional reimbursement codes for care coordination via telehealth, e-visits, radiology queries, and Evaluation & Management
  • Require electronic HIE standards as regulatory requirements for quality measurement and conditions of participation
  • Extend Regional Extension Center (REC) support
  • Extend Stark and Anti-kickback exceptions for donations of EHR software
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3 comments on "Interoperability Plan Underwhelms, Mostashari Resigns: Now What?"


FLPoggio (8/14/2013 at 11:25 AM)
Underwhelming and a clamity? You bet!. And consider this, here we are almost twelve months from when the first drafts of the 2014 Edition Certification testing (previously known as Stage 2) was issued and all we see are six vendors with fully certified EHRs. Meanwhile all inpatient Stage 1 certifications will terminate as of 9/30/13. As of today major players like Siemens, GE, and Cerner are NOT certified for a full EHR. On the smaller end of the market we are missing; Healthland, QuadraMed and NTT Data (Keane). As I have said on this blog before, the process and details under 2014 are far more difficult than ONC would admit, and as noted earlier the test scripts are still changing. In fact while working through some test data with several of my clients this week we came across three situations where the test data was in error. When we brought this to the attention of the test labs they simply said, "We'll notify ONC, but for now just ignore it".

Michael Matthews (8/14/2013 at 10:03 AM)
While this article speaks to many of the remaining challenges to interoperability, there is a glaring omission of the progress and growth of eHealth Exchange (formerly known as Nationwide Helath Information Network Exchange). In just the past 12 months, eHEX has grown to over 40 participants; has over 100 more in the onboarding queue; has redesigned the testing and onboarding process to become more scalable and efficient; and has engaged HealtheWay to support operations and testing. In addition to private sector engagement, eHEX provides critical access to Federal agencies such as the VA, DoD and SSA. The road ahead will certainly require continued dedication, vision and hard work, but let's pause for a moment to recognize how far we've come and the roadmap that exists for the future. Michael Matthews, Chair HealtheWay Board Immediate Past Chair of eHEX Coordinating Committee

Bobby Gladd (8/13/2013 at 7:21 PM)
"Extend Regional Extension Center (REC) support" How? With NO funding? The RECs are effectively done. I know they recently touted that, but it's an utterly empty proposal, a PR platitude. One presentation topic at the last ONC Annual Conference in DC was "The Grant Closure Process" for RECs.