In 2008, the National Quality Forum (NQF) released a seminal report identifying areas for improvement in the US healthcare system including population health, coordination of care, improved safety, increased efficiency, reduction of racial disparities, patient engagement, and, later, privacy and security. These ideas were subsequently embodied in a framework called “meaningful use” and accorded financial incentives under the HIPAA and HITECH acts to the tune of thirty billion USD.

The meaningful use program has fallen into some disrepute due to onerous accounting requirements. Recognizing the legitimacy of these concerns, the Centers for Medicare and Medicaid Services revised guidelines for 2015 to reduce reporting burdens and better align the long term goals with practice.

In February the Health IT Policy Committee reported that only about three percent of the 4,993 hospitals in the US have not registered or participated in the program.

So, why are we having so many problems with interoperability?

It certainly was intended to be this way. One of the key goals of meaningful use was coordination of care, an area fundamentally based on interoperability. Specific requirements were set for percentages of types of clinical documents to be exchanged using standards between heterogeneous systems. The intended outcome of this was that EMR’s would be able to prove document exchange out, and then show use in practice.

Today a lot of documents are exchanged electronically, and while the overall percentage that are still faxed is unknown, the MU-2 target was 10% so we know for sure that it’s at least 90%.

Surely it’s cheaper to send documents over the internet than to send them via fax, particularly when 97% of hospitals have already registered or participated in MU-2? How is it possible that fax transfers even exist in this brave new world?

What I’ve discovered in our service center is that ringing a hospital health information department and asking for records via an electronic transfer is not always fruitful. Worse, still one hospital commented that they paid their vendor by the message, and fax was cheaper.

One hospital does not make a trend, but the response got me thinking about another way to move interoperability along. I’d like to see CMS change reimbursement to pay a small percentage of a specialist visit to support electronic transfer of that data to the referring provider. Fax data would not receive these dollars.

Since medicare and medicaid represent a significant percentage of healthcare in the US I bet this would change behaviour really fast!

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