Pilot program gives clinicians direct access to claims data, putting patients over paperwork and at the center of their care

Today, at the White House Blue Button Developers Conference (BBDC), the Centers for Medicare & Medicaid Services (CMS) announced changes that further protect and strengthen Medicare by unleashing the power of data and placing it firmly where it belongs, in the hands of patients and the clinicians who treat them.

This week, as the agency celebrates the anniversary of Medicare, CMS is accelerating the transformation of the nation’s healthcare system to one that is based on value by increasing patient and provider access to the data needed through a new pilot program for clinicians called “Data at the Point of Care” (DPC). DPC is based on an industry-standard application programming interface (API), and is part of the MyHealthEData Administration-wide initiative led by the White House Office of American Innovation. MyHealthEData is designed to empower patients around a common aim – giving every American access to their medical information so they can make better medical decisions.

The DPC pilot program will transform healthcare delivery by leveraging Medicare’s Blue Button data to provide clinicians with access to claims data. The claims data will fill in information gaps for clinicians, giving them a more structured and complete patient history with information like previous diagnoses, past procedures, and medication lists. Blue Button 2.0 has provided better access to this data for patients but now CMS is going a step further and helping to connect clinicians to their patients’ information. Clinicians will be able to access the DPC pilot data directly within their workflow, without needing to log into another application. This in turn will reduce burden in the exam room and give clinicians more time to deliver high quality care for their patients.

“This pilot program is another example of how the Trump Administration is doing everything possible to bring our healthcare system into the 21st century. Technology, coupled with open data sharing, is how we will improve value, control costs and keep patients healthy while ensuring a solvent Medicare program for generations to come.”
Seema Verma
CMS Administrator

Currently, patient information often becomes trapped within health system siloes, preventing patients from accessing their complete health information aggregated into one usable health record. This creates a problem for patients during visits with providers who are looking to obtain the most complete medical history possible for the person they are treating. Doctors are left offering treatment solutions with incomplete patient histories, putting patients at risk and potentially duplicating tests and treatments that can be costly or unnecessary.

Clinicians participating in the DPC pilot program will be allowed to request a Medicare beneficiary’s claims data from CMS to get a full snapshot of their care including from other healthcare providers the beneficiary has seen for care. This will be done through a developer-friendly, industry-standard API using Health Level 7’s Fast Healthcare Interoperability Resource (FHIR®) standard, one of the most popular protocols for joining disparate systems together to promote interoperability and seamlessly share health information.

DPC is one of many critical steps CMS is taking to build on our actions to make a truly interoperable healthcare system. For example, CMS launched Blue Button 2.0, the first-ever FHIR-based claims API for Medicare beneficiaries, last year. Blue Button 2.0 gives beneficiaries the ability to securely connect their data to apps and other tools developed by innovators. Engagement and partnership with the technology community has involved more than 2,000 developers from over 1,100 organizations that are using synthetic data in the Blue Button 2.0 sandbox. Currently, 28 organizations have applications in production.

Most recently, CMS issued the Interoperability and Patient Access Proposed Rule. This proposed rule would require all health plans regulated by the rule to follow CMS’s lead with Blue Button 2.0 by making patient data available through an API. This will make it easier to access, use, and share claims data for 85 million patients including those covered by Medicare Advantage, Medicaid, CHIP and health plans sold on the Federal exchanges.

BBDC brings developers together to network, learn, build software, and share insights on how Medicare claims data can be leveraged to improve health outcomes for patients.

Clinicians who are interested in participating in the DPC pilot program can sign up by visiting: https://dpc.cms.gov. Beneficiaries who wish to opt out of data sharing can do so by calling 1-800-Medicare.

For more information on Blue Button