CMS advances interoperability & patient access to health data through new proposals
The Centers for Medicare & Medicaid Services (CMS) proposed policy changes on February 11, 2019 supporting its MyHealthEData initiative to improve patient access and advance electronic data exchange and care coordination throughout the healthcare system. The Interoperability and Patient Access Proposed Rule outlines opportunities to make patient data more useful and transferable through open, secure, standardized, and machine-readable formats while reducing restrictive burdens on healthcare providers.
In addition to the policy proposals, CMS is releasing two Requests for Information (RFIs) to obtain feedback on interoperability and health information technology (health IT) adoption in Post-Acute Care (PAC) settings, and the role of patient matching in interoperability and improved patient care.
“For far too long, electronic health information has been stuck in silos and inaccessible for healthcare consumers,” said CMS Administrator Seema Verma. “Our proposals help break down existing barriers to important data exchange needed to empower patients by giving them access to their health data. Touching all aspects of healthcare, from patients to providers to payers and researchers, our work leverages identified technology and standards to spark new opportunities for industry and researchers while improving healthcare quality for all Americans. We ask that members of the healthcare system join forces to provide patients with safe, secure access to, and control over, their healthcare data.”
The MyHealthEData initiative empowers patient access through application programming interfaces (APIs), ensuring access and use of their healthcare data while keeping it safe and secure.
Last year, CMS launched the Blue Button 2.0 application programming interface (API) in Medicare fee-for-service (FFS), allowing beneficiaries to access their health claims information electronically through the application of their choosing. CMS currently has over 1500 application developers building tools with this API.
Because health information is useful to patients, and CMS is interested in providing individuals with access to their health information, similar to its approach to Blue Button 2.0, CMS is proposing to require Medicare Advantage (MA) organizations, state Medicaid and CHIP FFS programs, Medicaid managed care plans, CHIP managed care entities, and QHP issuers in FFEs to implement, test, and monitor an openly-published Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR)-based APIs to make patient claims and other health information available to patients through third-party applications and developers.
As patients move throughout the healthcare system, in particular from payer to payer, they should be able to maintain access to their healthcare information. CMS is proposing to require MA organizations, Medicaid managed care plans, CHIP managed care entities, and QHP issuers in the FFEs to support electronic exchange of data for transitions of care as patients move between these plan types. This data includes information about diagnoses, procedures, tests and providers seen and provides insights into a beneficiary’s health and healthcare utilization.
By ensuring patients have access to their information, and that information follows them on their healthcare journey, CMS can reduce burden, eliminate redundant procedures and testing, and give back valuable clinician time to focus on improving care coordination, and ultimately health outcomes.
Practices that unreasonably limit the availability, disclosure, and use of electronic health information undermine efforts to improve interoperability. Public reporting and prevention of information blocking would benefit patients and caregivers to know if individual clinicians, hospitals, and critical access hospitals (CAHs) have submitted a “no” response to any of the three attestation statements regarding the prevention of information blocking in the Promoting Interoperability Programs. Making this information publicly available may motivate clinicians, hospitals, and CAHs to refrain from information blocking.
CMS is looking for ways to facilitate private sector work on a practical and scalable patient matching strategy. Together with the Office of the National Coordinator for Health Information Technology (ONC), CMS is requesting feedback on how it can leverage its authority to improve patient identification and safety to encourage better coordination of care across different healthcare settings while advancing interoperability.
The RFIs continue the national conversation about improving the healthcare delivery system and includes how CMS can:
- Promote interoperability
- Reduce burden for clinicians, providers, and patients, while encouraging care coordination, and
- Lead change to a value-based healthcare system.
To view the proposed rule (CMS-9115-P), please visit the Federal Register.
