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CMS Pilot API

A 360° view of your patients’ history

As patients move throughout the healthcare system, providers often struggle to gain and maintain a complete picture of their medical history. Data at the Point of Care fills in the gaps with claims data to inform providers with secure, structured patient history, past procedures, medication adherence, and more.
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Note: Data at the Point of Care is currently a pilot program from CMS. Learn more

How does Data at the Point of Care reduce your burden and help you improve care?

Reveals the medical history of your new patients

Avoid having to rely on paper, faxes, or the patient’s memory to know past diagnoses, procedures, and medications.

Lets you see how other providers are caring for your patients

Learn about any other provider visits, new diagnoses and medications, completed procedures and preventive items, and urgent care, hospital, or ER visits.

Gives insight into your patients’ medication history & adherence

View medications that were filled at the pharmacy to learn about possible gaps in medication history and adherence.

How does Data at the Point of Care improve your patients’ experience and give them better care?

Reduces their frustration and documentation

Patients no longer need to recall and retell their entire past history at each visit.

Gives them more time with you for current needs

Patients get more of your time to focus on their concerns and issues instead of you wasting time searching for information.

Keeps the entire provider team on the same page

Patients receive better coordination between their providers because the whole team has a full picture of their care.

About the pilot

Data at the Point of Care is a pilot API program that enables healthcare providers to deliver high quality care directly to Medicare beneficiaries by making a patient’s Medicare claims data available to the provider for treatment needs. The information can be accessed in the existing workflow and without logging into another application or portal. Claims information can be used to confirm information, fill in gaps in care, and improve patient safety. For more information about the pilot read our FAQ.

CMS is looking for provider organizations who are interested in connecting first to synthetic claims data and then, after successful testing and validation with the synthetic data, connecting to production claims data for their patients. With a goal of ensuring this information is in the existing clinical workflow, the provider is encouraged to speak to their existing vendors for electronic health records, population health, and record notification to participate with them in the pilot. CMS is seeking input and feedback from healthcare providers and their technology partners throughout the process.

CMS is especially interested in working with healthcare providers who already receive claims from other payers and who have successfully integrated the information into provider's existing workflow. healthcare providers with experience using Blue Button 2.0 or the Beneficiary Claims Data API pilot project are encouraged to request access to the Data at the Point of Care pilot project as well.

Pilot data comes from inpatient, outpatient, and pharmacy claims, including:

  • Diagnoses
  • Procedures
  • Preventive tests
  • Medications

Plus visit data for:

  • Outpatient care
  • Hospital admissions
  • Emergency room care
  • Urgent care

Getting started

  1. Request access to the pilot

    Do this on the Request access page.

  2. You will receive an email

    Within 1 - 2 business days, you will receive an email with instructions on how to access the synthetic (test data) sandbox.

  3. Develop and test

    When CMS is ready to provide access to the synthetic data for testing, they will email you with details.

  4. Provide a demo

    The Data at the Point of Care team will review your implementation to determine whether you’re ready for production. Remember, this is a pilot process that will move slowly.

  5. Perform initial test and feedback cycle

    Receive production credentials and test with production data. Continue providing feedback!

About the data

The claims data is provided using the industry-standard HL7 Fast Healthcare Interoperability Resources (FHIR) resources, specifically the Bulk FHIR specification.

FHIR is a specification for how servers that provide healthcare records should be set up.

FHIR provides a framework for the exchange of healthcare-related data, allowing any system to access and consume this data to solve clinical and administrative problems around healthcare-related data.

Data at the Point of Care will be using the following endpoints from the FHIR spec:

  • patient endpoint
  • explanation of benefits endpoint
  • coverage endpoint

Blue Button 2.0 provides FHIR-formatted data for one individual Medicare beneficiary at a time, to registered applications with beneficiary authorization. See https://bluebutton.cms.gov/.

BCDA provides FHIR-formatted bulk data files to an ACO for all of the beneficiaries eligible to a given Shared Savings Program ACO. BCDA does not require individual beneficiary authorization but does allow a process for patients to opt out of data sharing.

Data at the Point of Care pilot provides FHIR-formatted bulk data files to fee-for-service providers for their active patients as needed for treatment purposes under HIPAA. Data at the Point of Care does not require individual beneficiary authorization but does allow a process for patients to opt out of data sharing.