Health Record Enablement

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Health Record Enablement
Promoting HIT Adoption in the HRSA
Community November 5, 2007

• W. Ob Soonthornsima
• Blue Cross and Blue Shield of Louisiana

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Blue Cross and Blue Shield of Louisiana

• Headquartered in Baton Rouge, eight regional
  offices
• States oldest and largest health insurer, began
  in 1934 in New Orleans
• Serves 1.2 million customers
• 90 percent of all LA providers in BCBSLA networks
• Tax-paying mutual company, owned by its
  policyholders
• Companys subsidiaries include HMO Louisiana,
  Inc. and Southern National Life Insurance
  Company, Inc.
• Companys core strategy addresses cost and
  quality of health care and the uninsured

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Health Information Technology A National/
Regional and Local Agenda

• In 2005, BCBSLA established LaHIT Strategy to
  help enable electronic health records in
  Louisiana. This is a part of the companys
  strategy to improve access to quality and
  affordable healthcare
• HIT collaboration started in early 2005 with La.
  DHH, major hospitals, other state agencies,
  eHealth Initiatives, and BCBSLA. Katrina has
  accelerated the collaborative efforts
• Adoption and expansion of HIT is essential in the
  recovery of the healthcare system in Louisiana

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82 of the 2,200 network physician providers in
Orleans St Bernard could not be reached by
1/1/2006. Members did not take their drug
supplies with them Contacting members and
providers a formidable challenge Telecommunicat
ions, mail services were major issues
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October 2005 - Blue Cross Provides Claims-Based
Health Histories to Katrina and Rita Evacuees

• What is Claims-based Health Record (CHR)?
• Submitted claims (medical, Rx, lab, etc.) are
  packaged into clinical episodes
• Patient-centric information
• Provides a level of encounter history 3-year
  view
• How is it used?
• CHR is made available to BCBSLA members and
  providers through secure web portals, or through
  the companys call center
• Adoption trend
• Thousands of records have been retrieved by
  members and providers
• CHR is available to other members across the
  state (and not restricted to members in the
  hurricane-impacted areas)

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Claims-based Health Record
PORTALS
Authentication
Member Identifier

• Clinical Relevancy
• Patient Centricity
• Security and Privacy

CHR Retrieval
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Critical Enablers of Electronic Health Records
(BCBSLA HIT Strategy)
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Since 2006, BCBSLA has been participating in the
LaHIE (Louisiana Health Information Exchange) to
establish an operating health information
exchange entity.
The company is working with La Dept of Health and
Hospitals, State Medicaid, key hospitals to
establish an operating HIE with sound governance,
effective clinical use, sustainable operating
model and measurable results.
Identify HIE strategic partnership opportunities

• HHS contracted with DHH in 2006 to
• Demonstrate interoperability
• Clinical information exchange
• Scalable org/technology infrastructure
• Provide security / privacy model
• Provide operating / business model

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Success Factors for State-level Health
Information Exchange
Challenges
ONCHIT September 2006 Report by Linda Kloss,
CEO, AHIMA
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State-Level HIE Activities
ONCHIT September 2006 Report by Kelly Cronin,
ONCHIT
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U.S. Focus on HIE Proliferation

• Security and Privacy Solutions
• Address state law practice of medicine barriers
• Governance models
• Sustainable business models
• Role of private payers
• Integration of state public health and healthcare
  programs

ONCHIT September 2006 Report by Kelly Cronin,
ONCHIT
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Louisiana Health Information Exchange Project -
Background

• Late 2005, HHS / DHH (La Dept. of Health and
  Hospitals) contract to demonstrate health
  information exchange capabilities
• February 2006, DHH convened stakeholders. Eight
  partners agreed to collaborate and publish data
• Project ends November 2006

LaHIE Phase 1
April, 2007
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Phase 1 Objectives(based on HHS contract)

• Make health information accessible from
  Katrina-devastated areas
• Demonstrate interoperability within a market
  and between markets
• Demonstrate exchange of health information among
  a variety of healthcare providers
• Provide organizational infrastructure and
  technology that is scaleable
• Provide a security and privacy model
• Develop a cost/revenue model for sustainability

LaHIE Phase 1
April, 2007
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Collaboration

• Public-Private Partnership
• Payer-Provider Partnership
• LaHIE Partnership
• Continued support
• Shared goals and vision
• Potential funding partners

LaHIE Phase 1 Project Accomplishment
April, 2007
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Governance

• Third-party Non-Profit Entity
• Preserve Public-Private collaboration
• Aligned with Louisiana Health Care Quality Forum

LaHIE Phase 1 Project Accomplishment
April, 2007
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Security and Privacy

• Core SP principles established
• Model policies defined
• LaHIE operates closely with HISPC (Health
  Information Security and Privacy Committee),
  another ONCHIT project

LaHIE Phase 1 Project Accomplishment
April, 2007
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Clinical Use-Cases

