ONC Chief Talks MACRA, Meaningful Use

Under MACRA, improvements to meaningful use will continue, as will opportunities for information exchange, predicts the National Coordinator for Health Information Technology.

October 14—the day the MACRA final rule was released—found Vindell Washington, MD, head of the HHS Office of the National Coordinator, in San Francisco briefing the Association of Health Care Journalists.

In between other national briefings, I had 20 minutes to interview Washington one-on-one about the impact of the final rule and the road ahead for healthcare and healthcare IT. This transcript below has been lightly edited.

HLM: What do you say to hospital executives in particular now? They weren't so much addressed by MACRA, but they still face rule upon rule still with meaningful use. Is this going to continue to work for hospitals?

Washington: The meaningful use program I think has been very successful in the adoption space for hospitals.

I had an opportunity look at some of this data a couple of months ago, and if you look at where we were versus where we are now in terms of adoption and deployment, it's just not even close: 96% or 98% of [hospitals] are using electronic health records.

As a former hospital executive, I know that much of that came from the regulation to do this work. To imply otherwise, it doesn't ring true to me.

HLM: Many hospital executives want to declare victory on meaningful use and go home.

Washington: Yes, but the question is what's next. There are opportunities for [health systems] to exchange information better.

There is still more work to be done and as I look at what's happened with MACRA and the physician place and space, there are two things that come to mind.

The first thing is the physician environment is not the same as the hospital environment. If you were to line up the 5,000 hospitals and take out the critical access hospitals, [the remaining facilities] are much more alike than… a pathologist's office versus a family practitioner's office.

Moving to the next phase, there is an opportunity for greater flexibility pieces.

On the hospital side, there are certainly opportunities as we move forward and as the program matures. We're continually making changes to both the framework and the structure, and I presume that those improvements to that program will continue. It's not a static thing.

HLM: Is the technology providers now possess adequate to fulfill the MACRA objectives? Many physicians I talk to feel that the technologies in front of them, the certified EHR technologies, are more geared toward the last war—how do we get paid—and not so much geared toward what MACRA is trying to achieve.

Washington: I think of it more as an arc as opposed to sort of a point in time. We certainly need continued improvements in technology, but that's not different in healthcare than in other areas. The central point of it is that technology is critical for these activities and for this community-centered and population-centered care.

HLM: Prior to HIMSS last March, vendors and providers signed the ONC interoperability pledge. Now it's almost November. Has that pledge yielded results?

Washington: We have a very high percentage of folks now who say that information is being exchanged. Our survey results said that 8 in 10 folks are underscoring enhanced exchange of information.

We had a site visit to San Diego, and a site visit to Tulsa, Oklahoma, where there were competing vendors that had made that pledge. They now have more and more flow of information. Hillcrest and St. John's, I think, were two that we looked at out there. So there are incremental improvements.

We are also engaged in stakeholder listening sessions with some of those pledgees about interoperable medication list exchanges, [and] about moving information using FHIR and APIs, and are now using that information to work on this nationwide effort.