Join us at 11 a.m. CT (12 p.m. ET/9 a.m. PT) on Thursday, July 7, for an hour-long chat about new and coming consumer uses of medical records. The chat will be moderated by Chicago Tribune health care reporter Bruce Japsen and feature panelists Jim Anfield and Bill Flamm.
The topic of consumer medical records is on the verge of taking on perhaps its greatest importance in the next two years as the nation's health care industry moves from paper files to computerized records. The momentum is picking up this year as federal stimulus money to help with the transition is starting to arrive at doctor offices and hospitals across the U.S.
In addition, medical care providers are also moving slowly toward a new model of health care delivery known as accountable care organizations, encouraged under the health overhaul law, that create a new type of payment system by tying medical-care provider reimbursements to the quality of medical care and outcomes.
Chat topics addressed will include information on how doctors, hospitals and insurance companies will be using digital information. Other topics will include how consumers might be able to save money and help in the effort to make doctors and hospitals more accountable.
Jim Anfield is the senior director, health information technology for Health Care Service Corp., parent of Blue Cross and Blue Shield of Illinois (a subsidiary of the nation's fourth-largest health insurance company) as well as Blues plans in Texas, Oklahoma and New Mexico. Anfield's role includes work on several of the insurer's health information exchange efforts.
Bill Flamm is the director of finance, information systems and operations forChicago area medical group Pronger Smith MedicalCare, a group of 60 physicians with multi-specialties that has patients largely onChicago’s South Side and south and southwestern suburbs.
If you are unable to make the chat and would like to send your question in advance, e-mail Bruce Japsen at firstname.lastname@example.org.
Welcome to today's chat on digital medical records and accountable care. My guests today are Jim Anfield of Blue Cross and Blue Shield of Illinois, Illinois largest health plan, and Bill Flamm of Pronger Smith Medical Care.
So, how will coming digital records improve patient care and what are Blue Cross and Pronger doing in this regard?
Thursday July 7, 2011 10:59 Bruce Japsen
The development of the pilot Health Information Exchange (HIE) has been a collaboration by many organizations (Hospitals, Medical Practices, and Insurance Companies) over the past 7 years. The concept is to securely penetrate the walls between organizations and their individual medical information systems. The objectives are to share important medical information among medical organizations when that information is needed most, i.e. emergency room visits, and with patients by providing them their updated medical information from non-affiliated medical organization from one website. Once this project is up and running, we will study the pilot to understand the true benefits and impacts to patient outcomes and provider/payor effectiveness.
Thursday July 7, 2011 11:00 Bill Flamm
So what are the basics of this program so consumers, patients and doctors know what to expect?
Thursday July 7, 2011 11:02 Bruce Japsen
From a Pronger Smith perspective, it's making medications, allergies and selective labs available to participating emergency rooms and our patients via the web through our portal.
Thursday July 7, 2011 11:05 Bill Flamm
[Comment From GuestGuest: ]
When will the HIE be up and running inChicago? Will all providers be in this exchange?
Thursday July 7, 2011 11:05 Guest
We expect our pilot to be fully operational later this summer. Pronger Smith is now live on the system. Given the pilot nature of the project, we have initially limited this to a few key providers as we go live.
Thursday July 7, 2011 11:08 Jim Anfield
From Pronger's persective, we are live but are only letting our employees view for two weeks to test. Then we will open it up to the first 100 patients to sign up. Then we will open it up to 100 patients at a time for quality control purposes.
Thursday July 7, 2011 11:08 Bill Flamm
[Comment From DougDoug: ]
I am associated with a new practice that purchased an EMR system, partly because of the sums promised by the government if I met the tests established. However, nobody seems to have an answer to the question of how I can get the reimbursements advertised. Is there any place I can go to get such information?
Thursday July 7, 2011 11:09 Doug
Doug - You should probably contact the Centers for Medicare and Medicaid Services for a federal reimbursement issue. The U.S. Department of Health and Human Services also has a regional office. That number is 312-886-2896
Thursday July 7, 2011 11:11 Bruce Japsen
[Comment From emagon4523emagon4523: ]
i'm interested in how these records are being watermarked to verify they have not been altered.
Thursday July 7, 2011 11:11 emagon4523
Security of all medical records is regulated by the Federal government with the HIPAA act.
Thursday July 7, 2011 11:11 Jim Anfield
[Comment From Jeffrey Buckman MDJeffrey Buckman MD: ]
How can electronic health care records show that quality of care has improved? rather than just improve "charge capture" Also, are there meta analysis studies out that show that both medical errors, quality of life, and morbidity statistics are improved after implementation of an EHR?
Thursday July 7, 2011 11:11 Jeffrey Buckman MD
Pronger Smith's experience: we worked with Blue Cross Blue Shield to create a medical home pilot program at our practice. We used a combination of data generated by Pronger Smith and Blue Cross to identify gaps in care, create outreach programs (both automated and manual) and instituted "supervisits." The disease states that we targeted were diabetes, COPD, CHF and asthma. At the end of the first year we saw a 30% decrease in emergency room visits. We also saw a significant reduction in hospital days. When we looked at the 10 patients with the biggest gaps in care, in a year over year comparison we saw their hospital admits drop from 14 with 84 days spent in the hospital to 6 admits with only 25 days spent in the hospital. This affects not only the quality of life for our patients, but also had a significant favorable financial impact.
