1. Cook, Gena

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Oncology's transformation to value-based care is happening fast. Just this year we have seen the introduction of the Oncology Care Model from the Center for Medicare and Medicaid Innovation, and the bipartisan Cancer Care Payment Reform Act of 2015 (H.R. 1934). We've also learned about the success of small-scale patient navigation pilots such as the University of Alabama's Patient Care Connect Program.

GENA COOK. GENA COOK... - Click to enlarge in new windowGENA COOK. GENA COOK is CEO of Navigating Cancer (

With this transformation comes a myriad of new quality measures for cancer programs to capture and report. The ability to do this in a scalable fashion will rely on the right technology solutions.


Thanks to the HITECH Act, nearly all oncology practices today use EHRs of one sort or another. But HITECH failed to mandate that EHRs interoperate with other technology solutions. About a dozen dominant EHR products exist today and many don't talk to each other well (or at all).


For patients, transferring records between adjacent health care facilities still requires getting hundreds of pages printed, transported, and then scanned, even when both facilities are using the same electronic health record system.


For providers, suboptimal software from their EHR vendor is often the only option, meaning no freedom to choose best-of-breed technology. Even when providers spend time duplicating entries into separate systems, they often can not readily access this information when they need it because it has been blocked from flowing back into their EHR.


Thus, more than $30B of federal money in EHR meaningful use incentive payments intended to foster an interconnected web of better health care resulted in the creation of information silos, and a limited experience for patients and providers alike.


To realize the health care transformation to value that will lead to better outcomes, less hospitalizations, and greater patient satisfaction at economically sustainable costs, physician practices and hospitals need more than just the digitization of their clinic workflow. They need visibility into nationwide population health management benchmarks and tools for better patient engagement; they need technologies that can interoperate. Unfortunately, top EHR vendors have thwarted interoperability and government regulations have not required it to date.


But last month, the critical need for interoperable Health IT reached the national limelight from multiple channels. CMS introduced final stage 3 meaningful use rules, which lay out penalties for non-interoperable Health IT beginning January 1, 2018. The Senate introduced a new bipartisan bill designed to strengthen accountability for technology vendors around Health IT interoperability.


10-Year Interoperability Roadmap

The Office of the National Coordinator for Health Information Technology (ONC) shared their 10-year interoperability roadmap, which lays out how we can move towards interoperability by the end of 2017. And in a rare twist, the leaders of dominant EHR vendor companies announced a collective commitment to "go arm in arm to work closely with Washington to help alleviate the interoperability-measurement burden faced by the government."


While this is all good news, the reality is that a well-defined measurement of interoperability will not move the needle if EHR vendors aren't willing to share information. As described in the Report to Congress on Health Information Blocking from earlier this year, economic and market conditions have resulted in business incentives for some entities to exercise control over electronic health information in ways that unreasonably limit its availability and use. And as ASCO recently announced, reports of information blocking are increasing.


As a patient care and engagement solution for cancer programs that readily integrates with any other EHR vendor, we at Navigating Cancer have experienced interoperability blocking firsthand. Even after health care providers have chosen to sign contracts with us, EHR vendors have either announced that they have no plans to interoperate with our application or stalled in making any real progress toward interoperability.


Responding to the government's announcements around interoperability, Robert Wergin, MD, the board chair of the American Academy of Family Physicians, recently said: "Our members and the AAFP are very concerned with the very slow progress toward achieving truly interoperable systems. Furthermore, we strongly believe there is need for increased accountability on industry and decreased accountability on those who are using their inadequate products. We need more than a roadmap; we need action."


Will health IT interoperability happen in stride with our transformation to value-based payment models, or will that become the bottleneck?


In 2011, no Medicare payments were made through alternative payment models; by 2014, approximately 20 percent of payments were made this way. In January of this year, Health and Human Services Secretary Sylvia M. Burwell set goals for 30 percent of traditional Medicare payments to be tied to value-based payment models by the end of 2016, and for 50 percent by the end of 2018.


Explicit Goal

HHS also set the explicit goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018. And implementation of the Medicare Access and CHIP Reauthorization Act of 2015, signed into law in April of this year, poses a major opportunity to transform health care delivery to value through the new Merit-Based Incentive Payment System. Within the next few years, many practices across the nation will embark on the transition to value.


With interoperable EHRs, we will not only save patients and providers the time and energy required to print and scan documents and input duplicate entries; we will finally be able to use the wealth of data now amassing to learn about medical practice at the national scale, improve outcomes, realize risk-stratified care delivery, and meet the requirements of the alternative payment models that are taking hold.


Health IT needs mandatory and explicit standardization for the mechanism by which software programs can talk to one another, called application program interfaces (APIs). We encourage all stakeholders to add your voice to the call for explicit interoperability requirements now.


To read more about Navigating Cancer's vision for better cancer care through interoperable health IT, see our recent executive report at