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CMS Testing Pilot to Give FFS Medicare Providers Historical Claims Data on Patients


CMS said it is piloting the integration of Medicare historical claims data into electronic health records to give physicians more information about their patients at the time of an office visit.

CMS said Tuesday it is launching a pilot program where Medicare fee-for-service providers can sign up to have unlocked patient claims data integrated into their electronic health record (EHR), depending on what kind of EHR system they use.

The announcement was made at the second Blue Button 2.0 developers conference. The initiative invites tech developers to use an open application program interface, more commonly referred to as an API, in order to access and work with health data.

The idea is that consumers and beneficiaries would use apps built by the developers so that their information is portable and available at every doctor’s visit.

CMS said the initiative, called Data at the Point of Care (DPC), is part of the transformation to value-based care. DPC and Blue Button are both part of the administration’s MyHealthEData initiative.

“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,” said CMS.

During a call about the project, CMS Administrator Seema Verma said the pilot would not require extra steps on the part of physicians and will integrate into the EHR, depending on the EHR used.

According to CMS, physicians will not have 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,” CMS said.

Over 2000 developers are currently part of the Blue Button initiative, Verma said.

CMS said it cannot give a projection as to how many providers will participate.

The claims information will only be available to providers who have already seen the patient; it will not be available if a provider has never seen the patient before.

In addition, patients will have the right to opt out if they do not want their claims data shared with their doctors.

CMS said the project launches Tuesday, and providers can request access to the pilot. CMS will start deploying to the first few providers with test data in August and plans to start testing with production data in September and October.

The announcement came on the anniversary of Medicare and Medicaid, which was signed into law by President Lyndon B. Johnson on July 30, 1965.

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