Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services (2012) / Chapter Skim
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5 Anticipating a Data-Centric Future
5 Anticipating a Data-Centric Future
Pages 107-124
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From page 107... ...
For example, if data from longitudinal studies, clinical observations, and other health care activities were made available to researchers, studies of the comparative effectiveness of alternative medicines could be conducted in a fraction of the time and cost required for clinical trials, which are often extremely 107
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From page 108... ...
Several trends in health care illustrate the broad need for a more data-centric approach, including the diffusion of electronic health records (EHRs) , practitioner positioning into care networks, and increased consumer access to and demand for health and medical information.
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From page 109... ...
Galvin, and the National Roundtable on Healthcare Quality, 1998, "The Urgent Need to Improve Health Care Quality," Journal of the American Medical Association 280(11)
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From page 110... ...
Nationwide investment in EHRs and EHR systems -- enabled through HITECH -- is occurring on such a broad scale that it has the potential to accomplish some sea changes in the information infrastructure of health care delivery across the country and to generate the fine-grain data needed for improved health care delivery. For example, although the focus today is heavily on clinical transactions and data capture, insurance recipients will increasingly have the ability to access information about their health directly through secure patient portals.
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From page 111... ...
An example of the complexity of this effort can be seen with respect to the use of billing data for quality measurement; although some relevant information can be extracted, that data alone is not enough. Future efforts are likely to require ongoing attention to high-resolution information in the form of natural language or formalized data flows realized through an evolution of ontologies, terminologies, and, ultimately, relevant standards that can help to ensure that meaning is not lost in the translation of data to understanding.
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From page 112... ...
Additional information from certain geo graphic regions or practice settings might then be collected, if problems arise, to help illuminate the source of a problem. The committee is aware of the assumption of some that CMS should plan to collect information on patients following what Diamond and colleagues call the "dominant paradigm" for handling population health data: "gather copies of all the detailed information one needs, normalize the information once one has it, and then run queries against that data storehouse."12 Such an approach -- if applied to CMS's role in analyzing and monitoring health care quality, equity, and safety -- has drawbacks in terms of cost and the potential for violations of privacy, and may reduce the acceptability of EHRs for many practitioners.
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From page 113... ...
To permit earlier release of claims, CMS could use a variety of strategies, such as providing an interim data set of the mostused information on a quarterly basis with the limitations clearly spelled out. Many of the modernization steps discussed throughout this report will make data integration easier (for example, integrating the reports from Medicare Managed Care with those from fee for service)
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From page 114... ...
It is reasonable to assume that the equivalent of citizen engagement in health services and health policy research will increase, analogous to social networking in other domains, as will online dialogue relating to the output of such efforts.19 POLICY ANALYSIS One of the most important secondary uses of CMS data on health care encounters is the analysis of current spending patterns and projections of future spending. The number of reports that make use of CMS encounter data is vast; two of the most important are the annual trustees' report 16 See http://www.medicare.gov/Dialysis/.
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From page 115... ...
20 The Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, 2011, 2011 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds , available at https://www.cms.gov/ReportsTrustFunds/downloads/tr2011.pdf, last accessed July 21, 2011. 21 Medicare Payment Advisory Commission (MedPac)
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From page 116... ...
ind=158&cat=3&sub=42, last accessed August 1, 2011. 26 Agency for Healthcare Research and Quality, 2010, "Disparities in Healthcare Qual ity Among Racial and Ethnic Minority Groups: Selected Findings from the 2010 National Healthcare Quality and Disparities Reports," available at http://www.ahrq.gov/qual/ nhqrdr10/nhqrdrminority10.pdf, last accessed August 1, 2011.
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From page 117... ...
CMS leadership also gave presentations to the committee on the primacy of equity in advancing a health quality agenda.32 And indeed, the value of these data has been succinctly described by HHS Secretary Kathleen Sebelius, who stated in her March report to Congress: "Improvements in the way data is collected help to pinpoint and address where 31 Medicare Improvements for Patients and Providers Act of 2008, HR 6331, 110th Con gress, 2nd session. 32 Terris King, CMS Office of Minority Health, 2011, "Health Disparities," presentation to the committee, April 18, Baltimore, Md.
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From page 118... ...
But as has been noted by both the current administrator of CMS and the secretary of HHS,36 and as industry experience demonstrates,37 it is materially more productive and efficient to identify questionable billings in advance of payment. An ability to analyze all claims prior to pay ment as a basic element in CMS's fraud detection would enable unusual patterns to be identified and holds to be placed on those that are most 33 Department of Health and Human Services, Office of the Secretary, Office of the Assis tant Secretary of Health, Office of Minority Health, 2011, Report on Minority Health Activities as Required by the Patient Protection and Affordable Care Act, P.L.
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From page 119... ...
Similarly, pattern analysis of claims submitted by all providers for beneficiaries who have reached retirement age is likely to be productive in terms of identifying unusual and suspicious changes in billing behavior. The current separation of the Medicare and Medicaid programs allows duplicate billings by the same provider for the same service.
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From page 120... ...
at CMS is data integration -- across programs and across patient, provider, and plan domains." See CMS, 2010, "Modernizing CMS Computer and Data Systems to Support Improvements in Care Delivery," December 23, available at https://www.cms.gov/InfoTechGenInfo/Downloads/ CMSSection10330Plan.pdf, last accessed October 21, 2011. 43 CMS, 2011, "New Technology to Help Fight Medicare Fraud," press release, June 17, available at http://www.cms.gov/apps/media/press/release.asp?
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From page 121... ...
Wide public access has the potential to be exciting -- opening up the possibility of a health information economy by allowing anyone to develop innovative analytic measures from the data -- but would also raise concerns about such things as the residual identifiability of individual-level data, biased competitive use of the data, and so on. Such broad disclosure
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From page 122... ...
Benefits to a centralized approach could include: -- The comprehensive ability to measure detailed outcomes; -- Support of large-scale research on comparative effectiveness; -- Public and institutional access to unbiased summary data; and -- Potential for consumers to have direct access to their own integrated data, experience with cases similar to their own, alternative treat ments, and so on. Offsetting these benefits are: -- Technical challenges of operating a national data warehouse for all clinical data; -- Creation of a prime target for security threats; and -- Political challenges related to the role of government with regard to such data.
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From page 123... ...
CONCLUSION Recent pieces of legislation -- including the Medicare Improvements for Patients and Providers Act of 2008, the HITECH provision of the American Reinvestment and Recovery Act, and the Patient Protection and Affordable Care Act -- have the potential to improve health care in the United States, and much of that change is data-dependent. The effective analysis and management of data have the potential to reduce costs, by giving providers the information necessary to choose effective treatments and also by allowing CMS to identify improper payments and prevent fraud; improve overall public health by reducing disparities in treatment and also by rewarding effective outcomes; and empower consumers by providing them with information to manage their own health and also by providing them with information on the quality 47 This model would have an effect on the organization of the data and involve direct interaction with those that fund these capabilities.
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From page 124... ...
124 STRATEGIES AND PRIORITIES FOR INFORMATION TECHNOLOGY AT CMS of providers. A learning health care system should emerge over time, improving the quality, equity, and safety of care for both individuals and populations.
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