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CMS Administrator Seema Verma lays out plan for 'digital data revolution'

Health plans doing business in Medicare, Medicaid, ACA, are being asked to share claims data, and all information should be transferable, Verma says.

Susan Morse, Managing Editor

A year ago during HIMSS18 in Las Vegas, Centers for Medicare and Medicaid Services Administrator Seema Verma said she wanted to end the use of fax machines for healthcare transactions.

On Tuesday at HIMSS19 in Orlando, Verma gave more details on how CMS is moving providers, and also payers, to patient-centered initiatives from a new mandate from the Office of the National Coordinator for consumers to have immediate, electronic access to their health record, including through their smartphones.

Verma also called upon insurers to share claims data.

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CMS is proposing that all health plans doing business in Medicare, Medicaid, and through the federal exchanges share health claims data and other information electronically with their patients.

The data should also be transferable, from doctor to doctor and plan to plan when a patient changes plans, Verma said.

For hospitals, as a condition of participation in Medicare, CMS is proposing that hospitals must electronically notify providers in a patient's care team whenever a patient is admitted, discharged, or transferred to another care setting.

CMS is putting out a call to action to have the entire HIPAA designated record set made available electronically.

"Looking forward, we want to see a future where it's more than notification at discharge, instead the entire record set will follow the patient," Verma said.

To encourage the industry to align in supporting the flow of data across the  healthcare system, CMS is launching a project that uses the FHIR Bulk Spec to share Medicare claims data with accountable care organizations. This means that CMS is  sharing claims data for ACO participants in a bulk format.

CMS is seeking comment.

"In particular, we want to know how we can put the weight of CMS behind patient identity and patient matching," Verma said. "This is a critical issue that has plagued data sharing efforts for years, and we need to find a solution."

In the digital data revolution imagined by CMS, health records are created at the time of birth and accumulate information on every interaction, from tests, to procedures to devices. The data could then be used by researchers, after a patient grants access, to prevent disease and develop personalized evidence-based treatments.

Medicare Advantage encounter data is available to researchers and Medicaid data will be available later this year.

Standards-based APIs will connect data and incorporate it into a single record.
There are now over 1,500 developers with a blue button app, Verma said.

Physicians and health systems will be able to use tools such as artificial intelligence and machine learning to help interpret the information.

Tools that are used at the point of care will be user-friendly for clinicians, with no extra effort or millions of clicks, she said

Verma did not elaborate on what it will take for hospitals and physicians to get to the digital data revolution, but half of a clinician's score in the new promoting interoperability program is now based solely on sharing data with patients, not on use of the EHR.

Verma said CMS wants to drive down cost. Actuaries predict that if nothing is done to better control healthcare costs, by 2026, one in every $5 will be spent on healthcare.

The underlying flaw in reimbursement models, despite value-based care efforts, is that providers are being paid for sickness, Verma said.

"When providers have responsibility for managing a budget and their reimbursement is tied to the results they produce, they will find innovative ways to keep people healthy and lower costs," she said.

Each party blames someone else for the lack of sharing data. Everyone is culpable, including the government, Verma said. There's also fear about sharing proprietary information.

Some hospitals even have to ask permission from EHR vendors to use their own data. 

"Let me be clear," Verma said. "The idea that patient data belongs to providers or vendors, is an epic misunderstanding. Patient data belongs to patients."

The rules announced on Monday build on the MyHealthEData work from last year. Information blocking, siloed data is no longer acceptable, even as the use of fax machines remains a reality.

"We can sequence the entire human genome," Verma said, "but we still can't get much more than a print-out, fax or CD-ROM when we leave the doctor's office."

Twitter: @SusanJMorse
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