A National Measurement Roadmap for Nationwide Interoperability

The National Quality Forum today released a comprehensive framework to measure and assess the nation’s progress toward interoperable electronic health information exchange. This landmark work by NQF and its Interoperability Committee provides critical support to national efforts to improve interoperability and advance the Triple Aim for better health, better care and better value.

Recognizing the national imperatives, the 21st Century Cures Act directed that interoperability and patient access are immediate national priorities and set six-month, one-year, and longer-term requirements to move those priorities forward now. Congress defined “interoperability” to embrace both the electronic exchange and the usability of exchanged electronic health information for all users—the “complete access, exchange, and use of all electronically accessible health information.”

Likewise, the Medicare Access and CHIP Reauthorization Act (MACRA) launched the biggest change in Medicare reimbursement and delivery system reform in decades, moving from fee-for-volume toward value-based purchasing. Not surprisingly, MACRA identified widespread interoperability as a national priority for delivery system reform.

NQF’s report provides the first national framework for measuring the quality, gaps and impact of interoperability across key settings and users of health care. It covers the availability and exchange of electronic health information across the continuum of care, the usability of that exchanged information,
its applicability and effectiveness, and—the holy grail—the impact of interoperability on outcomes such as care coordination, patient engagement, health outcomes and cost savings.

The framework covers interoperability across the continuum of care, not just EHR-to-EHR exchange—because real-world care delivery extends well beyond the reach of electronic health records. For example, the framework includes measure concepts for nonclinical settings, such as housing, community health centers, schools, social services and jails, as well as clinical settings. It includes measure concepts for patient-generated health data and social and environmental determinants of health—which may be critical for shared care planning with patients and family caregivers, and understanding and serving diverse populations with complex needs—alongside measure concepts for the range of clinical data.

One key strategy for interoperability and usability is patient (and provider) access to electronic health records with applications of the individual’s choice through open application programming interfaces (APIs), much as smartphone-based applications have spurred innovation and transformed access and usability across so many areas of modern life. NQF’s framework has an app for that, too—a measure concept on access through APIs.

This framework gives important guidance to measure developers on key concepts where measures are needed to identify the extent or lack of interoperability so that we can make interoperability a reality across the continuum of care. This means providers and patients have access to the patient’s health data and summary of care records, and providers, like patients, finally have access to patient-generated health data and social and environmental determinants of health that are critical to understanding the patient’s health status. With this framework, we can measure whether providers and patients can access and use the relevant data, in the right format and workflow, that they need to evaluate the relative value of care and services and determine next steps, as MACRA envisions.

In short, NQF’s report presents a national measurement roadmap for nationwide interoperability—a critical contribution to our immediate national priorities.

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Mark Savage was a co-chair of NQF’s Interoperability Committee. The National Quality Forum is a private, independent, nonprofit organization committed to healthcare quality measurement and improvement.

About UCSF’s Center for Digital Health Innovation:

In 2013, the University of California, San Francisco founded its Center for Digital Health Innovation (CDHI), which partners with technology companies to solve real-world health problems and speed the implementation of innovation into everyday health care. CDHI is renowned for its thought leadership in digital health. For example, CDHI and Cisco are working together to build technology platforms and ecosystems that power digital health innovations and connect clinical data with dispersed patient-consumer data and synthesize them with powerful analytics to revolutionize health care nationwide. This service, called Health Stack, will consist of a digital health application marketplace, API services, and secure, cloud-hosted data interoperability across EHRs, devices, and apps. Health Stack will create and enable an ecosystem of innovative health apps that improve workflows, care quality, and patient engagement by creating true health data interoperability. Similarly, CDHI is partnering with Intel and GE to build algorithms and data models for enhanced clinical decision support behind the scenes and at the point of care.

UCSF’s Center for Digital Health Innovation recently submitted comments to the Office of the National Coordinator for Health Information Technology on important core use cases and cross-cutting themes for the nationwide interoperability and trusted exchange framework that ONC is developing to implement provisions of the 21st Century Cures Act.

Mark Savage
Director, Health Policy
Center for Digital Health Innovation
University of California, San Francisco

BlogBryan Mazzarello