CMS advances MyHealthEData with new pilot to support clinicians

Aug. 2, 2019
Pilot program gives clinicians direct access to claims data, putting patients over paperwork and at the center of their care

In a news release, CMS says it is accelerating the transformation of the nation’s healthcare system to one that is based on value by increasing patient and provider access to the data needed through a new pilot program for clinicians called “Data at the Point of Care” (DPC).

DPC is based on an industry-standard application programming interface (API) and is part of the MyHealthEData Administration-wide initiative designed to empower patients around a common aim - giving every American access to their medical information so they can make better medical decisions.

Currently, patient information often becomes trapped within health system siloes, preventing patients from accessing their complete health information aggregated into one usable health record. This creates a problem for patients during visits with providers who are looking to obtain the most complete medical history possible for the person they are treating. Doctors are left offering treatment solutions with incomplete patient histories, putting patients at risk and potentially duplicating tests and treatments that can be costly or unnecessary.

CMS launched Blue Button 2.0, the first-ever FHIR-based claims API for Medicare beneficiaries, last year.  Blue Button 2.0 gives beneficiaries the ability to securely 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.

The DPC pilot program will leverage Medicare’s Blue Button data to provide clinicians with access to claims data. The claims data will 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.

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 a developer-friendly, industry-standard API using Health Level 7’s Fast Healthcare Interoperability Resource (FHIR®) standard, one of the most popular protocols for joining disparate systems together to promote interoperability and seamlessly share health information.

Most recently, CMS issued the Interoperability and Patient Access Proposed Rule. This proposed rule would require all health plans regulated by the rule to follow CMS’s lead with Blue Button 2.0 by making patient data available through an API. This will make it easier to access, use, and share claims data for 85 million patients including those covered by Medicare Advantage, Medicaid, CHIP and health plans sold on the Federal exchanges.