Transforming CMS Data Sharing with User-Centered APIs

Transforming CMS Data Sharing with User-Centered APIsSession #112, August 11, 2021

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Product Manager, CMS

Anna Routh

DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS.

Product Manager, CMS

Nicole Pham

Engineer, CMS

Alberto Colón VieraDirector, OEDA; Chief Data Officer, CMS

Allison Oelschlaeger

2#HIMSS21

WelcomeProduct Manager / DASG, OEDA

Anna Routh

Engineer / DASG, OEDA

Alberto Colón Viera

Director, OEDA; Chief

Data Officer, CMS


Product Manager / DASG, OEDA

Nicole Pham

#HIMSS21

Conflict of Interest

Alberto Colón Viera


Anna Routh

Nicole Pham

Each person has no real or apparent conflicts of interest to report.

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#HIMSS21

Agenda

• What is CMS doing?

• Appreciation of the complexity of this CMS service

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#HIMSS21

Learning Objectives

• Identify the user groups who can receive Medicare claims data via a CMS Application Programming Interface (API), and describe the use cases

• Explore the human centered design methodology to design with the users,

not for them

• Describe the methods used to track success of the products

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#HIMSS21 6

Data & Analytics

Strategy Group

(DASG)

Mission

Build customer-focused,

standards-based

products that enable

health data access to

beneficiaries, providers,

and industry partners for

improving healthcare

delivery and care

coordination.

Vision

Transform U.S. healthcare

by enabling outcome-

driven care and

empowering decision-

makers with the data

they need.

#HIMSS21 7

BB2.0

• For Medicare

beneficiaries

• Single data call

API Ecosystem 2018

BFD

• Backend for

DASG APIs

#HIMSS21 8

BB2.0 BCDA

• For Medicare

beneficiaries

• Single data call

• For Accountable

Care

Organizations

(ACO)

• Bulk data calls

• For Providers

• Single and Bulk

data calls

• For Part D

plan (PDP)

sponsors

• Bulk data

calls

DPC AB2D

API Ecosystem 2021

BFD

• Backend for

DASG APIs

#HIMSS21 9

Security

Our team has

grown in the last

year

● Strengthened our product management,

incorporating product and research thinking

● Build WITH our direct users

LIKE, A LOT

Product Management

Engineering and Infrastructure

DASG

#HIMSS21 10

• No human centered design roles

• Many risks to not having HCD

• So even though we aren't resourced

in the perfect way, we embrace

HCD anyways.

Having no HCD titles but driving HCD outcomes

http://www.e-

cartouche.ch/content_reg/cartouche/ui_access/en/html/GUIDesign_UCD.html

#HIMSS21

DPC

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Who have we reached?

51BCDA

46BB2.0

24AB2D

8

#HIMSS21

7DPC

10BB2.0

5BCDA

Major Research Initiatives

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2AB2D

#HIMSS21

How do we

conduct research?

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Discovery Sprints

Google Group Threads

Conferences and Events

Holistic DASG ecosystem customer understanding

In-Person and Virtual Meetings

Improving our synthetic data

Version 2 of the APIs (including the upgrade to FHIR r4),

Validating and learning of additional use cases

Improving the credentialing process, Rostering and

Attribution, Communication preferences

Transforming CMS Data Sharing with User-Centered APIs #HIMSS21

Medicare beneficiaries already interact with a rich community of healthcare providers

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Beneficiaries

Accountable Care

Organizations

Part D Plan Sponsors

Healthcare Provider

Third Party Applications


DASG's services strive to meet the existing user journeys surrounding beneficiaries

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BB2.

0

BCD

A

DP

C

AB2

D

Beneficiaries

Accountable Care

Organization


Healthcare Provider



DASG's services have the challenge of balancing many considerations

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BCD

A

BB2.

0

BCD

A

DP

C

AB2

D

Beneficiaries

Accountable Care

Organization


Healthcare Provider


Upholding policies that

govern data usage and

data sharing (Privacy Act,

HIPAA)



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BB2.

