Federal health officials from CMS and CDC are adopting USCDI standards to further interoperability and public health equity goals.
Officials from the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC) and the Office of the National Coordinator for Health IT speak on a data interoperability panel at the HIMSS conference in Chicago on April 18.
The latest in a collaborative federal effort to modernize public health data includes a new office implementing a comprehensive public health data strategy and greater alignment within the core set of data standards fueling health IT interoperability. The overall effort also aims to help achieve public health equity goals.
A new Centers for Disease Control and Prevention (CDC) office — the Office of Public Health Data, Surveillance, and Technology — is one of several CDC Director Rochelle Walensky announced in 2022 in response to lessons learned from the COVID- 19.
The new service aims to fill gaps in access to public health data and thereby improve decision-making and response to public health emergencies.
“As we open the new office, one of our departments will be dedicated to data policy and standards work. Working in public health, at CDC, but most importantly with our health care and with our federal partners, to really accelerate the work will be to incorporate standards and interoperability, especially in our core data systems,” said Jennifer Leyden , acting director of the panel office at the HIMSS conference in Chicago on Tuesday.
A foundational tool for this work is the US Core Data for Interoperability (USCDI), a set of health data classes for nationwide, interoperable health information exchange that continues to evolve. The Office of the National Coordinator for Health IT (ONC) is preparing to release the fourth version of these standards this summer to include 20 new data elements within one new and eight existing data classes.
Some of these new data elements include alcohol use, average blood pressure, and allergies to non-medication substances.
As ONC continues to refine USCDI, the new versions raise the bar for what public health leaders call a baseline vision for the future of interoperable health data that advances current health equity goals.
“Don’t let harmonization come after the fact, do it when you build,” said ONC Office of Policy Deputy Director Elizabeth Myers. “This is a deliberate step to choose harmonization as the path to its construction.”
The Centers for Medicare and Medicaid Services (CMS), along with the CDC, is one of the prominent partners using the standard to transform data modernization around digital quality measures (dQM), or data that can come from multiple sources, such as medical devices for patients compared to electronic clinical quality measures (eCQM) or electronic medical record data alone.
“One of the challenges in measuring quality is the lack of consistency,” said Michelle Schreiber, director of CMS’s Quality Measurement and Value-Based Incentives group. Schreiber described how the lack of consensus about what constitutes the best measure of blood pressure, for example, has “created all kinds of chaos.”
“We’re looking to resolve this issue and make sure that doesn’t happen as we look at data standardization,” she added.
Because equity is a key component in high-level federal strategic visions such as the President’s Management Agenda and the Public Health Data Strategy, one continuing question will be how factors such as maternal health or social determinants of health affect the USCDI .
“It’s a difficult balancing act because to some extent we have the limitations of the scope of the regulations,” Myers said. “We have to try to figure out how to balance what is the bottom versus how do we facilitate what is built on top of USCDI is the floor.”
“Health equity is actually one of those great use cases when we start talking about USCDI,” Schreiber said, citing the public-private project Gravity, which created a grassroots approach to building social data for integration into clinical care. “[The project] it’s actually making its way into the USCDI conversation, so things like social drivers of health, for example, that haven’t really been captured before will end up being built into USCDI and ultimately … policy.”
Setting health standards through USCDI is just one of many initiatives to improve how data is shared and accessed. Another notable initiative is CMS’s December 2022 proposed rule that would streamline prior authorization processes and require payers to implement standards to allow for more complete patient records when transitioning between payers.
“Building on the technology foundation that was established in the May 2020 CMS Interoperability and Patient Access final rule (85 FR 25510), these policies would play a key role in increasing efficiency, reducing overall payer burden, and provider and improving patient access to health information,” a CMS spokesperson told GovCIO Media & Research.