The following are just some of the types of information that emerging demands will likely require CMS to provide:

  • Information to support consumers and patients in health maintenance and improvement. CMS is experiencing increasing expectations and demands for making data and information tools available to support consumer empowerment and patient-centered medical care. Examples of such expectations and demands include the following: interfacing more proactively with program beneficiaries and patients through consumer-friendly user interfaces (making secondary non-electronic channels available as needed), offering access to personal health information, and providing users with decision-support tools to help them make better-informed decisions about health choices.

  • Information to support a “learning health care system.”4 CMS must identify those areas in which timely access to accurate information will best contribute to objectives for health care improvement just as other large enterprises are using information to meet analogous business objectives. Examples of such areas include the following: (1) collecting and disseminating meaningful data on quality (especially data that can be generated from and incorporated readily into provider workflows), (2) promoting population health (which also has specific implications for data needs and data structures),5 and (3) generating claims data in a timely fashion (e.g., to support the effective functioning of accountable care organizations6). CMS may well need to be able to partner with patient-centered medical homes to provide the necessary data.

  • Information needed to implement the meaningful-use program for electronic health records. Pursuant to the provisions of the HITECH Act described in Chapter 1, CMS must determine whether an eligible health care provider meets the prescribed meaningful-use criteria in order to determine when it is appropriate for incentives to be paid or for penalties to be applied. CMS is the final arbiter with respect to meaningful-use outcome measures, which will ultimately need to be generated from EHR data. This responsibility demands new levels of IT sophistication from the agency and its partners. Not only will CMS have to be able to share data and extract information related to meaningful-use criteria from clinical health information, but it will also be playing an integral role in defining how such data are collected. This new role raises a host of issues related to standards, data modeling, terminology, best practices, accuracy, completeness, security, and confidentiality, and it will need to be factored in to the design of CMS’s process and planning for its future IT infrastructure.

  • Consumable data about health provision and outcomes. CMS will need to support the provision of data and information, often of new types, to a wide variety of users. This is largely

4

 See the Institute of Medicine’s Roundtable on Value and Science-Driven Healthcare and its associated reports (available at http://www.iom.edu/Activities/Quality/VSRT.aspx) for more on the topic of a learning health care system.

5

See D.J. Friedman and R. Gibson Parrish II, “The Population Health Record: Concepts, Definition, Design, and Implementation,” Journal of the American Medical Informatics Association 17:359-366, 2010.

6

The term “accountable care organization” refers to a health system model that organizes care providers into entities responsible for managing patients and delivering a continuum of care across different institutional settings, such as hospitals, outpatient clinics, and so on.



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