CMS ehealth strategy aims to build HIT infrastructure

Speaking during a webinar that kicked off National Health IT Week, Robert Tagalicod, director of the Centers for Medicare & Medicaid Services ' (CMS) Office of E-Health Standards and Services, said that the designated week serves as an opportunity for the agency to share its strategy for electronic data-driven healthcare over the next five years.

That includes joining mobile technologies with clinical savvy and practice to save lives, dramatically improve patient care and significantly lower the costs through the mobilization of healthcare data and interventions that engage consumers where they are, whether rural, urban, at home or in a facility and regardless of socioeconomic status, he said.

"CMS is taking the lead in ehealth strategies and implementation given our policy, payment and program levers," Tagalicod said. Those levers include administrative simplification, health information exchange and privacy and security initiatives.

Tagalicod said the agency is attending to several trends as a major payer and regulator including mobile technology, broader access to telemedicine, patient-centered personalized medicine, clinical, genetic, genomic and environmental information, greater demand for real-time information, interactive healthcare via social medicine and Web 2.0 applications and analytics including user-friendly interactive digitalization. “The theme of this week is unmistakable—we acknowledge the increased demand for consumer engagement and patient access to information. Our vision of ehealth is based on those trends.”

Achieving the goals requires partnership, Tagalicod said. “We’re working across federal and private sectors to increase the level of ehealth standardization industry wide." Federal partners are important “because we need standardized health data to get to interoperability. We recognize that people cross different healthcare settings and payment settings. We need to get information across these settings to provide quality and safe care."

To achieve these “overarching improvements,” Tagalicod said there are four strategic objectives:

1. Optimal alignment of ehealth policies and implementation across public and private sectors. "We understand and hear that there are several policies across [the Department of Health & Human Services] that could be better aligned and better communicated. Our commitment is to address those opportunities for alignment so it is easier and less burdensome to deliver better care."

2. Standardization of data management and analytics. "The opportunity of the aligning of exchanging data claims and payment data with clinical information from EHRs and HIEs along with patient sentiment and behavior data is a way of looking at and transforming healthcare."

3. Enhancement of privacy and information security compliance and efforts to make sure that people understand how their data are being used to improve healthcare.

4. Strengthen ehealth outreach, education, technical assistance and capacity building. "Whether consumers or providers...education interventions need to be targeted to certian cohorts so they can use innovative models and pilots to transform healthcare practices."

Ehealth has several parts, said Robert Anthony, CMS health insurance specialist. The agency is working to put together an ehealth roadmap to show how the different programs come together to allow data exchange and interoperability between systems that can increase care coordination to increase quality of patient care. "That’s really what ehealth is all about for us--improving outcomes."

Anthony said his office is always asked why so many different programs—Meaningful Use, quality reporting, ICD-10, payment reform, etc.—are happening at the same time. “When you really stop and think about the end result of all these different programs, it really represents a profound shift in the healthcare landscape when fully implemented. We will have a health IT infrastructure that supports lots of settings and complement initiatives so we can start to manage risk and apply targeted, coordinated interventions. In a lot of ways, CMS is becoming a population health agency with these different efforts.”

The “notion of interoperability” underpins these efforts, Anthony said. The sharing of the healthcare data that comprises national healthcare information and delivery infrastructure while ensuring privacy and security is key to making information exchange possible and useful.” Interoperability efforts also address the fact that the overwhelming majority of Americans are receiving care from multiple providers, he added.

The health IT landscape is evolving and the HER incentive program has made a massive difference, Anthony said.  “We are adopting this infrastructure upon which we can build so much more to be effective in meeting the triple aim.” Without the ability to move data from one provider to the next, data are limited in their usefulness, he said. “Centralized health information exchange is where we start to see the aggregation of data that can be transformed into useful services that will support direct patient care and population health. Once we integrate data through HIE, we can normalize data standards and the more we see HIE proliferate, the more data are aggregated and used, and the more providers will accept and use those data standards.”

Anthony compared to the various components of ehealth as interlocking pieces that serve as building blocks for the health IT infrastructure.