CMS outlines data exchange plans to aid quality, cut burden

The agency is teaming up with ONC to further develop the core dataset of patient data and resolve pain points in current administrative processes.

The Centers for Medicare & Medicaid Services is continuing to work on future efforts to lay the groundwork for future interoperable data exchange in healthcare.

The federal agency, which oversees federal health programs and has been playing a leading role in encouraging data exchange and consumer access to health data, outlined initiatives it’s pursuing in a blog post on the CMS website, posted on Wednesday.

These initiatives are important because they could lay the groundwork for improving and facilitating data exchange for healthcare organizations, and ease current burdens related to gathering and disseminating public health and care quality information.

The blog, under the byline of Chiquita Brooks-LaSure, administrator for CMS, notes that the agency is “working closely with the Office of the National Coordinator for Health information Technology” on efforts to standardize patient data so it can be easily moved between healthcare organizations.

The joint initiative, called USCDI+, is intended to enable CMS to make progress on the use of interoperable datasets for quality measurement and in other areas.

Healthcare organizations currently are required by ONC’s 21st Century Cures Act final rule to incorporate the United States Core Data for Interoperability (USCDI) as a baseline for data elements accessible through certified electronic health record technology. As such, it’s become the minimum dataset for the healthcare delivery systems in the country. In July, ONC published a second version of USCDI, which includes updates that will enable the exchange of data on social determinants of health, sexual orientation and gender identity.

USCDI+ is a service that ONC will provide to federal partners, such as CMS, who need data that extends beyond the core established by USCDI. CMS and the Centers for Disease Control and Prevention (CDC) are leading efforts that will involve USCDI+ for quality measurement and public health.

“The goal is to continue to improve data exchange across the healthcare ecosystem, including public health systems, for better coordination of care, enhanced clinical decision-making and a higher quality of care for patients,” Brooks-LaSure writes.

CMS also is working with ONC to determine how the Trusted Exchange Framework and Common Agreement (TEFCA) can support “a variety of CMS use cases.”

The agency also is looking to find ways to resolve vexing administrative transactions that the industry is currently facing or must solve in the near future.

For example, CMS is looking at technology tools that streamline processes like prior authorization to reduce burdens on patients, providers and payers. Several industry efforts are underway, including initiatives by HL7’s Da Vinci Project and AHIP, to try and resolve highly manual approaches to prior authorization.

CMS is also looking to standards to facilitate price transparency efforts, particularly the Advanced Explanation of Benefits (AEOB).

“CMS is also exploring the use of a standards based API, using the HL7 Fast Healthcare Interoperability Resources (FHIR)” to aid in developing the AEOB, the blog notes.  “FHIR … may allow a consumer-friendly AEOB to be produced that could encourage important discussions between patients and their care teams regarding cost and value. The use of FHIR is critical to enabling payers to send data to patients, and to providers for a seamless exchange.” The use of standards and Application Programming Interfaces (APIs) will be key to enabling secure data exchanges and improved access to patient records across the ecosystem, CMS notes.

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