CMS, CDC Collaborate on Data Standards to Transform Public Health

The latest in the collaborative federal effort to modernize public health data includes a new office executing a comprehensive public health data strategy and more alignment within the core set of data standards fueling health IT interoperability. The overall effort also intends to help meet 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 pandemic.

The new office aims to address gaps in public health data access and thereby improve decision-making and action around public health emergencies.

“As we stand up the new office, one of our divisions will be dedicated to data policy and standards work. Working across public health, across CDC, but most importantly with our health care and with our federal partners to really accelerate the work will be the incorporation of standards and interoperability particularly across our core data systems,” said the office’s Acting Director Jennifer Layden on a panel at the HIMSS conference in Chicago Tuesday.

A foundational tool to this work is the U.S. Core Data for Interoperability (USCDI), a set of health data classes for a 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 non-medication substance allergies.

As ONC continues to refine the USCDI, new versions raise the floor for what public health leaders call the baseline vision for the future of interoperable health data, which furthers ongoing health equity goals.

“Don’t let harmonization come after the fact, do it when you’re building,” said ONC Office of Policy Deputy Director Elisabeth Myers. “It’s a deliberate step of picking harmonization as a pathway to build it.”

The Centers for Medicare and Medicaid Services (CMS), along with CDC, is one of the prominent partners leveraging the standard to transform data modernization around digital quality measures (dQMs), or data that can come from multiple sources such as patient medical devices, versus electronic clinical quality measures (eCQMs), or data solely from the electronic medical record.

“One of the challenges in quality measures has been a lack of alignment,” said Michelle Schreiber, director of CMS’ Quality Measurement and Value-based Incentives Group. Schreiber described how a lack of consensus on what constitutes the best measure for blood pressure, for example, has “created all kinds of chaos.”

“We’re looking to solve that issue and make sure that that doesn’t happen as we look through data standardization,” she added.

With equity being a key component in federal top-level strategic visions such as the President’s Management Agenda and the Public Health Data Strategy, one of the ongoing questions will be how factors such as maternity health or social determinants of health influence the USCDI.

“It’s a hard balancing act because to some extent we have the limitations of the scope of regulations,” said Myers. “We have to try to figure out how to balance what the floor is versus how we’re facilitating what’s built on top of it. USCDI is the floor.”

“Health equity is actually one of these great use cases when we start talking about USCDI,” said Schreiber, citing the public-private Gravity Project, which created a grassroots approach to building social data for integration in clinical care. “[The project] actually made its way on to the USCDI conversation so that things like social drivers of health, for example, that really weren’t captured before will ultimately be embedded in the USCDI and ultimately … policy.”

Defining health standards through USCDI is just one of many initiatives to enhance how data is shared and accessed. Another notable initiative is CMS’ December 2022 proposed rule, which would streamline processes related to prior authorization and require payers to implement standards to enable more complete patient records in the transition between payers.

“Building on the technology foundation that was established in the May 2020 CMS Interoperability and Patient Access final rule (85 FR 25510), in concert, these policies would play a key role in increasing efficiency, reducing overall payer and provider burden, and improving patient access to health information,” a CMS spokesperson told GovCIO Media & Research.