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April 16, 2013 4:41 pm

Applaud previous poster who is NCQA Recognized level 3 PCMH.

EHRs are currently very helpful in tracking patients over time and comparing results across patients and providers in a practice. This is very important for implementing the medical home model that emphasizes chronic disease management.

Where EHRs need to move towards is helping providers get information from other providers, with the specific challenge being lack of interoperability and tracking patients across different care settings. Complex patients that have 5+ care plans – none of which are shared across the care team – are a symptom of this problem. I would encourage ONC to continue to support addressing these gaps in EHR capabilities through MU standards and certification.

April 16, 2013 4:53 pm

In regards to the third bullet, ONC should continue to promote interoperability standards and certification criteria across the continuum of care. This will allow important information to flow freely for research, quality measurement and other ‘big data’ analysis purposes.

April 17, 2013 4:54 pm

Thanks for your question. Not all providers are eligible for HIT incentives and under existing payment schemes are not encouraged to adopt HIT. This includes important care centers for complex patients, like long term care facilities. Changing that would require a legislative fix, so I’m not sure it is appropriate for this strategic plan, but it is still critical.

Even for those providers that have adopted HIT, their systems often do not communicate. For example, when a PCP sends a referral document to a specialist, their systems may be unable to process it. Hospitals may be able to communication electronically with their own outpatient providers, but not with providers outside of their system. These gaps in the technology make it difficult to track patients across care settings, do medication… more »

…reconciliation and maintain shared care plans – all of which are important for coordinated, effective care.
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April 16, 2013 8:47 pm

Welcome to Planning Room willr, and thank you for your comment. Can you elaborate on what specific challenges there are relating to interoperability and tracking patients across different care settings?

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