About CMS

The Centers for Medicare & Medicaid Services (CMS) is the agency within the U.S. Department of Health and Human Services (HHS) that administers the nation’s major healthcare programs. The CMS oversees programs including Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the state and federal health insurance marketplaces.

The challenge

How might we help the Centers for Medicare & Medicaid Services modernize their technology so that they can share data across the healthcare ecosystem to support patient-centered, data-driven decision making and innovative research?

The Presidential Innovation Fellow (PIF) will work in the Data & Analytics Strategy Group (DASG) within the Office of Enterprise Data & Analytics and report to the DASG Director, Yadira Sanchez. DASG designs, develops and promotes the use of innovative mechanisms to securely share data internally within CMS and externally to partners. DASG has been primarily focused on data sharing though the use of HL7 FHIR formatted Application Programming Interfaces (APIs). The PIF will focus on long-term strategic planning to continue the growth and use of FHIR in the API development and standardization.

Guiding this work are two major initiatives that are driving interoperability at CMS:

1. The MyHealthEData initiative was launched with the aim to empower patients by ensuring that they control their healthcare data and can decide how their data is going to be used, all while keeping that information safe and secure. MyHealthEData is intended to help to break down the barriers that prevent patients from having electronic access and true control of their own health records from the device or application of their choice. This effort approaches the issue of healthcare data from the patient’s perspective, giving patients control of their healthcare data and allowing it to follow them through their healthcare journey. The MyHealthEData initiative is a government-wide initiative led by the White House Office of American Innovation with participation from HHS – including CMS, the Office of the National Coordinator for Health Information Technology (ONC), and National Institutes of Health (NIH) – as well as the U.S. Department of Veterans Affairs (VA).
2. The Interoperability and Patient Access final rule (CMS-9115-F) delivers on the Administration’s promise to put patients first, giving them access to their health information when they need it most and in a way they can best use it. As part of the MyHealthEData initiative, this final rule is focused on driving interoperability and patient access to health information. Lack of seamless data exchange in healthcare has historically detracted from patient care, leading to poor health outcomes, and higher costs. The CMS Interoperability and Patient Access final rule establishes policies that break down barriers in the nation’s health system to enable better patient access to their health information, improve interoperability and unleash innovation, while reducing burden on payers and providers. Patients and their healthcare providers will have the opportunity to be more informed, which can lead to better care and improved patient outcomes, while at the same time reducing provider burden.

The MyHealthEData initiative and the Interoperability and Patient Access final rule drive all of the work that DASG supports. Below is a quick introduction to the DASG suite of products:

• The Beneficiary FHIR Data Server (BFD) is the backend data repository for all DASG developed APIs. BFD contains patient, claims, and coverage information for Medicare beneficiaries.
• The Beneficiary Claims Data API (BCDA) enables Accountable Care Organizations (ACOs) to retrieve Medicare Part A, Part B, and Part D claims data for their aligned beneficiaries.
• Blue Button 2.0 (BB2.0) is a developer-friendly, standards-based API that enables Medicare beneficiaries to connect their claims data to the applications, services and research programs they trust.
• Medicare Part A & B Data to PDP Sponsors provides Medicare Part D plan (PDP) sponsors with Medicare Parts A and B claims data for their enrollees aimed at promoting the appropriate use of medications and improving health outcomes.
• Data at the Point of Care is a pilot that will test sharing Medicare Fee-For-Service data with healthcare providers that can be used at the point of care to inform them of things they don't already know, to confirm things that are suspected, to fill gaps in care, and to improve patient safety.

With a focus on long-term strategic planning as described above, the PIF will:

Engage with the FHIR developer community both in government and private industry

• Understand what it means for CMS to be FHIR-compatible
• Contribute back to the FHIR standards to ensure standards can accommodate CMS’ data needs
• Drive adoption of the standard at CMS and be an advocate for CMS’ FHIR-based APIs to industry

Understand where the industry is driving towards as the push for interoperability continues

• Support an open community of engagement at CMS
• Participate in discussions for changes and updates to the CMS Interoperability and Patient Access rule
• Evaluate current policy and work with the team to develop a roadmap and action plan for CMS to implement

The PIF may also participate in hands-on development of FHIR-based APIs.