Government // Enterprise Architecture
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Medicare Details IT Modernization Plan

Agency aims to transform into an information-centric organization to improve its delivery of healthcare services and manage new programs and requirements outlined in federal law.

Health IT Boosts Patient Care, Safety
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Slideshow: Health IT Boosts Patient Care, Safety
The report said CMS' Enterprise Data Environment (EDE) is the central technical hub of its Health Care Data Improvement Initiative (HCDII). "The essence of the EDE core design is to improve the integration, completeness, quality, timeliness, and accessibility of CMS data," it said.

The document also said, "The vision is to transform the data environment from one focused on processing claims to one with state-of-the art capabilities for data analysis and information sharing. CMS knows that its data are not sufficiently integrated to provide consistent help in program management decision making."

CMS recognizes that it must transform itself into an information-centric organization if it is to improve its delivery of healthcare services and manage new programs and requirements, the report explained. To that end, EDE will support the implementation of electronic health records (EHRs), the Affordable Care Act, and CMS' priority program areas, Medicaid and CHIP transformation, and managed care encounter data for Medicare and Medicaid.

The agency also outlined the difficulties it faces, and said its systems are unable to provide 360-degree views of patient and provider information.

"The agency's beneficiary and provider systems can be characterized as a fragmented patchwork. At this time, CMS cannot combine patient-based Medicare Advantage encounters, prescription drug, Medicare hospital, Medicare physician, durable medical equipment, and Medicaid data to support a longitudinal patient healthcare view. Each CMS stakeholder must search for the most authoritative data from a variety of systems and do his best to understand the inconsistent dictionaries, structures, data lifecycle phase, and other complexities of each system," the report said.

"For example, in fee-for-service (FFS) Medicare alone, there are more than 30 fragmented, unsynchronized sources of claims data," the report said. "This situation will worsen when CMS is asked to provide national-level data integration to support predictive modeling analytics, comparative effectiveness research, health insurance exchanges (HIE), and value-based purchasing (VBP) reforms."

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