CMS, USDS Pilot Unlocks Patient Data to Boost Provider Care

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The project allows health care professionals to see claims information for past treatments instead of relying on patients’ memories.

Silos across America’s health care system burden most patients with the laborious task of remembering all the medical attention they receive and force doctors to offer treatment solutions without the full context of their patients’ comprehensive medical background. But as one of the largest payers of health care in the country, the Centers for Medicare and Medicaid Services collects troves of valuable claims data that could empower patients and clinicians to leverage data to make more informed health care decisions—and that’s exactly what the agency aims to do.

CMS, with the U.S. Digital Service, launched a new pilot program Tuesday called “Data at the Point of Care.” Unveiled at the White House’s second annual Blue Button Developer Conference, insiders say DPC could transform health care delivery across the nation, granting clinicians unprecedented access to patients’ claims data to enhance the services they provide. 

“This new program will help fill in the areas of missing information that currently plague providers,” CMS Administrator Seema Verma said on a call with reporters ahead of the announcement. “By providing claims information to providers at the point of care, we are enabling them to spend more time providing high-quality care for their patients and spend less time chasing down information or working with an incomplete picture of the patient's medical history.”

Also on the call, Senior Advisor to the President Jared Kushner noted that the move demonstrates the administration’s priority of unlocking data to foster innovation across the health care sector. 

“The government has a ton of data, and the private market has a ton of data,” Kushner said. “By making things interoperable, we’re trying to give more power to the patients. We’re trying to give them more control but also encourage a whole new wave of innovation.”

Unlocking Data to Offer Better Care

DPC is based on an industry-standard and developer-friendly application programming interface, or API.

“If you want to think about an API in layman's terms, it's really just two systems communicating,” Shannon Sartin, executive director of the USDS team at Health and Human Services who led the DPS project at CMS, told Nextgov. “So as opposed to a person being in the middle, or pieces of paper being sent back and forth, you can actually allow two sytems to communicate and share information directly with each other.”

The problem that DPC ultimately seeks to solve is a painful reality for Amy Gleason, the USDS product manager who led development efforts around the project. 

When her daughter was diagnosed with a rare but serious autoimmune disease that only affects about 2,000 kids across the U.S., Gleason learned firsthand the debilitating challenges caretakers and patients face in trying to receive the best care.  

“My daughter sees 12 different doctors that are across six different health systems, and each doctor that she goes to doesn’t know what the other doctors are doing,” Gleason explained. “So every time she goes to the doctor, the first thing they ask is ‘what happened since the last time I saw you?’ and they are actually expecting her to remember all of the things that have changed and they want updates on all that.” 

But any time a clinician or provider sees a patient, they submit bills to Medicare or insurance providers in an electronic format, which generally lists all the insights and treatments given during the visit. Through the DPC pilot program, doctors will gain the ability to tap into that claims information and download it directly into their workflow without logging into other applications. If it works as planned, providers can use the API to request information on those they are actually treating instead of asking patients to remember everything that happens to them. CMS can evaluate their request, see if they can use that information, and then send that data back through a bulk API to give them that information.

“After this project, instead of saying, ‘what happened since the last time I saw you?’ doctors can instead say ‘oh it looks like you went to see Dr. Thomas for a kidney stone,’ or ‘I see you didn't go to the cardiologist I referred you to, is there something I can help you with?’” Gleason said. “So it really fills in the gaps of that information that they need to be able to treat the patient and it also removes that burden on the patient.”

CMS’ drive to harness data in this capacity was also partially inspired by the agency administrator’s own personal experience with disconnected health data. In 2017, her husband collapsed and went into cardiac arrest while traveling at an airport with their two children. Though he is a physician, Verma could not easily access any of his health information to share over the phone with the medics who were treating him. 

“It was this really powerful experience where she realized that she had this opportunity to work on this issue that could really save a lot of lives,” Sartin explained.

This first iteration of the DPC pilot uses synthetic data. Now that it is live, providers can request access to participate on dpc.cms.gov. CMS said it plans to deploy to the first few users in August and they’ll start testing with production data between September and October. From there, they’ll roll it out to other providers as the pilot continues to evolve. 

If it’s deemed a success, CMS said DPC will be made available to all fee-for-service providers. Though they can’t project how many will sign up, insiders said initial research suggests most are interested in participating. 

“We learned providers really really want this claims information and they are very, very convinced that it will help them deliver better care, be better doctors and give a better experience to their patients,” Gleason said. 

While they are only using test data now, Sartin also made a point to emphasize how the team worked diligently to ensure patient privacy was and will be preserved throughout the process. 

“Serving the Medicare and Medicaid populations, we certainly want to make sure that we protect our beneficiaries first and foremost,” she said. “So we do some due diligence about what applicants are allowed to connect with APIs.” 

Sartin also added that though the name of the pilot may change in the future, it’s meant to articulate the heart of the service that DPC aims to provide. 

“We wanted to make sure not just that the doctors get the information, but that they actually have it to use while they are seeing patients at the point of care,” she said. “It was really important for us to ensure that the data got to the point of care.”

More than Just an API 

Prior to launching DPC, CMS rolled out the APIs Blue Button and Blue Button 2.0, which enable beneficiaries to securely access and connect their data to applications and other tools developed by innovators. At this point, more than 2,000 developers from over 1,100 organizations are using synthetic data in the Blue Button 2.0 sandbox and 28 organizations also currently have applications in production.

“It’s been this really powerful movement around just this concept of leveraging this claims data as an additional powerful source,” Sartin said.

Officials across USDS expressed an enthusiastic belief that the Blue Buttons, DPC and other CMS efforts around Medicare claims and payment reforms, will transcend this initial use and become a catalyst for improvements and transformation across the entire health care landscape. 

“People really want a model that they feel safe using and that they trust has been proven and tested, and so one of the things I think CMS really has the opportunity to do is to set that example and say ‘here’s a way that you can do this, we have tested it, we have deployed it,’ and that will give others confidence that if CMS can do it, then they will do it too,” Gleason said. 

USDS Deputy Administrator Edward Hartwig also told Nextgov CMS’ unique position and data access enables it to empower the private sector to innovate by providing the “bedrock foundation” of clean data sets they can leverage. This enables the agency to set an example for collaborative modernization across government and industry.  

“It’s really important to think about this as it’s not just about building the API, it’s not just about building the service—it’s about running the process internally and showing that it works and showing that commitment to it—so it’s like reference implementation,” he said. “It’s really about proving the point by the government accepting the initial risk and creating a pathway for others.”

And while it’s still unclear if most providers will give it a go, Gleason has high hopes that the pilot will revolutionize how data is shared across the medical sector. 

“I think this could also be something that really creates a model for data-sharing, first with claims data and then once it works you can also do it for other clinical data and other use cases. So I think it could be a tipping point to really get data flowing in the health care system,” Gleason said. “I’ve never been more excited about a project and I really think it has a huge impact on the industry and could end up being one of the more impactful things I've done in my life.”