How Liberating Patient Data Improves Patient Care
Access to healthcare data is a fundamental right, both for patients and for their trusted clinicians.
However, data liquidity — delivering the right information to the right people at the right time — is not easy to achieve. This is especially true in healthcare, where data is siloed across a variety of sources such as electronic health records, practice management and billing systems, lab results, patient-reported outcomes apps, and more.
This dizzying array of data leaves patients and their doctors in the dark, with access only to incomplete, outdated health records. For example, many primary care physicians (PCPs) treat patients suffering from multiple chronic conditions, yet struggle to find an up-to-date list of all prescribed medications during in-person visits. When the patient can’t remember, and the datasets are incomplete and flawed, the physician may prescribe a potentially harmful medication or fail to prescribe one that is necessary. In these situations, this lack of transparency can be downright dangerous for physicians and their patients.
An inability to consistently obtain basic information, such as records from a recent ER visit or a list of prior diagnoses, makes it much harder for doctors to offer well-informed care.
Fortunately, there’s been a momentous shift in the industry and federal policy over the past year. New initiatives are aimed at breaking down barriers and empowering patients to control how their healthcare data is used while providing unprecedented access to PCPs, payers, and other healthcare providers.
Starting with the MyHealthEData interoperability initiative from the Centers for Medicare and Medicaid Services (CMS), there are now three channels for accessing electronic health data that put patients and their doctors in control:
- Blue Button 2.0: Through Blue Button, patients can easily select and provide consent to any number of CMS-approved applications. These applications range in how they provide information and insights into a patient’s historical health data from both clinical and financial perspectives.
- Beneficiary Claim Data API: This API is targeted towards enabling Accountable Care Organizations to retrieve Medicare claims data in bulk for their assigned beneficiaries to support population management.
- Data at the Point of Care (DPC): DPC is a new pilot designed to empower physicians to request access to historical Medicare fee-for-service claims for their patients, and thus incorporate this data into their patient care workflows.
In addition, the Office of the National Coordinator for Health Information Technology is working to finalize the Trusted Exchange Framework and Common Agreement. This goal of this agreement is to outline a common set of principles, terms, and conditions to enable a nationwide exchange of electronic health data to health information networks, healthcare providers, and health plans to have secure access to electronic health information when needed.
As Chief Product Officer at Clover Health, I am excited by this progress and applaud CMS, under Administrator Seema Verma, for leading the charge to improve data interoperability in healthcare. Beyond being a Medicare Advantage insurer, we are also a health tech company committed to taking these initiatives a step further for our members and providers.
In fact, we are already building on top of these resources to enhance Clover’s provider-facing technology aimed at improving clinical decision-making at the point of care. Providing a personalized, longitudinal clinical overview of each member, our technology uses proprietary machine-learning models to surface potential new diagnoses and gaps in care and to suggest care plans based on clinical evidence.
Arming physicians with trustworthy, up-to-date patient data at their fingertips is crucial to improving America’s healthcare system. With the convergence of forming interoperability standards and unprecedented data sharing, I’m confident that Clover, along with other payers, providers, and health systems, will be empowered to provide better care and improve outcomes for patients.
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