​​MACRA University

MACRA requires the Department of Health and Human Services (HHS) to "establish metrics for the exchange and use of clinical information to facilitate coordinated care and improve patient outcomes between participants in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and others nationwide." 


In July of 2016 the Office of the National Coordinator of Health Information Technology posted on their blog two measures in response to feedback from stakeholders:


  • Measure #1: Proportion of health care providers who are electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding (querying); and integrating information received from outside sources.


  • Measure #2: Proportion of health care providers who report using the information they electronically receive from outside providers and sources for clinical decision-making.


Discussion:  In general this will encourage providers to take advantage of existing health information exchange and the Direct Model.  Once providers successfully engage in workflows associated with interoperability they generally agree with its value.  For example, the ability to import lengthy medication lists for new patients can save a practice substantial amounts of time and are available in certified EHR systems.  Information regarding medications that have been prescribed for each patient are maintained in local pharmaceutical databases that use standards allowing them to be imported directly into EHRs, including all relevant information (drug name, dose, frequency, start date, special instructions, etc.).  The provider will need to review the imported medication list for accuracy and completeness, but this process is time effective as compared to entering medications de novo. 


One area that remains less than fully mature, however, are problem lists.  The can be imported via a clinical summary or similar file using standards required for certified EHRs.  However, they sending practice may or may not have invested the time to updated problem lists.  They are often incomplete, contain outdated information, and is some instances incorrect diagnoses. Importing problem lists into EHRs requires a higher level of oversight and review, but this exercise generally leads to a problem list that is accurate and reliable. 


Attaching the most recent progress note, history & physical, consultative report, radiology reports, etc., to the electronic message also adds value, and it allows the receiving provider to validate the information they receive as clinical data.  



Interoperability Under MACRA