Talking ‘Bout A (Healthcare Economy) Revolution

By: Rick Borden and Kate Woods

On August 13, 2018, the Centers for Medicare and Medicaid Services (CMS) held the Blue Button 2.0 Developer Conference in Washington, D.C., a gathering of leading healthcare and technology business and thought leaders. Over 350 organizations were represented, from Fortune 500s, to electronic health record companies (EHRs),  and startups. Why were they there? What were they talking about? And what were their lofty goals?

The “why”, at least in part, is the data of 53 million Medicare beneficiaries’ now accessible through the CMS’ Blue Button 2.0 API (Application Programming Interface), including Part A, B, and D data. API is software that allows two programs to speak to one another, providing a standard doorway, so to speak, so one application can connect to another.

The “what” at discussion, is no less than the next frontier in the US Healthcare economy and the power of the consumer at its center.

Their lofty goals? Nothing less than to foment a healthcare economy revolution; tactical goals include reducing patient burden, streamlining health information and reducing or at least significantly reducing barriers to interoperability.

These goals have a lot riding on open APIs, as well as the HL7’s (Health Level-7) draft standard, FHIR (Fast Healthcare Interoperability Resources). This allows the use of common data types so that data is consistent, which allows the easy transport of data from one database to another. One apparent benefit of FHIR is the facilitation of interoperability among legacy healthcare systems. This would make it easier to provide healthcare information to healthcare providers and individuals across a wide spectrum of devices including computers, tablets and cell phones. It would also allow third-party application developers to provide medical applications which can be easily integrated into existing systems.

Seema Verma, CMS Administrator, believes we are at the beginning of the digital healthcare revolution and stated “We’re unleashing the most powerful force in our economy: the consumer.”

Standardization will be key. The CMS has clearly thought about this, mapping over 1,300 fields directly from its claims data warehouse into the FHIR. There is at least one claim available for each of the 53 million Medicare beneficiaries’ data contained within the warehouse (de-identified, of course). This all seems long overdue to John Doerr of Kleiner, Perkins, Caufield and Byers, who couldn’t state definitively where the first wave would break – consumers, providers, or apps in general – but was very clear that making the vision of interoperability a reality was long overdue.

The availability of synthetic data for testing is no less than a shot across the bow in the healthcare economy revolution. It will allow experimentation and testing without increasing the privacy risk to patients. By making this data available in synthetic form the CMS has opened up a host of possibilities for innovating in healthcare based on real information, while simultaneously protecting members’ protected health information. This synthetic data availability may also support the elimination of aged production data by healthcare companies in their innovation labs and development processes. The ability to use valid data to build new service models or products from could prove to be a truly breakthrough element in advancing the healthcare economy. But it should not be misconstrued as a silver bullet.

While it appears that the CMS has put forth a considered approach to sharing data – with defined security controls and participation requirements – healthcare companies will still need their own clear vision on patient-centered goals and business initiatives. Healthcare companies will still need to ensure they have their own well defined project specs, security controls and project management processes, inclusive of regulatory compliance controls in place when mining the CMS data. The CMS has provided a tool – albeit a valuable tool – that opens up Medicare data for use and experimentation in a controlled environment. Still, it is just a tool. Healthcare organizations who successfully navigate and use the CMS tool to create innovative healthcare services and products will also need to arm themselves with good people, processes, policies and a fundamental understanding of the laws and regulations under which they operate. Some things never change; even in revolutions.

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