CMS Launches Pilot to Give Clinicians Access to Patients’ Claims Data
The Centers for Medicare & Medicaid Services (CMS) is launching a pilot called “Data at the Point of Care” (DPC) that will provide clinicians with access to claims data through Medicare’s Blue Button initiative.
Announced at this week’s White House Blue Button Developers Conference (BBDC), CMS officials said that DPC is based on the FHIR standard, and is part of the MyHealthEData administration-wide initiative from 2018 that is broadly designed to empower patients around a common aim—giving every American access to their medical information so they can make better medical decisions.
The claims data that will become available through DPC, CMS officials contend, can fill in information gaps for clinicians, giving them a more structured and complete patient history with information like previous diagnoses, past procedures, and medication lists.
“Blue Button 2.0 has provided better access to this data for patients, but now CMS is going a step further and helping to connect clinicians to their patients’ information. Clinicians will be able to access the DPC pilot data directly within their workflow, without needing to log into another application. This in turn will reduce burden in the exam room and give clinicians more time to deliver high quality care for their patients,” the federal agency said in a press release.
Clinicians participating in the DPC pilot program will be allowed to request a Medicare beneficiary’s claims data from CMS to get a full snapshot of their care, including from other healthcare providers the beneficiary has seen for care. This will be done through the FHIR standard, which CMS attests “is one of the most popular protocols for joining disparate systems together to promote interoperability and seamlessly share health information.”
Clinicians will have the ability to “request access” to participate in the DPC pilot, and then over time, wait for CMS to get back to them with specification information and sample data for testing.
Last year, CMS launched Blue Button 2.0, a FHIR-based claims API for some 44 million Medicare beneficiaries. Blue Button 2.0 gives beneficiaries the ability to connect their data to apps and other tools developed by innovators. Engagement and partnership with the technology community has involved more than 2,000 developers from over 1,100 organizations that are using synthetic data in the Blue Button 2.0 sandbox. Currently, 28 organizations have applications in production, according to CMS.
And in February, CMS issued its “Interoperability and Patient Access” proposed rule, which, if finalized, would require all health plans regulated by the rule to follow the government’s lead with Blue Button 2.0 by making patient data available through an API.
In a statement responding to the pilot announcement, Blair Childs, senior vice president of public affairs, at the Charlotte, N.C.-based Premier Inc. said, “Access to claims data at the point of care—and potentially within the clinical workflow—will empower clinicians to deliver high quality, effective and safe care. We support the use of public, non-proprietary and open APIs to ensure health data sharing in electronic health records (EHRs). While this announcement is a good step, we believe healthcare providers need EHR vendors to open their data platforms to application developers through open APIs. This is critical to fostering more competition and allowing for easy-to-use applications for clinicians.”
Also related to Blue Button 2.0, CMS announced at the conference the release of the CARIN Blue Button data model and draft implementation guide. The guide, from the CARIN Alliance, includes more than 240 claim data elements that have been agreed on by multiple regional and national health plans. These data elements are included in what CMS is calling the common payer consumer data set, or CPCDS, and have been mapped them to HL7 FHIR resources with the goal to better assist health plans implement the CMS Interoperability and Patient Access proposed rule, officials said.
Executives from several leading health plans, Apple, Google, Microsoft and others have signed up to test out that data model and guide.
Companies Reaffirm Commitment to Interoperability
Last August at the Blue Button 2.0 Developer Conference, six of the world's biggest technology companies, including Microsoft, Google, IBM and Amazon, made a joint pledge at the White House to remove interoperability barriers and to make progress on adoption of health data standards.
At that event, Microsoft joined with Amazon, Google, IBM, Salesforce and Oracle to jointly commit to support healthcare interoperability by advancing healthcare standards such as HL7 FHIR and the Argonaut Project. They also pledged to remove interoperability barriers, particularly as it relates to the adoption of technologies enabled through the cloud and artificial intelligence (AI).
In a joint statement, the technology companies made a commitment to remove barriers to “frictionless data exchange,” noting that they share “the common quest to unlock the potential in healthcare data, to deliver better outcomes at lower costs.”
Now, a year later at the Blue Button Developers Conference, the companies have come together to reaffirm that commitment, noting in a joint statement the importance of both CMS and ONC (the Office of the National Coordinator for Health IT) aiming to require the use of the FHIR standard for APIs in their proposed rules earlier this year.
The signed statement from the companies read, “We have seen the early promise of standards-based APIs from market leading health IT systems, and are excited about a future where such capabilities are universal. Together, we operate some of the largest technical infrastructure across the globe serving many healthcare and non-healthcare systems alike. Through that experience, we recognize the scale and complexity of the task at hand. We believe that the techniques required to meet the objectives of ONC and CMS are available today and can be delivered cost-effectively with well-engineered systems.”
The renewed statement continued, “We are committed to introducing tools for the healthcare developer community. After the proposed rule takes effect, we commit to offering technical guidance based on our work including solution architecture diagrams, system narratives, and reference implementations to accelerate deployments for all industry stakeholders. We will work diligently to ensure these blueprints provide a clear and robust path to achieving the spirit of an API-first strategy for healthcare interoperability.”
Additionally, the National Institutes of Health (NIH) also is taking steps to promote the use of FHIR in its funded clinical research, the organization announced in a July 30 blog post from Patti Brennan, director, U.S. National Library of Medicine, a component of NIH.
At the Blue Button Developers Conference Clem McDonald, M.D., chief health data standards officer at NLM, announced two notices issued by NIH regarding FHIR. First, the Guide Notice on FHIR encourages NIH-funded investigators to explore the use of FHIR to capture, integrate, and exchange clinical data for research purposes and to enhance capabilities to share research data. The notice aims to make all NIH-funded researchers aware of the emerging ability to extract data from EHRs using FHIR and encourage them to use FHIR-compatible formats when sharing data, consistent with privacy restrictions and informed consent, according to officials.
Second, the Notice of Special Interest was posted to inform the small business innovation research and small business technology transfer communities of NIH’s interest in supporting applications that use FHIR in the development of health information technology products and services. NIH is interested in the implementation of the FHIR standard in health IT applications, such as the integration of patient- and population-level data from EHR systems, access to and management of electronic health information, the development of clinical decision support systems, the enhancement of recruitment into clinical trials, and improving privacy and security for electronic health information, its officials said.
