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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
Allison Oelschlaeger
Product Manager / DASG, OEDA
Nicole Pham
#HIMSS21
Conflict of Interest
Alberto Colón Viera
Allison Oelschlaeger
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
4
#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
Transforming CMS Data Sharing with User-Centered APIs #HIMSS21
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
Part D Plan Sponsors
Healthcare Provider
Third Party Applications
Transforming CMS Data Sharing with User-Centered APIs #HIMSS21
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
Part D Plan Sponsors
Healthcare Provider
Third Party Applications
Upholding policies that
govern data usage and
data sharing (Privacy Act,
HIPAA)
Transforming CMS Data Sharing with User-Centered APIs #HIMSS21
DASG's services have the challenge of balancing many considerations
17
BB2.
0
BCD
A
DP
C
AB2
D
Beneficiaries
Accountable Care
Organization
Part D Plan Sponsors
Healthcare Provider
Third Party ApplicationsKeeping the beneficiary’s
interest at heart
Transforming CMS Data Sharing with User-Centered APIs #HIMSS21
DASG's services have the challenge of balancing many considerations
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
Part D Plan Sponsors
Healthcare Provider
Third Party Applications
Transforming CMS Data Sharing with User-Centered APIs #HIMSS21
- 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
Transforming CMS Data Sharing with User-Centered APIs #HIMSS21
• 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
3
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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