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I am very concerned about inadequate EMR functionality restricting physicians' ability to "compete" under MIPS. Difficulties reporting eCQMs out of EHRs are becoming more widely known as MACRA implementation proceeds and were one big reason Andy Slavit delayed MIPS implementation with "pick your pace" last year. Did you read the Inspector General's report on QPP implementation? It called for CMS to develop backoffice IT solutions to help MDs report clinical quality measures. Why don't we call for CMS to contract out -- not build themselves -- a super HIE or series of regional HIEs which could remove the burden of report writing from MDs and deliver actionable dashboards to clinicians in real time, while computing aggregate performance metrics for virtual groups and all others? I submit this investment in infrastructure would pay for itself 10 fold in physician morale AND in jump starting our ability to develop win-win quality based incentive contracts.