CMS pilot taps FHIR to give clinicians access to claims data

The Centers for Medicare and Medicaid Services is launching a pilot program that leverages HL7’s Fast Healthcare Interoperability Resources standard to enable clinicians to access claims data directly within their workflow.

At Tuesday’s White House Blue Button Developers Conference, CMS announced the Data at the Point of Care pilot, part of the Trump administration’s 2018 MyHealthEData initiative designed to put patients in control of their own healthcare information so they can make informed medical decisions.

Also See: CMS issues final rule to provide patients with access to health data

Last year, CMS launched the first FHIR-based claims application programming interface (API)—called Blue Button 2.0—for Medicare beneficiaries to connect their data to apps and other tools. Now, the agency’s new Data at the Point of Care pilot is intended to help better connect clinicians to their patients’ healthcare information via the FHIR API.

“The DPC pilot program will transform healthcare delivery by leveraging Medicare’s Blue Button data to provide clinicians with access to claims data,” according to CMS. “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.”

In addition, the agency contends that the pilot will reduce the burden in the exam room and give clinicians more time to deliver high-quality care for their patients.

Verma-Seema-CROP.jpg
Seema Verma, Centers for Medicare and Medicaid Services administrator nominee for U.S. President Donald Trump, speaks during a Senate Finance Committee confirmation hearing in Washington, D.C., U.S., on Thursday, Feb. 16, 2017. Verma, the businesswoman Trump selected to oversee Medicaid, the health care program for 74 million low-income Americans, has said the program is structurally flawed by policies that burden states and foster dependency among the poor. Photographer: Pete Marovich/Bloomberg

"The Data at the Point of Care pilot provides Medicare claims data directly to providers to promote better patient care,” CMS Administrator Seema Verma told the White House Blue Button Developers Conference on Tuesday. “Accessed right in a providers existing workflow, there is no logging into another application or portal required. By leveraging the FHIR Bulk spec, Data at the Point of Care ensures that providers can access crucial data and insights on their patients.”

Earlier this year at the HIMSS annual conference, CMS announced the Beneficiary Claims Data API as a method for the agency to share claims data with accountable care organizations to drive value-based care and increase participation in new payment models.

“This API was the first implementation of the FHIR Bulk Spec to share Medicare claims data,” commented Verma. “As you all know, bulk is one of the most important keys to interoperability, allowing us to share data on groups of patients instead of just individuals.”

The initiative is only a first step, said a statement issued by Blair Childs, senior vice president of public affairs for Premier, a group purchasing organization serving healthcare providers.

“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,” Childs said. “We support the use of public, non-proprietary and open application programming interfaces to ensure health data sharing in electronic health records.

“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,” he added. “This is critical to fostering more competition and allowing for easy-to-use applications for clinicians.”

Additional information on the Data at the Point of Care pilot is available here for clinicians interested in participating in the program.

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