Episode 6: Dispatches from the Blue Button Developers Conference
Today’s edition is titled “Dispatches from the Blue Button Developers Conference.” This annual event brings together some of the nation’s top private-sector developers who are helping CMS to better serve Medicare beneficiaries by leveraging Medicare claims data. This podcast features key remarks from CMS Administrator Seema Verma, the application developers and Medicare beneficiaries, regarding the launch of the pilot project, Data at the Point of Care, and the value of these applications.
Intro-Bill Polglase: Today’s edition of CMS Beyond the Policy will focus on the recent Blue Button Developer Conference, where the Data at the Point of Care pilot was announced. This was an exciting conference, filled with innovative ideas focused on enhancing healthcare delivery. Let’s start by hearing from CMS Administrator Seema Verma, as she kicked off this conference:
ADMINISTRATOR SEEMA VERMA Remarks: One of our administration’s key focuses is on innovative payments that align financial incentives for providers to deliver efficient, high-quality care. And when providers have a responsibility for managing care and the reimbursement is tied to results, instead of just the volume of services, they will be incentivized to find innovative ways to keep people healthy, prevent disease, lower cost, and improve health outcomes. So, changing the way that we pay providers will also allow patients to seek high-value care. And I am going to get to interoperability.
The sharing of data in interoperability underpin this entire move to value in healthcare in innovation. Without access to their own data, patients lack the information and therefore the power and ability to shop around for services. So, if they have innovation about cost and quality and their healthcare record, they can move around the healthcare system more freely, looking for the best deal and the best value.”
The Trump administration has been working since day one to unleash the power of data and to give patients control of their health information. And that’s why we announced the My Healthy Data Initiative last year. And I’m proud to say that we already have tangible results. We’ve made Medicare Advantage encounter data available to researchers for the very first time. And we’ve also announced that we’ll be doing the same thing for Medicaid data later this year. We significantly overhauled the Meaningful Use program. We now call it Promoting Interoperability. And we reward doctors and penalize hospitals to encourage them to make sure patients have access to their health data. And we’ve mandated that clinicians and hospitals use EHRs that make APIs accessible to patients, giving them access to their data and the ability to use the tools they want to navigate their data.
This was our first step in freeing up data from EHRs. And we’re also actively participating in the Standards Development Process to create a common language to exchange data. And, of course, we launched Blue Button 2.0, the first-ever FHIR-based claims API for Medicare beneficiaries -- and the reason that we’re all here today.
As part of My Healthy Data, Blue Button 2.0 is already giving our beneficiaries the ability to securely connect their claims data to apps and to other tools developed by innovators. You all have been amazing partners in helping us empower patients with their data. We’ve seen over 2,000 developers from over 1,100 organizations using synthetic data in the Blue Button Sandbox. And we currently have 28 organizations with apps already in production. These apps give patients ways to manage and improve their health. And later today, you’ll hear from these app developers directly.”
“Now, I’m getting to the really good part. Building on all of our work with Blue Button and ACOs, I’m extremely pleased to announce this afternoon our new Data at the Point of Care Pilot. Today’s announcement is a critical step in our efforts to change provider reimbursement and move towards value.
Providers often struggle to have a complete picture of a patient’s medical history, including procedures, medications, and preventative services. And patients carrying the burden of remembering their health information at each and every encounter. And personally, I can barely remember what I had for breakfast, let alone the date of my last tetanus shot. And I live in Indiana, but I work in D.C. So, if I actually had time for a doctor’s appointment, I would have to travel with records of -- or folders of paper records. Claims data can fill in this gap. And the Data at the Point of Care Pilot provides Medicare claims data directly to providers to promote better patient care. Accessing the data will provide providers the opportunity to take this data into their existing workflow, and there’s no logging into another application or a portal that’s required.
By leveraging the FHIR bulk spec, Data at the Point of Care ensures that providers can access crucial data and insights on their patients. So, we did this for ACOs, and now we’re doing it for all doctors.
