ORLANDO, Fla.—For as much as the CMS tries to move away from it, the phrase “meaningful use” continues to hang over the agency's information technology agenda.
While the release of proposed regulations last week to bolster data exchange generally got a positive response at HIMSS19, industry stakeholders stressed the need for sharing relevant—meaningful—information.
“There's patient access to non-administrative data and access to clinical-level,” said Nader Mherabi, senior vice president, vice dean and chief information officer at NYU Langone Health. “Sometimes the government gets that all mixed up. What we need is meaningful, just-in-time exchange. Giving me a (lengthy) continuity of care document when I only have 10 minutes to see a patient is useless. It has to be something that I can make sense of. That kind of exchange is much more important.”
The long-awaited proposals from the CMS and the Office of the National Coordinator for Health IT aim to push more data into patients' hands.
Speaking at HIMSS19 last week, CMS Administrator Seema Verma called it the “beginning of the data revolution.” Verma drove home her belief that the industry failed to fulfill the promise of the meaningful use program—which was renamed Promoting Interoperability last year—and maximize the more than $30 billion the federal government spent to digitize healthcare, thus forcing the government to step in to drive change.
Among other things, the CMS wants any health plan doing business with the agency—through Medicare, Medicaid, the Children's Health Insurance Program and Affordable Care Act exchanges—to give patients immediate electronic access to claims data by 2020. The agency also wants to mandate that hospitals immediately send an electronic notice when a patient is admitted, discharged or transferred. And that's likely just the beginning, Verma hinted during her speech.
The agency would use participation in Medicare as the stick.
Execution of such a requirement is critical. Providers could end up on the receiving end of different admission, discharge and transfer alerts in different formats, explained Chuck Christian, vice president of technology and engagement at the Indiana Health Information Exchange. That could prove challenging for some providers.
Both the CMS and ONC also laid out plans to end data-blocking. The ONC rule specified seven exemptions for withholding information. The CMS' actions build on rules finalized in 2018 that put providers on the hook financially for not sharing information. “The idea that patient data belongs to providers or vendors is an epic misunderstanding. Patient data belongs to patients,” Verma said.
While the CMS and the ONC have to go through a comment period before pushing out final rules later this year, the Center for Medicare and Medicaid Innovation is likely to enforce early adoption through its voluntary payment models.
“Where you eventually want to get here is relatively simple: You want patients and their delegates to get free access to electronic, easy to use information within 24 hours,” Innovation Center Director Adam Boehler said during a news briefing at HIMSS19.
To power greater patient control of data, the CMS is pushing the use of application programming interfaces—APIs. This builds on Verma's unveiling of the Blue Button initiative at last year's HIMSS. The project allows beneficiaries to collect patient data, including claims information from insurers, on their mobile devices. Currently, 18 Blue Button apps have been deployed and 1,500 developers are working on new ones.
APIs will speed up data exchange, but IT officials have concerns around privacy and security. Christian wondered how the agency will vet developers, for instance.
“Cybersecurity has to fundamentally change the way we do things,” said Kevin Charest, chief information security officer at Health Care Service Corp., which operates Blue Cross and Blue Shield plans in five states. “We have to be in the cloud and on premises, and we have to do all of that simultaneously, with a talent shortage and a set of tools that aren't ready for prime time yet.”
—Aurora Aguilar contributed to this article.