Two health insurers decided to share parts of patient records electronically, though the effort falls short of creating a full electronic medical record.
Blue Cross and Blue Shield of Florida and Humana will team up to allow clinicians across Florida to view via the Internet basic patient health information stored in both companies' databases, giving about one-third of privately insured Floridians a watered-down form of an electronic medical record.
The health plans, which hope to launch the first phase of the system by February, also aim to beef up the system later next year to create a more advanced, Web-based source of clinical support.
"It's certainly not a complete electronic medical record," said William Kerr, M.D., chief medical officer at Jacksonville, Fla.-based Blues plan. "We think it's at least making available the information we have."
Initially, the system will offer physicians only a limited set of data drawn from claims records of the two health plans going back two years. The information at first will include dates of service and provider names for patient visits to hospitals and physician offices, lab tests and radiology work. It will also allow clinicians to view previous patient diagnoses and prescription histories, including dosage, Kerr said.
But the goal is to build a system that will offer more complex clinical information and functions and be compatible with developing EMR initiatives, Kerr said. Combined, the two plans claim coverage for about 4.3 million Floridians.
The Florida announcement comes as the federal government last week delayed announcing the winners of a series of contracts to private organizations to help plan and induce the creation of a national system of healthcare information technology interoperability and data sharing.
The recent hurricanes also spurred action on the IT front. David Brailer, national IT coordinator at HHS, announced the launch of a temporary prescription drug database for areas affected by Hurricane Katrina while Richardson, Texas-based Blue Cross and Blue Shield announced plans to produce electronic summaries of clinical information on its members affected by Hurricane Rita.
William Bria, M.D., a physician informaticist and president of the Association of Medical Directors of Information Systems, said payers' claims data -- such as what the Florida network will use -- is suitable for retrospective analysis but lacks the specificity needed in front-line clinical care.
Bria called the Blues-Humana effort a good beginning, but the real value will come when clinicians can immediately determine what an insurance company will cover. For example, a real-time health plan formulary checker and e-prescribing tool that would tell exam-room physicians what prescriptions are covered "would make a significant impact in terms of efficiency of decisionmaking, accuracy of prescriptions and getting things done," Bria said.
The Florida network will be built with a Web-based infrastructure already in place for claims administration called Availity Gateway and should launched by February 2006, Kerr said. Availity, the service provider, is a joint venture of Humana and a Florida Blues subsidiary. Availity already provides Web-based services such as claims submission and eligibility checking, Kerr said. Records held by the two plans will be queried for the past two years, and their existence will be reported to the provider, organized by the date and type of service.
According to Kerr, an office worker might typically use the clinical reporting system when the patient's eligibility is checked, and specific results would be printed out by the clinician to use during the visit. While that would make the system accessible to any provider with Internet access and a Web browser, it would be a far cry from an interoperable EMR.
For now, lab and radiology results will not be reported to the clinician, they will have to go to the lab vendor or radiological service for results, Kerr said, but simply knowing that a blood test or the scan has been performed could at least eliminate some duplication of service.
Later next year, the plans hope to add reporting capabilities, such as lab results and radiology reports, as well dynamic functions such as adverse drug or drug-reaction alerts and notifications of overdue tests.
The service will be limited to the two plans' Florida patients and the data will remain on the two companies' databases, Kerr said. The system will not give providers access to diagnosis and treatments for psychiatric care, substance abuse or HIV, the companies said. These areas of care are often subject to greater privacy restrictions under state privacy laws than the privacy rules promulgated under the federal Health Insurance Portability and Accountability Act.
This story was originally published in the Oct. 3 issue of Modern Healthcare.