Bill Polglase: That’s a great introduction from the Administrator, on the importance of empowering our patients with data, and the new Data at the Point of Care pilot, which will fill in the information gaps for providers, by using claims data to give providers structured patient history information such as diagnoses, past procedures, and medications.
The administrator used a term that I’m not familiar with – FHIR – let’s back up a bit and hear from a CMS expert about what FHIR is.
Allison : Hi this is Allison Oelshlaeger. I'm the chief data officer at the Centers for Medicare and Medicaid Services here to talk to you about FHIR, the fast healthcare interoperability resource. So, we have all of this data spread across the health care system. Some of it with your insurance plan such as claims data, a lot of it's with various doctors and health systems through their electronic health records systems. And we have other data in lab services, radiology, etc. So, FHIR is a protocol for joining all of this disparate data together from all of these systems and there's a lot of technical aspects to FHIR, but the easiest way to think about it as a non techie is that it's a common language for health IT systems to share information.
So, for example, if you speak French and I speak Spanish but we both speak English, then we can communicate. FHIR is that for health IT systems and data. You've also probably heard the term API, or application programming interface. This is the code that governs the access points to a system and returns data when it's pinged. And the FHIR standard created a standardized API to allow the exchange of clinical and business health related data. One of the most exciting things about FHIR is that it's an easy way for software developers to work -- it's easy for software developers to work with. This facilitates innovation and competition in the area of health IT and really allows lots of different application developers and software developers to create tools to help patients and doctors improve care.
And that's why CMS is so excited about FHIR. We see it as a great way for empowering the drive towards interoperability and empowering patients with their data getting it out of the IT systems and into the hands of patients and their doctors and their caregivers in a form that allows them to use and share this data to -- for better care, to improve care coordination, and to improve health.
Bill Polglase: Thanks so much for that useful background, Allison. I now have a better understanding of how FHIR enables interoperability and allows for these data advancements we’re so excited about.
Now let’s hear from some of the attendees at the Blue Button Developers Conference.
First, we’re talking with Aneesh Chopra, president of CareJourney, an open data service that democratizes care interventions research for providers, payers and pharma on the move to value.
Aneesh, What are your thoughts about today? How did it go?
Aneesh Chopra: I think today exceeded expectations. We saw a mixture of pretty positive policy announcements from CMS putting these new interoperability standards into production. The data at the point of care announcement, I think, is a breakthrough in ensuring patients get better care because the information about their history will be accessible to doctors who are treating them. But I also think the industry commitments that you heard on the health plan side and on the provider side to advance modern FHIR-based APIs for both debt exchange can be just as impactful. And so, we had a mixture of CMS leading with its own announcements, but also facilitating and encouraging the private sector to make a difference. And that combination of public and private action really demonstrated progress, and it makes the Blue Button developer conference home to, hopefully, an annual cycle of improvements for the industry. So, kudos to the team for success.
Bill Polglase: So, what do you think some of the next steps are between this year and next year?
Aneesh Chopra: Well, for sure we're going to be celebrating usage and adoption. So, we'll have a lot more apps deployed, a lot more case studies of how consumers are benefiting from this information, and hopefully feedback from sessions like today to make the next turn of the wheel even more effective. More data flows, faster, with more use cases. And I think that once you get on the flywheel of success as we're seeing now, you're going to have just the opportunity build on progress and that's what we're seeing.
Bill Polglase: And is there anything you want to add on the Blue Button program or just your experience with CMS, especially?
Aneesh Chopra: Yeah. No, I think the Blue Button developer program has been really trailblazing in finding ways to bring the app developer community into HIPPA protected data in a thoughtful way. And that's not easy to do. And it's suddenly set the standard, if you will, for how organizations welcome third party app developers into their healthcare data infrastructure. And so, even just simply serving as an example, I applaud the role that CMS has played
Bill Polglase: Thanks, Aneesh.
Now let’s hear from Danielle Lloyd with America's Health Insurance Plans. That's the trade association that represents health plans nationally.