0

BCD

A

DP

C

AB2

D

Beneficiaries

Accountable Care

Organization


Healthcare Provider

Third Party ApplicationsKeeping the beneficiary’s

interest at heart



18BB2.

0

AB2

D

BCD

A

BB2.

0

BCD

A

DP

C

AB2

D

Working toward healthcare

industry standards (such as

using HL7’s Fast Healthcare Interoperability Resources)

Accountable Care

Organization


Healthcare Provider



- DASG services are open source: The technology is developing out in the

open.

- DASG collaborates with technology communities, i.e. those around the Fast

Healthcare Interoperability Resources (FHIR).

- DASG conducts research constantly to understand and identify the most

important problems.

- DASG has an iterative process with production. We keep prototyping and

learning as a way to get feedback early.

Given these challenges, it has been essential for DASG to design with users, not for them

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#HIMSS21

Examples of our user perspectives and feedback

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Providing value

“This tool is going to be really

amazing because it will give so

much power, knowledge, and

ability when the patient is with us.”- From a provider interview

“Accessing Medicare Parts A & B

[claims data] would be

instrumental in helping us refine

our formulary.”- From an Part D Plan Sponsor interview

#HIMSS21

Examples of our user perspectives and feedback

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“BCDA feels like the future of claims

data exchange.”- From an Accountable Care Organization

interview

Proving interoperability

of healthcare data

“The first time we turned claims data

on in an EHR, I said 'aha! I got it!’”- From a provider interview

#HIMSS21 22

API’s

We use Application Programming Interfaces (APIs)

Policy

Our products provide technical

implementation feedback to policy makers

Interoperability

Our users aren’t specific about FHIR but

they do want interoperability

Leading by

example

Development Experience

Aim to continually improve our documentation,

data dictionaries and tools

#HIMSS21 23

CARIN for Blue Button

FHIR R4 conformant

CMS Connectathon

Our work with the FHIR community

DaVinci Member

Attribution workgroup

FHIRCommunity

#HIMSS21 24

DASG

Ecosystem

Shared Research Sessions

Share learnings and findings from our research sessions

Book Clubs

Good services, civic technologists guide

Shared Communities of Practice

Engineering CoP and Product and Design CoP

Shared Agile Ceremonies

PI Planning, Sprint Demos, Scrum of Scrums

Collaboration and Communication

Slack Channels, Open confluence pages

DASG Ecosystem Website

Currently creating a DASG ecosystem website

One DASG


• We set goals by establishing annual strategies at the OEDA and DASG levels

• We measure success by establishing and tracking the following:

• Objectives and Key Results (OKRs) every Program Increment (10 weeks)

• A North Star metric

• Key Performance Indicators (KPI’s)

• and Service Level Objectives (SLO’s)

Goal setting & measuring success

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Rate of Growth with

our North Star Metrics

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+37%

80%

+335%Beneficiaries served

335% growth in total number of

beneficiaries served through our API products since Jan 27, 2021.

FHIR R4 & CARIN BB

80% of our API products are fully

conformant with FHIR R4 and the CARIN for Blue Button IG.

Entities served

37% growth in total number of

entities served through our API products since Jan 27, 2021.

#HIMSS21 27

The Future

Incorporating service design perspective

→ CoPs1

Improving the development experience with

developers and healthcare leaders→ FHIR workgroups; better synthetic data and documentation

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Improving our products based on user needs

→ User research2

Improving the delivery of care through data sharing

→ Exploring new use cases and collaborations4

What’s next for DASG?

#HIMSS21

Questions?

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#HIMSS21

Thank you!

Speaker contact information:• Alberto Colón Viera, [email protected]• Anna Routh, [email protected]• Nicole Pham, [email protected]• Allison Oelschlaeger, [email protected]

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Transforming CMS Data Sharing with User-Centered APIs

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