Aims to reduce duplication, errors and costs while boosting quality of care
Heather Havenstein April 23, 2007 —
Blue Cross and Blue Shield insurance plans in four states are integrating the medical data of more than 11 million people into a single electronic health record (EHR) system in an effort to eliminate unnecessary treatments and to encourage preventive care.
The Health Care Service Corp., which runs Blue Cross and Blue Shield operations in Illinois, New Mexico, Oklahoma and Texas, has been working for two years to merge the plans’ various IT systems that contain data about eligibility, medication, lab visits, hospitalization and physician office visits into a single system. The Chicago-based company plans to provide its patients and doctors with free access to the integrated system.
The move by HCSC is a new twist on a national effort to shepherd the adoption of EHRs, which various government agencies are recommending in hopes of decreasing medical errors and bolstering the quality of patient care by replacing current disjointed paper records with a comprehensive electronic patient record.
To date, the effort has focused primarily on encouraging doctors and hospitals to install EHR technology. Many physicians, however, have balked at undertaking such projects because of their often hefty installation and maintenance costs. Physicians have also complained that even though they’re the ones who pay those expenses, it’s the insurance plans that receive the lion’s share of the financial rewards in the form of lower costs.
As the different insurance plans bring the service online through the rest of this year, HCSC will offer physicians and clients free access to the service, said Joe Taylor, vice president of enterprise business processes. Taylor detailed the effort Monday at the World Health Care Congress in Washington.
The HCSC system uses MeDecision Inc.’s Patient Clinical Summary software, which creates an EHR by gathering patient data from various sources, analyzing the data and applying analytics and rules to identify possible options for treating patients, Taylor said. Doctors can access the data with an Internet connection.
“We’re trying to take this data and empower it with some analytics to provide a more meaningful office visit between the member and their selected physician,” Taylor added. “Think about a health insurance company that is providing information to the physician saying, ‘We want you to do this test.’ There is a chance to do more prevention and more wellness [efforts] and to see a potential treatment opportunity and act on it.”
He noted that the system could use analytics and rules-based software to, for example, remind a patient and physician that an annual mammogram needs to be scheduled or send an alert when different physicians write a patient prescriptions for medications that can’t be used together.
The system will also provide physicians with a list of all tests done on a patient, eliminating the need for duplicate tests, Taylor said.
The system, called Blue Care Connection, went live in New Mexico and Oklahoma last year and in Illinois earlier this year. It will begin operating in Texas this summer, Taylor said.
“All of this hopefully will help to stem the high rate of [cost] increases in health care,” he added.
John Capobianco, president of Wayne, Pa.-based MeDecision, noted that doctors have been reluctant to invest in EHR tools that can cost from $35,000 to $100,000 and ultimately just feed data into a system but provide no information back to the doctor.
“He is not getting a whole lot of value out of all this big expense,” he said. “The economic benefit just isn’t there.”
The health plans, however, have multiple views of a patient’s history based on the different types of claims they pay, he added, and that information can be vital to a doctor. “[The health plans] are a wonderful source of the best set of data that is available today,” Capobianco said. “It is certainly a better record than any one individual would have.”