We recognize that a patient in a trauma situation may not be able to clearly communicate all their important medical information. One of our surgeons, Dr. Roman, had a great example. He was called at home by the emergency room to consult on a patient's treatment. The patient had failed to list a significant medication, which Dr. Roman found when he reviewed the patient’s electronic chart. In the absence of this information, the outcome for this patient would have been critical if not fatal. Our Cardiologist, Dr. Tejpal, states that he has found many medical information discrepancies and will always check Pronger¿s electronic health record when called by an emergency room. As more E HRs are implemented these non-events will become statistically relevant, unless you were one of these patients or one of their family members, then I would guess that you would think E HRs are significantly already.
Thursday July 7, 2011 11:13 Bill Flamm
[Comment From Mr. DwyerMr. Dwyer: ]
How will the complexity of migrating from ICD-9 to ICD-10 be addressed? (eg: ICD-9 code = 806.4 with its 6 ICD-10 scenarios)
Thursday July 7, 2011 11:14 Mr. Dwyer
ICD-10 is mainly viewed as a billing issue but will become a huge part of the EHRs. The level of detail that is going to be needed to bill is going to take extensive work on an EHR's part to build careguides and coding guidance.
Thursday July 7, 2011 11:16 Bill Flamm
[Comment From GuestGuest: ]
Do payers (health plans and insurance companies) get access to the records
Thursday July 7, 2011 11:17 Guest
For this pilot HIE, Blue Cross will not be receiving clinical information from the providers. In the future, this may change as we move to the medical home and ACO models of care as we partner with providers to provide more quality health care to patients.
Thursday July 7, 2011 11:18 Jim Anfield
Medical care providers with questions in the Chicago area can also contact the Chicago Health Information Regional Extension Center www.chitrec.org and the state of Illinois also has a site
Thursday July 7, 2011 11:18 Bruce Japsen
[Comment From Dr. BDr. B: ]
When will all EMR's communicate with each other and be able to exchange information with other EMR and proprietary software from hospitals, insurance companies? It seems there are a glut of companies trying to sell physicians EMRs but no standardization.
Thursday July 7, 2011 11:19 Dr. B
We believe the pilot HIE is a big first step in cross-communication between EHR systems. We also believe EHRs are really in their infancy and will vastly improve communication in the coming years.
Thursday July 7, 2011 11:20 Bill Flamm
[Comment From AmyAmy: ]
Are you aware of EHR systems which interface or include pharmacy operations?
Thursday July 7, 2011 11:20 Amy
Our HIE will include pharmacy data from both the payor and providers for each patient. From Blue Cross, this pharma data will come from Prime Therapeutics, our in-house PBM. Also, e-prescribe applications are also available in the market.
Thursday July 7, 2011 11:24 Jim Anfield
[Comment From AngieAngie: ]
Response to Amy's question - the VA's EHR connects all VA medical centers with each other and captures data from pharmacy, lab, imaging, notes, etc. A patient can go from on VA to another and the record follows him.
Thursday July 7, 2011 11:24 Angie
Some patients with Blue Cross and Blue Shield of Illinois and Pronger are already using electronic medical records. Here is an example of a patient's lab history. This is not a real patient, but a sample of what a patient would see.
Thursday July 7, 2011 11:26 Bruce Japsen
Thursday July 7, 2011 11:27
Thursday July 7, 2011 11:27
Please click the above to see a larger version
Thursday July 7, 2011 11:27 Bruce Japsen
[Comment From HerschHersch: ]
What is your experience with the device needed to capture the information electronically at the point of patient contact (tablet, net book,desktop)and how has live clinical data capture of patient information impacted communication between the provider and the patient?
Thursday July 7, 2011 11:27 Hersch
Yes - we are currently evaluating this type of technology and thinking through the integration of this technology with other information flows.
Thursday July 7, 2011 11:27 Jim Anfield
[Comment From GuestGuest: ]
How will digital medical record affect current business models? Will it be flexible? In addition, how will it merge or affect current systems?
Thursday July 7, 2011 11:28 Guest
EHRs have a significant impact on a medical practice's business model. It changes functions for physicians, nurses, medical records and other staff. Also, information systems will require ongoing investments in dollars, physicians and staff time to keep the medical workflow accurate and efficient.
Thursday July 7, 2011 11:31 Bill Flamm
Medical records through HIE are extremely important as we move to the medical home and ACO world. Care coordinators working as part of patient centered medical homes need to have the most accurate and up to date information in order to make the best decisions for care of their patients. This will help improve quality and also reduce the cost of care.
Thursday July 7, 2011 11:31 Jim Anfield
[Comment From JohnJohn: ]
I see that Google just stopped their medical record site. Does this give you concern as to the public reaction to E records. I think this is a great system and needs to be going forward ASAP
Thursday July 7, 2011 11:31 John
Yes - we read about Google's shutdown of their health offerings. This is more of a business issue than a medical records issue. We serve our members and providers serve their patients and we both have a vested interest in the healthcare of our customers. Google makes money by selling advertising to users of its many services.
