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INNOVATIONS IN
MEDICAL PRACTICE

providers to Health Information Exchanges has and exceed the measurement goals) and losers (those that don’t). Fur-
not been defunded, maintaining hope that during ther expectations are that small independent practitioners will have
the 2017 year, financial assistance for Texas physi- a greater challenge to meet these reporting requirements.
cians in deferring interface costs may be available.
Since 2011, HIEs have developed regionally with the intent to
Exchanging patient information in a clinical set- support clinical patient information exchange in that region. Cur-
ting is not new. Historically, much of that sharing rently, seven HIEs are operating in Texas in specific regions. While
was done via fax, telephone calls, through hard not covering the entire state, these initiatives have attained a crit-
coded records or giving records to patients to take ical mass in several communities. As an example, HASA, a com-
to a referring physician. The electronic version of munity nonprofit HIE, started developing data exchange in South
data sharing consists of a combination of elec- Texas and has expanded this support into the North Texas region.
tronic medical record (EMR) and a health infor- With a core function to aggregate patient information in real time
mation exchange (HIE). This concept was from multiple organizations and provide a single longitudinal pa-
promoted federally in 2010 in a three-stage multi- tient record to practicing physicians, HASA has since broadened
year approach called Meaningful Use, with incen- its support to the community.
tives for physicians and hospitals to engage. The
first step, converting physician practices from Recognizing the uniqueness of its data for a community, HASA
paper to electronic records, has been painful, but uses its analytics capabilities to provide critical reports to many or-
has advanced to a level where virtually every hos- ganizations: discharge and ED visit alert reports for payers, read-
pital currently uses electronic data capturing and, missions and readmissions forecasting reports for hospitals and
according to a study done by the Office of the Na- clinics, and quality and MIPS reports for physicians, to name a few.
tional Coordinator for Health Information Tech- HASA is the first HIE in Texas to apply for Qualified Registry sta-
nology (ONC), as of 2015, 79 percent of physicians in Texas tus with CMS so that it can assist MIPS participants in submitting
reportedly use EMRs1. Contrast that, however, with a mere 15 per- their reports.
cent taking advantage of their EMR to exchange patient information
to other providers. The latter has been a critical element of stages 2 With a state-level technology layer to connect the multiple HIEs
and 3 of Meaningful Use. to each other, collectively HIEs are a source for care continuity during
disasters. And by leveraging community reporting, HIEs can assist
For many practitioners, the transition to an EMR has been diffi-
cult, disruptive, and sometimes costly due to retraining and technical continued on page 20
downtime. Federal incentives, however, made it worthwhile for visit us at www.bcms.org 19
many. Now that incentives for furthering the user of EMRs have de-
creased, it is not surprising that physicians are skeptical and cautious
to take next steps to fully explore the capabilities of their EMR. At
the same time, more providers and physicians realize that in order to
participate in the new payment options, electronic data sharing will
be a requirement. An example is the newly introduced MACRA re-
porting for Medicare.

MACRA reporting (or as it now is called the Quality Payment Pro-
gram or QPP) allows physicians to participate individually or in
groups (MIPS program) or as part of an Alternate Payment Models
(APM) where physicians accept risk for reimbursement. CMS antic-
ipates that in its first year (2017) most eligible professionals (EPs)
will qualify for MIPS. The program consolidates quality measures
(PQRS), Meaningful Use, and Value Based Payments requirements
into three simplified areas. In addition, CMS is expanding the ways
in which the information can be submitted. CMS considers the pro-
gram a zero sum gain and expects it to have winners (EPs who meet