CMS Pilot Gives Physicians Access to Beneficiary Claims Data at the Point of Care

A new pilot project from the Centers for Medicare and Medicaid Services (CMS) will give physicians access at the point of care to Medicare claims data for new patients through Blue Button 2.0 data as well as third-party applications and electronic health records (EHRs) data, via application programming interfaces (APIs).

The pilot program, called Data at the Point of Care (DPC), was announced at a recent White House Blue Button 2.0 Developer Conference in Washington, DC. It is part of the Centers for Medicare and Medicaid Services (CMS) interoperability strategy, known as the MyHealtheData Initiative. According to CMS, DPC leverages Blue Button data, which will fill in information gaps for clinicians, giving them a more structured and complete patient history with information such as previous diagnoses, past procedures, and medication lists.

Clinicians will be able to access the DPC pilot data directly within their workflow, without needing to log in to another application. This in turn will reduce burden in the exam room and give clinicians more time with their patients, according to CMS.

“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,” a CMS press release states.

This will be achieved through an 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 share health information. According to CMS, over 2,000 developers are using the Blue Button 2.0 API and 28 organizations have launched programs aimed at making patient data available to patients themselves.

Mary Butler is associate editor at Journal of AHIMA.

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