• Emergency room access
• Primary care access
• Emergency response
• Clinical effectiveness and efficiency measures
  defined

LaHIE Phase 1 Project Accomplishment
April, 2007
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HIE Solution

• Web-based uniform access
• Hybrid architecture health info. repository
  with federated data access
• Security policy enabled
• Data exchange based on CCR (continuity of care
  record) standard
• Claims data Clinical data Complete
  Patient-centric View

LaHIE Phase 1 Project Accomplishment
April, 2007
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HIE Data Publishing Partners
LaHIE
Baton Rouge Primary Care Collaborative
non-publishing steering members
LHCR
HEALTHWORKS
April, 2007
LaHIE Phase 1 Project Accomplishment
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LaHIE Phase 2 Objectives (proposed)

• Expand participation from health plans and
  providers.
• Establish an operating model for a health
  information exchange governance, operating
  structure and business model, expansion of
  security and privacy practices, and scope of
  partnership and participation.
• Validate the current technical solution and
  compare it with other potential solutions. This
  analysis will deliver a strategic technology
  decision for an operating exchange.
• Validate and demonstrate HIE value through
  effectiveness and efficiency measures.

LaHIE Phase 2
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In 2006, BCBSLA launched an e-prescribing program
as a form of electronic medical record (EMR).
Implement e-prescribing pilot to 500 physicians
Being the first health plan in the state to
sponsor a substantial e-Rx pilot, Blue Cross
wants to encourage wide adoption of EMR in
Louisiana.
Increase adoption of HIT among small to medium
physician groups
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Why is e-Prescribing Important?

• Adverse drug reactions send more than 700,000
  Americans to the ER each year
• 7,000 deaths per year attributed to medication
  errors
• Administrative complexities of prescribing cost
  10,000 per doctor per year
• 1.5m injuries per year from medication errors

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e-Prescribing

• e-Prescribing
• Saves lives Saves money Saves time

Dr. Todd Cooley, an internist at Baton Rouge
Clinic, shows the clinics new Pocketscripts
device.
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How e-Prescribing Works
Spans multiple stakeholders - Physician,
Pharmacy, PBMs Health Plan
PATIENT
Pharmacy
Insurance Plans
Receives prescriptions electronically
Physician Practice
Connects with Plan to Determine patient
eligibility
RxHUB
Clearinghouse enabling Plan, PBM,
Physician interaction
SureScripts
Prescriptions checked for interactions formulary
compliance at point of care
Clearinghouse enabling Physician and Pharmacy
interaction
PBMs
Import/export data to and from practice
management systems / EMR applications
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e-Prescribing Benefits

• Prescriber
• (Administrative Perspective)
• Quicker refill process
• Reduced pharmacy calls
• Access to plan specific formulary
• Ensures legible prescriptions are transmitted to
  pharmacy
• Access to prior authorization forms
• Personalized frequently used Rx lists
• Electronic pharmacy address book
• _________________________________
• Health Plan
• Increased safety compliance
• Control increasing healthcare cost trends
• Improved formulary adherence
• Increased generic dispensing rate

• Prescriber
• (Clinical Perspective)
• Drug-drug drug-allergy interaction alerts
• Access to patients medication history
• Mobile Rx writing
• Drug reference guide
• Reporting capabilities
• ____________________________________
• Patient
• Saves patients money
• Increased safety reduces potential adverse drug
  interactions
• Reduced pharmacy wait times

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Blue Cross Sponsorship Program
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Personal Experience

• This has been a great addition to my
  practice, said Dr. Eduardo Rodriguez, a New
  Orleans internist and nephrologist who
  participates in the pilot program, which uses
  PocketScript, Zix Corporations e-prescribing
  service. I dont write any more prescriptions.
  I love it.
• Rodriguez said he likes the service for many
  reasons. I can avoid handwriting mistakes, he
  said. The system keeps a log of all the
  prescriptions a patient is taking, my office
  staff doesnt have to wait on the phone, and I
  can see the insurers preferred drug list.

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In October 2007, BCBSLA launched a consumer-based
portable PHR strategy
BCBSLA advocates patient ownership of health
record. The company emphasizes PHR portability
which is critical to consumer adoption.
Define PHR strategy
Increase awareness Ensure security /
privacy Consumer ownership of healthcare
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My PHR _at_ BCBSLA

• Store personal information
• demographic data
• medical history
• Offer opportunities to improve health
• Prescription-based (warnings and suggestions)
• Research/Resource
• Reminders and Warnings
• Sharing relevant information with Providers,
  loved ones and other care givers
• Claims-based health record feed
• Portable continued access and usage even when
  the member is no longer with Blue Cross

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Sharing your Personal Health Record with loved
ones and/or trusted care providers.
Preparing for an office visit.
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Tracking Tests and Results, as well as other
Progress Measurements
Documenting your wishes for Advanced Directives
and Donor Information
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Creating Personal Health Records for your family
members
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Thank You!!!!

• Questions?