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New CMS Pilot Program Gives Physicians Claims Data Access


Here’s what it’s going to take to succeed.

Doctors with a tablet

The “Data at the Point of Care” (DPC) program 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. According to CMS, MyHealthEData is designed to empower patients around a common aim-giving patients access to their medical information so they can make better medical decisions.

The pilot program leverages Medicare’s Blue Button data to provide doctors 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
• medication lists

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“Now that the CMS DPC pilot has been announced, the question on most healthcare executives’ minds is, ‘What will it take for it to succeed?’,” says Jay Anders, MD, chief medical officer of Medicomp Systems, a physician-driven provider of clinically contextual patient data solutions, in Washington, D.C.

“The answer is really quite simple: Give physicians exactly what they need, when they need it. While the CMS initiative is a good start, it’s important to keep in mind that busy physicians are already dealing with a patient data tsunami on a daily basis.,” Anders says. “So once the CMS claims data becomes more widely available, it will be more important than ever to give clinicians ready access to the actionable information they need at the point of care for sound clinical decision making, and to filter out the claims data that isn’t needed-for example, details on every durable medical equipment order placed for the patient. Importantly, the relevant information must be accessible quickly and easily, structured in the way that clinicians think and work.”

Close care gaps

“CMS has explained that the pilot’s focus on providing health claims data at the point of care is intended to ‘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,’” says Rodrigo Martinez, MD, chief clinical officer of TransformativeMed, which develops integrated apps that modernize the EHR for future innovation, in Seattle.

“If that comprehensive claims data is then combined with synergistic technology solutions and processes that clean the data, make it contextually relevant and present it in a format that is easily digested and actionable, then we will be taking a huge step forward in closing care gaps,” Martinez says. “This will be a foundational step in reducing the amount of time clinicians spend hunting for information and in reducing the burden currently placed on patients to recount complicated medical details. Furthermore, if executed correctly, healthcare executives will see benefits in the form of accuracy of documentation of medical complexity, along with improvements in care. quality, outcomes, and productivity-as well as potentially lower rates of clinician stress and burnout.”

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