Danielle, why is your organized interested in the Blue Button Developers Conference?
Danielle Lloyd: Well health plans are soon going to be required to put out a significant amount of data through open APIs. The final rule is not out but in some fashion. And today we want to learn more about what the developers are interested in doing with that information from their private plans.
Bill Polglase: Can you tell us why America’s Health Insurance Plans thinks interoperability is important?
Danielle Lloyd: Absolutely. Interoperability is key to care coordination and ensuring that the providers, and the consumers, and the health plans, too, have the information they need to really improve care and reduce costs at the same time. So, we do believe that it's important to make sure that the information can freely flow among the different stakeholders to do
Bill Polglase: Thanks so much for that perspective, Danielle.
Now let’s hear from someone in the medical technology industry, Peter Lee, the corporate vice president for Microsoft Healthcare.
Peter, what’s so exciting about being at this Blue Button Developers Conference?
Peter Lee: Oh, I think, you know, one of the fundamental blockers to a better health care world is data interoperability. And what has been happening today here at the White House is really just injecting more energy, more progress, and also a spirit of the entire industry coming together in order to allow the frictionless exchange of health data. And so, for a company like Microsoft, this is not only just good for people, good for our customers, but it actually helps our business. Because the more data that flows around in the world, the better our business and prospects are.
Bill Polglase: So, what was some of the most exciting things you heard this morning at the announcement section?
Peter Lee: Well, there is a big emphasis on the technology side on bulk data export. That's just really fundamental to really kind of accelerating the exchange of data. That's a very kind of technical, in-the-weeds thing. And then of course, on the policy side, the price transparency is huge, not only from the policy aspect, but it's going to spark the development of new technologies to support how health organizations can create price transparency. And so, all of that, I think, is, you know, those two things are just very exciting to me.
Bill Polglase: Is there anything else today you’re looking forward to hearing about?
Peter Lee: Well, we're always kind of keeping our ears to the ground, to seeing what people are doing and thinking about. You know, last year, at this conference, we found that people were thinking really innovative thoughts. You know, it's not just about making sure that consumers get access to their health data, when and where they need it. It's doing things like tracking the spread of antibiotic resistant microbes, super bacteria, through the health system. If you can do that, tracking earlier, stop in his tracks, you can really save lives. And FHIR is actually being used by some great organizations to do exactly that. And so, it's those sort of innovative ideas that we really just, really gets us excited. Makes us think hard about exactly how we should architect our services to support those things.
Bill Polglase: Thanks so much Peter, we really appreciate your insight. Let’s now talk with one of your colleagues at Microsoft Healthcare, Josh Mandel, the Chief Architect.
Josh, what are you most excited for today?
Josh Mandel: One of the things that I'm really excited about is a group of cloud providers including Microsoft, Amazon, Google, Oracle, IBM, Salesforce. All these cloud providers are getting together in support of health data standards. We made a commitment together last year on the stage here and we're sharing an update this year about all the work that we've done in support of those standards since last year.
Bill Polglase: Why is the work you’ve done on supporting the development of new standards for bulk data important?
Josh Mandel: Taking care of populations is hard work. You need to understand the risk and the individual needs of specific people within those populations. And in order to do that well, we need to be able to apply tools at scale to tens of thousands or millions of patients all at once. So being able to share data at that scale in a performant way becomes very important. If you can only access data one patient at a time, moving data around simply takes too long, doesn't perform well enough to use it in real life.
Bill Polglase: So, was there anything specific you’re looking forward to hearing about today?
Josh Mandel: I mean, one of the things that I've been super excited about has been the work that CMS has been doing directly to support not just the development, but the implementation of these same standards. I'm very excited to hear where CMS is going in terms of production level support.
Bill Polglase: That’s really helpful input, Josh. Next we’re going to talk with Arvind Sampath, from eClinicalWorks, another healthcare technology company. Arvind, what are you looking for here today, from the Blue Button Developers Conference?
