Premier Nudges CMS to Boost Patient Data Exchange, Interoperability

CMS should establish cross-continuum data standards, automate the prior authorization process, and integrate administrative and clinical data to advance interoperability and improve patient data exchange, Premier healthcare alliance outlined in a recent letter to CMS Administrator Chiquita Brooks-LaSure.

The healthcare alliance noted that while the ONC interoperability rule has helped promote seamless data exchange across the care continuum, nationwide health interoperability will require the support of CMS and its federal partners.

“It is essential to address ongoing interoperability challenges so that providers can improve care delivery, patient safety and performance, and to drive operational efficiencies,” Blair Childs, senior vice president of public affairs at Premier healthcare alliance, wrote in the letter.

“Without connectivity across the care continuum, data collection is fragmented and does not provide the total picture necessary for healthcare providers to deliver informed, coordinated care,” he continued.

COVID-19 has highlighted the fragmented nature of care delivery, Childs noted.

“Current approaches to prevent, manage, mitigate, and track cases during the COVID-19 public health emergency relied on home-grown, siloed, and antiquated data collection systems that are grossly inadequate—data sets are incomplete, lagged and collected in the wrong settings, rendering them virtually useless for identification and/or prediction of disease spread trends,” he wrote.

“The nation needs real-time data for syndromic surveillance, providing an upstream alternative to identifying cases before tests can detect them or patients are hospitalized,” Childs continued.

Premier urged CMS to establish cross-continuum data standards, rather than extending the collection of siloed standards to additional providers.

“A holistic approach is needed for data standards whereby standards are developed for use across care settings, though provider types vary in the level of acuity and types of conditions they are clinically appropriate to serve,” Childs wrote.

The healthcare alliance also encouraged CMS to work with ONC and its Health Information Technology Advisory Committee (HITAC), as well as the National Committee for Vital and Health Statistics (NCVHS) to integrate administrative, financial, and clinical data.

“There is an increasing need to leverage administrative, financial, and clinical data for multiple use cases, including payment, performance and quality improvement, research, and predictive analytics,” Childs explained.

Next, Premier called for CMS to automate the prior authorization process to reduce provider burden and ensure access to accurate health information at the point of care.

Consistent with its proposal to automate prior authorization, the alliance requested that CMS implement the Appropriate Use Criteria program included in Protecting Access to Medicare Act (PAMA) of 2014, which uses automation to ensure clinicians follow evidence-based care practices when ordering advanced imaging exams.

Premier then suggested CMS ensure that post-acute care providers, like skilled nursing facilities (SNFs), have interoperable data and access to electronic clinical surveillance technologies that can prevent healthcare-associated infections (HAIs).

“Clinical analytics technologies are currently not widely used in SNFs,” Childs wrote. “SNFs should have the same access to tools that will help them combat infection spread during any future outbreaks of COVID-19 and during their day-to-day operations, but unfortunately funding remains a significant barrier.”

To that end, CMS should explore policy options to incentivize SNFs to adopt this technology to reduce and prevent HAIs, the alliance asserted.

Next, Premier urged the agency to consider identifying a set of priority health IT activities as alternatives to the traditional program measures. This would allow hospitals greater flexibility by allowing them to use existing health IT activities to meet care coordination and interoperability goals. 

Finally, the alliance applauded CMS efforts to promote interoperability through model testing that focuses on using emerging standards and non-traditional patient engagement platforms.

“Premier supports advancing interoperability across the care continuum to help ensure interoperability across EHR systems and settings of care to unlock barriers to data sharing and care coordination between health systems, physician group practices, independent physicians, and post-acute care settings,” Childs wrote.

“Ongoing measurement to understand the status of health information technology adoption by providers and the ability of providers to share information across the continuum will be important in understanding the effectiveness of interoperability initiatives,” he concluded.