Last month, the Centers for Medicare & Medicaid Services (CMS) announced the formation of the Office of Enterprise Data and Analytics (OEDA) to oversee improvements in data collection and dissemination as the agency strives to be more transparent.
To head this office, CMS appointed Niall Brennan, the agency’s first Chief Data Officer (CDO). According to a CMS news release, OEDA will help the agency better harness its vast data resources to guide decision-making and develop frameworks promoting appropriate external access to and use of data to drive higher quality, patient-centered care at a lower cost. The creation of this new post and the data and analytics office builds on the steps CMS has taken in recent years to better harness its data resources both internally and externally, the agency stated.
The federal government clearly understands the power of data, especially Medicare data, and pushing the envelope with data transparency and interoperability will no doubt be a challenge. According to Arien Malec, former Office of the National Coordinator for Health Information Technology (ONC) Direct Project coordinator, now is the time to remove silos in government healthcare programs to help foster true interoperability (while also balancing issues around privacy).
Malec is currently the vice president, data platform solutions for RelayHealth, the Alpharetta, Ga.-based McKesson business unit that focuses on improving clinical connectivity. Having also served as ONC coordinator for the Standards and Interoperability (S&I) Framework, Malec is familiar with the challenges and opportunities that lay in the wake for Brennan. In a recent interview with Healthcare Informatics Associate Editor Rajiv Leventhal, Malec discusses the CDO position, the new federal office dedicated to data, as well as the hurdles and opportunities that lie ahead for both.
The CDO position seems to be an evolving one in many industries. Why is now the right time for this position in healthcare?
If you think about CMS, they are the nation’s largest payer and as such, their mission has been until now, to primarily work on data processing such as making sure claims get paid well, accurately, and on time. With the appointment of Todd Park as Chief Technology Officer (CTO) of the Department of Health and Human Services (HHS) in 2009 (Park recently stepped down as U.S. CTO), the focus was on opening up data with the precedent in mind of the National Oceanic and Atmospheric Administration (NOAA). NOAA opened up the weather data and spawned the whole industry with weather applications, really making that data more available across the nation. Todd had a mission to look at the sources of data across HHS, and his discovery at the time was that there was tremendous use of the data that CMS is administering on our behalf, and that use can further CMS’ primary mission as well as a secondary use. It’s really about CMS understanding the value that the data that they processing and collecting to serve their primary mission has to also serve a secondary mission.
Niall Brennan has a tough job ahead of him. What should his main focus be?
His focus should be one that serves the internal mission, as well as making the data more available internally and externally. Internally, things such as analytics on payment processing on waste fraud and abuse. Both of those things at their core have common concerns. If you think about CMS’ primary role as a data processor, there’s a certain level of data governance that needs to get accomplished, but if you want to make that data more broadly available, you’ll have to look at data governance more broadly. That’s a complicated thing, and involves a changing culture at CMS, making sure that the work they do benefits not just their primary role but also the nation as a whole. Niall will have support and backing throughout the agency, but I wouldn’t underestimate how much time it could take and how difficult it could be.
Data transparency is now becoming a core goal of CMS, right?
Absolutely it is. CMS is recognizing both the wealth of the data they have and the power, as well as the need to acquire new skills and competencies needed to [make data more broadly available]. And it will require a change in culture and mission, so it’s important to have someone at the top pushing it.
Is getting past these fragmented data silos a critical element in all of this?
One of the most interesting things about this position is that, because CMS is the nation’s largest payer, and because the agency actually has standards for interoperability—at least in regards to claims data—it has a tremendous role to play in standardizing more broadly. For example, CMS is sitting on the nation’s largest provider directory and that directory is currently available for a limited set of purposes, for administering payment processes and making sure there is a National Provider Identifier (NPI). Work is being done now to take that CMS provider directory and make it more available for the country. If they could do that, it will open up some of the questions that people are asking about interoperability.
What do you see in terms of this future of this position?
It is really mission-critical to create a C-level position for this. Folks need to see that, because what that does is create alignment and structure. We see this with the CIO, as that position used to report to finance. We have also seen this with the CTO role, which has been transformative in the federal government. And now we have the CDO. My prediction is that this will be a temporary phenomenon though, that it’s important now to raise and broaden this competency and business function. But 10 years from now, data will be how you run the business.
You used to work on the S&I Framework. How would you gauge the state of interoperability today?
When I left the Framework to go to ONC in 2009, we would plug in big electronic health records (EHRs) to get to other big EHRs, and the people who had them were large multi-specialty clinics connecting to hospitals. It was all the big guys who had technology. When I came back 18 months later, there were EHRs coming up all over the place. And that’s the big change in interoperability, with the prevalence of EHRs that has been triggered by meaningful use. We are seeing folks centered on accountable care and value-based payment, and that’s driving the need to collect manage and secure data, which at its core, is an interoperability problem. We are starting to see that problem really rise in importance. And those two factors—increased EHR prevalence and increased need of data for purposes of population health and value-based health—are driving interoperability like never before. I don’t believe initiatives such as CommonWell or the recently announced Project Argonaut would have gotten the same level of attention if those factors weren’t available. We are in the preaching years right now, and we have enough experience in this to be excited about the world that we’re in. There will be slips and falls we’ll have along the way, but I do think that we’re making tremendous progress and putting a whole lot of time energy and attention in this.
Since you have ONC ties, I have to ask. What are your thoughts about the recent high-level turnover at the agency?
I think ONC is going through a couple of things. If you just look at average tenure of the National Coordinator, they were all there about two years. Looking a layer down below that, you tend to still see that two-year pattern. It’s really, really, hard work. I was there for 18 months, and I loved it, but when people talk about others in the public sector being overpaid and underworked, it’s the absolute opposite in an agency like ONC.
I do think that we need to refill some of the top leadership positions, and there’s a level of energy being devoted to that. You need the rare combination of being able to marry policy and understand how to frame that policy when you’re talking to people who are less technology savvy such as folks at CMS and HHS.
We also need to reframe ONC much more about value-based care than about meaningful use programmatic, and Karen DeSalvo and Jacob Reider have said that as well. Important stuff needs to happen, but this is not the grinding end of ONC—I do not believe that. It’s a temporary blip from folks who are tired and wanted to go to the private sector world.