Thursday July 7, 2011 11:36 Jim Anfield
[Comment From JonathanJonathan: ]
You mentioned that you are about to do live testing on 100 patients. What does the mid-term role out plan look like?
Thursday July 7, 2011 11:36 Jonathan
Since this is a pilot, we are taking the rollout step by step, 100 patients at a time to ensure quality customer service.
Thursday July 7, 2011 11:36 Bill Flamm
[Comment From emagon4523emagon4523: ]
other than NAILBA - no one has any standards set-up and security is non-existant. are you comfortable knowing your sensitive mediacal records are out there floating around on the internet in someones inbox in unsecured format?
Thursday July 7, 2011 11:37 emagon4523
These electronic records are secure and are subject to HIPAA. Don't forget that paper records are already in place and may also sit on a unsecured fax machine for long periods of time.
Thursday July 7, 2011 11:39 Jim Anfield
With more health care systems moving toward electronic medical records, how do you feel about this movement? Electronic health records are a welcome change and long overdue
( 86% )
Electronic health records scare me and I do not welcome these changes
( 0% )
Electronic communication with my doctor (ex. e-mail) is fine but not confidential medical records
( 7% )
I have no feeling one way or another whether my records are digitized
( 7% )
Thursday July 7, 2011 11:39
Many doctors are hearing and slowly moving toward medical homes and Accountable Care Organizations. How does the Health Information Exchange work with ACOs and patient-centered medical homes?
Thursday July 7, 2011 11:41 Bruce Japsen
We believe that ACOs and Medical Homes are very similar to the current Blue Cross HMO structure which rewards attaining quality goals centered on preventative health care while managing serious medical conditions to improve a patient¿s quality of life, and to prevent and reduce hospital stays. Accomplishing these goals requires coordinating care and sharing medical information. So let¿s start with the basics; physician practices need to implement an Electronic Health record (EHR); you can¿t share what you don¿t have. Physicians who reference their E HR when talking to emergency rooms and other providers will save more lives. Next step is for us to have a functioning HIE in place for these physicians and organizations to share their data securely. Which brings us back to the reason for this project.
Thursday July 7, 2011 11:42 Bill Flamm
Yes - Blue Cross feels very strongly about the ACO and medical home models and we are investing heavily in building out functionality to help facilitate these care models.
Thursday July 7, 2011 11:44 Jim Anfield
For more information on Accountable Care Organizations, here is a recent story in the Chicago Tribune, Los Angeles Times and Tribune Newspapers on ACOs and ways they are already working in the private sector.
[Comment From Robert William KearnsRobert William Kearns: ]
Will the EHR/EMR be CCHIT certified?
Thursday July 7, 2011 11:44 Robert William Kearns
Understand that this is a federated data model. The HIE draws information from the participating provider's individual systems. If the providers plan on meeting meaningful use criteria, their systems need to be certified.
Thursday July 7, 2011 11:46 Bill Flamm
[Comment From JohnJohn: ]
Just a comment as to being secure: In my opinion records are not secure now. One goes into an office and gives SS #'s etc. to someone you don't even know
Thursday July 7, 2011 11:47 John
The use of the Social Security number is inconsistent across all medical care provider groups. Not all doctors and hospitals use that as an I.D. for patients. Increasingly, they don't according to industry observers I have talked to.
Thursday July 7, 2011 11:49 Bruce Japsen
In the HIE world, there are two basic data models - central and federated. For the central model, all providers send their clinical data to a centralized data center. For the federated model, all data reside at the providers until required at the point of query. Centralized repository has fallen out of favor due to high costs and liability issues. Almost all HIEs now use the federated model.
Thursday July 7, 2011 11:52 Jim Anfield
[Comment From DanDan: ]
How have you overcome communication errors between different EHR systems to maintain a consistent and accurate HIE?
Thursday July 7, 2011 11:52 Dan
They key to communication between providers on disparate systems is to use a standard called a CCD - Continuity Care Document. This is the standard record layout for clinical data and this allows us to bridge different record layouts.
Thursday July 7, 2011 11:54 Jim Anfield
[Comment From AlexAlex: ]
With EMR's being a major start-up cost for ACOs and medical homes, do you have any sort of estimate as to how much this would cost a provider?
Thursday July 7, 2011 11:54 Alex
The cost will vary based on your current system's capabilities or lack thereof.
Thursday July 7, 2011 11:55 Bill Flamm
Within the next week, we will have further information about the HIE posted to the Pronger Smith website at www.prongersmith.com
Thursday July 7, 2011 11:58 Bill Flamm
Thanks so much to Jim Anfield of Health Care Service Corp.'s Blue Cross and Blue Shield of Illinois and Bill Flamm of Pronger Smith MedicalCare for joining us today for our chat on digital health records, accountable care and other talks related to the coming world of electronic health information.
Please join us Tuesday at noon Central when the Chicago Tribune's Trine Tsouderos chats about how parents can protect their children from environmental chemical and toxin dangers.