Arvind Sampath: Just next steps in terms of what Blue Button has to offer. One of the biggest roadblocks that we've observed is the patient consent. In other words, in order for the provider to look at all of the Blue Button API data, every individual patient has to consent. Although accountable care organizations already have a consent model in place, so we'd be curious to know if there is a way that those two worlds would blend. I know there's a new program called BCDA where they are trying to do a bulk data -- bulk load of the data. But I'd like to see if there's a way we can marry the Blue Button program with the BCDA program, especially in terms of consent because that's becoming the biggest hurdle in terms of adoption so to speak.
Bill Polglase: What are your thoughts on where we are with interoperability?
Arvind Sampath: Well, yeah, interoperability is really vague. If you're asking is this a golden age of interoperability, I would say it's the beginning of it. Because we did not have FHIR. We did not have Blue Button 2.0, any of that, like a year and a half, two years ago. So, it is a great step forward is what I would say. And I would look forward to probably private payers also getting on the bandwagon, trying to do something like the Blue Button API. So, there is a standard across the board for all payers and not just Medicare and Medicaid. That would be a great way forward in terms of adoption. But if you're talking about the golden age of interoperability, I think it's the beginning of it right now with FHIR and SMART on FHIR and Blue Button 2.0 and all of these exciting programs are API, so to speak.
Bill Polglase: Finally, let’s hear from Jason McKee, the Director of Experience Engineering for Humana’s digital health and analytics Experience Center. Jason was a speaker at today’s conference. How did your talk about how Blue Button 2.0 was used in the real world go?
Jason McKee: Very well. I think the pilot for the data at the point of care that was announced and that I just got out of the session with was very, very promising, and there's potential applications for our care delivery organization as well as our in-home practice. So I think it's -- it was extremely beneficial to hear from the beneficiaries directly. And hear what a lot of our, you know, user research that we do every week really backs up is that people want to feel safe and want to have someone feel like a partner as opposed to using technology and feeling kind of disconnected from human interaction.
Bill Polglase: There was a roundtable today featuring feedback from Medicare beneficiaries. What was your major takeaway from hearing from Medicare beneficiaries?
Jason McKee: Just that they will absolutely use technology. They want to feel safe and secure in it and aren't as, from their perspective, weren't as comfortable going out and doing it on their own, but felt really comfortable when someone would kind of teach them and take the time to show them how that works. And so, that kind of just underscores and validates some of the research that we've done to that same effect. And so, it was just good to hear that that is true and that that's the way we need to be thinking about it is not how can we, you know, reach them through some massive e-mail campaign, but how can we kind of meet them where they are, and you know espouse the value of things like Blue Button and any programs that we might offer to help them, you know, live healthier lives.
Bill Polglase: And what are some next steps between this year and the next conference?
Jason McKee: I think the biggest next steps for us -- where our focus is, is around making our own version of it available as it relates to the proposed rulings and really using Blue Button as the guidepost of what a successful implementation of sharing data looks like. I think that's the biggest takeaway for us. And then how we can start to advance the prototypes that we've done around patient-facing apps like iBlueButton and that Humetrix has to offer and things of that nature.
Bill Polglase: Thanks to you Jason, and to all of our interviewees for making the time to speak with us about their impressions of the Blue Button Developers Conference, the future of EHR and medical technology, and the work CMS is doing to enable interoperability. We’ll end with some words from CMS Administrator Seema Verma as she kicked off this important conference – which also coincided with Medicare’s 54th birthday:
ADMINISTRATOR SEEMA VERMA: I believe a future where we leverage new technology while respecting EHR proprietary issues is possible. And it’s a journey that we’re on together. This administration is always listening, and we’re here to remove the roadblocks that are standing in your way of driving innovation. And so, my challenge to you today is to figure out how to take full advantage of all of the data that we’re unleashing to lower cost and to improve quality, to support a more sustainable healthcare system for all Americans. Ultimately, our work together could change the lives of millions of America -- Americans, and the trajectory of our nation’s healthcare spending. And I can think of no better way to honor the Medicare program today on its 54th anniversary.