By William L. Rich III, iHealthBeat
Knowledge is power, and there’s a treasure trove of incredibly powerful information that can be unlocked by sharing data from electronic health records.
Some physicians are able to share their data to help improve care coordination, efficiency and care for their patients. By doing this with EHR-based clinical data registries, these physicians are helping to advance medicine at an unprecedented pace. But other physicians have to pay exorbitant fees to their EHR vendors to integrate with registries for data sharing. In some cases, physicians are entirely prohibited from participating in a registry simply because their EHR vendors won’t allow it.
On July 23, the Senate Committee on Health, Education, Labor and Pensions held a hearing to shed light on data blocking and to find potential solutions to this problem. This is the latest in a number of recent government efforts to end a practice that has frustrated health care providers to no end.
Earlier this month, the House passed the 21st Century Cures Act (HR 6) with a provision (Title III Subtitle A) that would require that EHRs be interoperable by Jan. 1, 2018. And, last week, Sen. Bill Cassidy (R-La.), who serves on the Senate HELP Committee, indicated that he intends to follow the House’s lead and introduce similar legislative language on interoperability and data blocking by vendors when the Senate considers its version of the 21st Century Cures Act this fall.
While these discussions and legislative actions are steps in the right direction, what will they lead to and when? And for those experiencing data blocking, what are they losing out on while we wait for a solution?
EHR Integration Achieved Through Clinical Data Registries
Thanks to EHRs and the power of big data analytics, we now can use EHR-based clinical data registries to more quickly learn about how effectively health care providers are caring for patients and implement any necessary improvements. We can also more readily follow the long-term results of procedures, drugs and devices and assess how they improve patients’ quality of life.
Providers can use EHR-based registries to look at diseases and treatments not just for their own practice’s patients, but for large populations in real time. For the patient, this means that his or her doctor can base care decisions on the most recent clinical data available, pooled from the experiences of thousands of physicians and millions of patients around the country.
The American Academy of Ophthalmology launched its clinical data registry in 2014. The IRIS® Registry is one of the most innovative advances in ophthalmology and holds great potential for improving the quality of eye care and patient outcomes.
As an EHR-based registry, data can be received from EHRs using nationally recognized electronic data transfer standards, including CDA, CCDA, CCD, CCR, QRDA 1, etc. In addition, using a systems integrator, the IRIS Registry can also directly integrate with a practice’s EHR to automatically extract data with file exchange.
The American College of Cardiology launched its EHR-based PINNACLE Registry in 2009. The PINNACLE Registry is helping physicians more consistently provide guideline-based care for managing hypertension, coronary artery disease and heart failure, as well as for stroke prevention in atrial fibrillation patients.
Both registries use the same registry platform vendor to automatically populate EHR data, calculate measures and deliver rapid performance feedback to physicians, with no data entry required or workflow disruptions. In the 15 months since launching, IRIS® Registry is measuring quality and calculating measures from 12 million patients and 41 million patient encounters. Many other medical societies are now investing in similar registries.
Registries Streamline Government Reporting
One additional important benefit of EHR-based registries is streamlining participation in federal quality reporting programs. This has been a strong draw for physicians and has attracted the attention and support of the government.
In its recent strategic vision for physician quality reporting, CMS acknowledged that registries, such as the Academy’s, will become even more necessary in the future for physician offices seeking to comply with quality reporting regulations.
In addition, the Medicare Access and CHIP Reauthorization Act of 2015 mandated that the secretary of HHS use clinical data registries in the new merit system to relieve doctors of the reporting burdens required under the current quality measurement programs. Preceding this, in 2014, CMS introduced the qualified clinical data registry (QCDR) reporting mechanism for PQRS. The QCDR reporting option allows QCDRs to design, implement and report on non-PQRS quality measures that are more valuable to specialty practices and their specific patient populations. Both the IRIS and PINNACLE registries are QCDRs.
Data Blocking: Not a Technology Problem
Despite growth in EHR-based specialty registries, and increased support of their use by Congress and the Obama administration, certain EHR vendors continue to hinder physician participation.
The IRIS and PINNACLE registries have successfully integrated with 62 EHR vendors, but others are unwilling to join the pack. As it stands, both registries have been prevented from integrating with Epic EHR systems, and the IRIS Registry has yet to receive one record from Cerner EHRs. So what’s stopping them?
Clearly technology isn’t the root of this interoperability problem, and we’re glad that the Office of the National Coordinator for Health IT recognized in its information blocking report released earlier this year that EHR vendors’ commercial interests play a significant role.
The Academy would like to see ONC require, as a condition of certification, that EHR systems be able to exchange data with registries like the IRIS Registry. We hope that others passionate about the power of IT to innovate and improve care will show their support for this position and for interoperability legislation like that included in the Cures Act.
Individuals fed up with data blocking can also email the government about their experiences. CMS recently announced that it is collecting stories from patients, doctors and others on the receiving end of EHR health care data blocking. Send data blocking stories to noinformationblocking@cms.hhs.gov.
It’s crucial that your voices be heard so that all physicians and patients can fully benefit from EHRs and clinical registries and unlock more advances in medicine.