California and Mississippi are investing in health information technology projects that incorporate a broad range of longitudinal patient data and promise insight into population health.
Efforts to upgrade the quality of patient data on statewide health information exchanges are taking a leap forward in California and Mississippi.
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In The Golden State, a pair of healthcare payers have announced ambitious plans to launch the California Integrated Data Exchange. Blue Shield of California and Anthem Blue Cross have committed $80 million to operate Cal INDEX for three years.
The HIE will feature longitudinal patient information, which will enable healthcare providers and payers to see a broad range of clinical information over time, such as hospitalizations, medications prescribed, lab results, and allergy histories. This type of data is more comprehensive than encounter-based health records and can be used to study and track population health.
CA Powers Up $80M HIE to 'Create Value in the Data'
In Mississippi, the state Division of Medicaid has cut a deal with a healthcare analytics firm to create a statewide clinical data repository, a master patient index, and longitudinal patient records for more than 750,000 Medicaid beneficiaries.
No More "Islands of Information"
Cal INDEX is being designed like a public utility, Simon Jones, VP of health information technology product strategy at Blue Shield, said this week. As is the case with utility companies, uniformity and interoperability are key goals for Cal INDEX, he says. "It will allow us to plug information into that grid in a more uniform way."
Healthcare institutions, he notes, are notorious for creating "islands of information" such as primary care physician records.
Like a new public utility, Cal INDEX is expected to spread across the state over time, with early data collection efforts focused on large population centers. "You start out at big cities, then they get more ubiquitous over time and end up at the farm."
With access to Cal INDEX data set to be provided to patients, providers, payers, and academics, the new health information exchange is also embracing the philosophical spirit of a public utility, Jones said: "It's supposed to be for everybody."
Access to longitudinal patient data has the potential to drive significant gains in quality and cost efficiency. "People move across the healthcare ecosystem, and their information hasn't followed them," Jones said. But "Cal INDEX gives [physicians] a complete picture to provide the best care that they can" by offering a timeline view of a patient's health history.
Longitudinal patient data is an essential tool in population management, enabling providers to "get more proactive" about treating chronic diseases, which account for the bulk of healthcare spending nationwide, he adds.
Cal INDEX is also expected to help cut healthcare costs by reducing duplication and waste, including unnecessary repetition of lab tests.
After the Cal INDEX seed money runs out in three years, the health information exchange will be financed through subscription fees. While the precise mechanism for the subscription financing has not been determined, Jones says the cost of operating Cal INDEX will be spread as evenly as possible. "No single entity will bear the entire cost."
Cal INDEX is slated to be operational by the end of the year. The health records of 9 million people, about one quarter of California's residents, are expected to be available through the health information exchange.
Boosting Medicaid Management in MI
A health information exchange effort announced in Mississippi last week is expected to boost efficiency and quality of care in the state's Medicaid program.
The first step in the Mississippi project was creating a master patient index, boiling down the records of several million Medicaid beneficiaries over the past decade to identify the 750,000 residents who are actively using the Medicaid program today, state officials said.
The next step was creating a repository of longitudinal patient data, according to the state DOM Office of Information Technology Management.
"To increase efficiency while improving care, we need to offer Medicaid providers a full 360-degree, instantly accessible view to a high volume of data, said Rita Rutland, the agency's deputy administrator, in a media statement.
Emeryville, CA-based MedeAnalytics was brought in to build a master patient index for Mississippi's Medicaid beneficiaries. The senior VP and general manager of its health plan business unit calls the MPI for Mississippi's Medicaid beneficiaries "foundational infrastructure."
"When you cannot be certain whether two patient records are the same patient or two separate patients, and you multiply this by millions of cases at the population level, you see that you cannot have accurate multi-domain systems like that which we implemented in Mississippi without an MPI in place," said Scott Paddock.
His company reviewed millions of records spanning a decade, found 7 million non-unique individuals, and condensed them into 2.3 million unique beneficiaries.
State and federal funding is paying for the Mississippi health information exchange effort, but the cost was not disclosed.
A Call for Responsibility, Accountability
Kevin Coleman, head of research and data at Sunnyvale, CA-based HealthPocket, says health information exchanges have the potential to revolutionize the healthcare industry, but not without risk.
"The emerging use of vast amounts of patient data… holds the promise of reduced medical spending and improved clinical results, but it also brings with it the prospect of intrusions into medical choices previously decided between doctor and patient," he said.
Given the "enormous benefits" patient data can bring the nation, however, "the question for society is not whether or not to allow for the widespread use of patient data but, rather, how can it be [used] most responsibly and accountably."
Christopher Cheney is the CMO editor at HealthLeaders.