Sharing Clinical and Genomic Data on Cancer - The Need for Global Solutions.

n engl j med 376;21 nejm.org May 25, 2017 mary care practices for this demonstration, which qualifies as an Alternative Payment Model under the Medicare Access and CHIP Reauthorization Act (MACRA). Calls for fundamental payment and EHR reform are likely to trigger considerable discomfort and resistance. Many practice managers and payers and some clinician groups will mourn the loss of work documentation and process-based payment afforded by current EHRs and fee-for-service payment. Their substantial investment of time and money in the current systems and ability to benefit financially from them are not to be underestimated. These groups argue that paying for outcomes could be achieved with less disruption by simply grafting some value-based payments and penalties onto a fee-for-service model. This type of evolutionary approach is embodied in the MeritBased Incentive Payment option of MACRA. Although it is superficially appealing and encourages cost containment, this so-called pay-for-value plan relies even more heavily on EHR documentation and rewarding of achievement on process measures. It does little to reduce documentation burden or correct the misplaced emphases on care processes and service volume. Delivery from EHR purgatory is within our reach if we as a profession have the will to take more responsibility for outcomes. Not all outcomes are under our control, but focusing on those we can reasonably affect represents a genuine opportunity to restore meaning to our daily work and the social contract we have with our patients and society. Disclosure forms provided by the author are available at NEJM.org.