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How lack of interoperability affects value-based care

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Healthcare providers transitioning to value-based care face many challenges. The shift from the traditional fee-for-service emphasis on quantity of patient visits to the value-based reimbursement model requires extensive reporting and compliance with Centers for Medicare & Medicaid Services (CMS) regulations. Administrative burdens can hamper the delivery of value-based care for independent physicians. Another challenge is the practical application of electronic health record (EHR) interoperability for coordinated care.

The independent physician’s ability to collaborate with other healthcare providers, particularly to care for patients with chronic or complex conditions, is a critical factor in value-based care delivery. The challenges in EHR interoperability for coordinated care can impede the physician’s ability to share patient data and to electronically receive data from other physicians that could be crucial for the proper care of that patient.

Nishant Anand, MD, Chief Medical Officer for Population Health Services, Chief Transformation Officer for Adventist Health System and Chairman of the Adventist Health System ACO, recently provided written testimony at a House subcommittee hearing on Examining Barriers to Expanding Innovative, Value-Based Care in Medicare. In regard to interoperability, Dr. Anand stated that “As patients navigate throughout the continuum of care—through physician offices, hospitals, same-day surgery centers, or community clinics—their records should be easily transferrable between all organizations.

To provide true value-based care, physicians must be able to communicate with each other and with patients seamlessly and in real-time. Physicians who take advantage of EHR interoperability for coordinated care are able to receive and view test results, specialty physician visit notes, and other vital information related to the care of the patient electronically. Without interoperability, the patient must bring records to each physician visit or the primary care physician must request records from specialty providers. Either of those options could be time-consuming and result in lower quality care.

Dr. Anand adds that “One of the greatest challenges to achieve this level of interoperability is the lack of a single patient identifier that can move from system to system and ensure records can be passed between disparate entities without fail.” Without EHR interoperability, the patient and the independent physician face an “experience that is difficult and cumbersome, tests and treatments that are duplicated, and vital lifesaving information that is not always available.”