Agency mulls Medicare requirement that providers share data with patients

Register now

The Centers for Medicare and Medicaid Services hopes to release a proposal requiring healthcare organizations to give patients their medical information.

Healthcare information technology remains far behind all other major industries and is an inefficient system plagued by a lack of health IT interoperability, according to CMS Administrator Seema Verma.

“Providers are in a 1990s time warp where doctors are faxing patient records, medical staff are manually entering results into EHRs, and hospitals are handing out data on CD-ROMs while the rest of the country is functioning on fully digitized, integrated data that informs decision making instantaneously,” Verma told the Office of the National Coordinator for HIT’s Interoperability Forum in Washington, a three-day conference that kicked off on Monday.

While the federal government has spent more than $35 billion to get providers to adopt EHR systems, the technology is making their work more burdensome and causing widespread physician burnout, contends Verma. As a result, she said “doctors are still recording their notes on paper, and they’re still faxing patient records.” Verma challenged the industry to make every physician office in America a “fax-free zone” by 2020.

In addition, the CMS chief railed against the lack of health IT interoperability. “What we have today is a technological Tower of Babel where systems speak different languages, information is not communicated, records are not interoperable, and patients and providers don’t have access to the information they need to make the best decisions,” she told ONC’s interoperability conference.

However, Verma said that CMS and ONC are working together to realize a “shared vision for a health ecosystem where data can flow easily between patient, provider, caregivers, researchers, innovators and payers.” In particular, she revealed that CMS is considering a requirement—as a condition for participation in the Medicare program—that providers share data with patients in a universal electronic format.

Verma noted that CMS announced in March the launch of the MyHealthEData initiative—led by the White House Office of American Innovation—to put patients in control of their own health data so they can decide how their information is used.

Also See: Fed initiative to put patients in control of their health data

“Imagine a world in which your health data follows you wherever you go and you can share it with your doctor—all at the push of a button,” she told the conference. “Imagine if, in turn, your doctor didn’t have to spend so much time faxing records and staring at a computer during an appointment. Imagine if you could track your medical history from your birth throughout your life, aggregating information from each health visit, your claims data and the health information created every second through wearable technology. Imagine if our health records weren’t just used by our doctors in their workflow, but rather if EHRs allowed third-party applications to access and leverage that data in innovative ways for both patients and doctors.”

At the same time, Verma said the MyHealthEData initiative is about more than just patients and doctors gaining access to EHRs but driving innovation throughout the healthcare system, creating new tools and solutions that “advance research to cure diseases and provide more evidence-based treatment guidelines that ultimately will drive down costs and improve health outcomes.”

She announced that CMS recently released Medicare Advantage datasets, and in 2019, the agency expects to make Medicaid and Children’s Health Insurance Program data available to provide researchers and innovators with information on a new population of 74 million beneficiaries.

“Once all this data becomes available, advancements in artificial intelligence will make it possible to analyze the data at the speed of light, and the possibilities are endless,” Verma observed. “Machine interoperability is just as important as the interoperability of EHR systems. And, as you know, a huge amount of healthcare information comes to us from devices such as heart monitors and CT scans. It’s vital that those devices share data and be interoperable, just as much as we need our doctors’ notes and medication lists to be interoperable.”

The goal is to get patient records and all medical devices to connect seamlessly to EHRs, according to Verma, who said CMS sees the future of interoperability centering on digital health and the implementation of open application programming interfaces.

“Let me be clear, we will not shrink from this vision or delay its implementation—we are committed to requiring that providers begin using 2015 Edition certified EHR technology starting in 2019 because this version opens up APIs,” she emphasized. “By committing to the 2015 Edition version, we are opening the door to innovators in this room to solve our most confounding health challenges. And, this is important because it will finally put patients in control of their data and their healthcare, as MyHealthEData was intended to do.”

Because CMS is the nation’s largest healthcare payer, Verma believes that the agency has a critical role to play in helping the industry to achieve interoperability by incentivizing physicians and hospitals to give patients electronic access to their health records.

“We want to leverage technological innovation to deliver value to patients and hold healthcare vendors accountable,” she said. “With 130 million Americans served by CMS, we have the power to transform the delivery and value of care across the country. That is why we are taking a lead role to advance Health IT and interoperability with an API-first approach for the sharing of data.”

As part of the MyHealthEData initiative, CMS is leveraging HL7’s Fast Healthcare Interoperability Resources (FHIR) standard and OAuth 2.0 security profiles so that Medicare beneficiaries will be able to access and share their claims data in a universal digital format.

“When we announced MyHeathEData, we also unveiled Blue Button 2.0—a developer-friendly, standards based API, which will allow a majority of Medicare beneficiaries to connect their claims data to third party applications, services and research programs,” added Verma. “There are now 600 developers signed up to experiment with this API, more than doubling participation since March of this year. And, next week, we are hosting the first Blue Button 2.0 Developer Conference.”

She has called on private health insurers to follow suit and “begin releasing claims data as we did with Blue Button 2.0, and make data available to patients.”

For reprint and licensing requests for this article, click here.