Merger May Revitalize California’s Flagging Effort To Pool Medical Records

Stephan Lieske, an IT specialist at PB Health in Baltimore, shows nurse Danysha Sterling how to access patients' medical records electronically. (Gabe Dinsmoor/Baltimore Sun/MCT via Getty Images)

After a sluggish start, the Cal INDEX medical database has agreed to a merger that would create one of the largest repositories of patient records in the country.

The nonprofit California Integrated Data Exchange, launched by insurers Blue Shield of California and Anthem Inc. with much fanfare in 2014, announced Tuesday that it intends to merge with the Inland Empire Health Information Exchange. Together, they would have insurance claims and medical records of 16.7 million people.

Obama administration veteran Claudia Williams, 53, will take the helm as chief executive on Feb. 1.

San Francisco-based Cal INDEX is an ambitious initiative to give hospitals and doctors a single place to get patient information culled from medical records and insurance claims. State leaders and other supporters say giving an emergency room or a doctor the ability to instantly access a patient’s medical history can improve the quality of care, reduce medical errors and cut wasteful spending.

Across the country, efforts at creating these digital databases or health information exchanges often have hit technical snags and industry turf battles. One of the most successful examples has been the Indiana Health Information Exchange, which holds records on more than 12 million people and participation by more than 100 hospitals and 12,000 medical practices.

The California database merger, which is subject to approvals from the state attorney general, is expected to close in the first quarter of 2017. The newly formed organization will be renamed later.

Williams served as senior adviser for health innovation and technology at the White House from 2012 until last week. Previously, from 2010 to 2012, she was director of health information exchange in the information technology office at the U.S. Department of Health and Human Services.

She helped oversee federal stimulus money for expanding electronic medical records and creating regional health information exchanges.

In an interview, Williams said she’s eager to put her government experience into practice in California.

“I was looking at the best opportunity for me to make good on the promise of actually getting information moving to improve patient care,” Williams said.

Access to real-time patient information has become critical as the U.S. health care system moves away from fee-for-service medicine and overhauls how care is delivered. A wide variety of payment reforms, such as creation of accountable care organizations and scrutiny of hospital readmissions, rely on hospitals and physicians knowing about all of the various care patients receive, whether it’s in or outside their normal provider network.

Williams said she wants the California database to electronically alert primary care doctors every time one of their patients arrives in the emergency room so they can follow up appropriately.

“I have a lot of knowledge of what works and doesn’t work,” she said.

Williams is taking over an organization that thus far has fallen short of its hype. The involvement of Blue Shield and Anthem was designed to give Cal INDEX an early boost by providing records on millions of Californians who have insurance coverage through the two companies. At launch in 2014, the two insurers said they were investing $80 million in the project.

But several challenges soon emerged. Its first CEO, David Watson, lasted less than two years and left to work in the private sector. There were two interim CEOs in the meantime.

Also, as in other states, persuading additional health plans and medical providers to supply patient data and pay fees to access the information proved difficult because they’re used to being competitors.

Cal INDEX holds data on 11.7 million people, and the Inland Empire health exchange — serving providers in 18 counties, including the Central Valley — will bring an additional 5 million patient records and 150 participating health care partners.

Last month, Cal INDEX got a shot in the arm when a big health system in Southern California, St. Joseph Hoag Health, announced it was joining the exchange.

Dr. Bradley Gilbert, chairman of the Inland Empire exchange and CEO of the Inland Empire Health Plan, said “this is a case of two is better than one. Each have different strengths that complement each other well.”

Inland Empire Health Plan, which serves Riverside and San Bernardino counties, has contributed about $4 million to the health information exchange there since it was founded in 2009.

Dr. Farzad Mostashari, the former national coordinator for health IT in the Obama administration, hired Williams in Washington and said she excelled at running the federal grant program for health information exchanges.

He said some regional exchanges have tried to gain the endorsement of the state Medicaid program to increase participation among hospitals and other providers.

For now, the California Department of Health Care Services, which runs Medi-Cal, doesn’t have a direct business relationship with Cal INDEX.

“The first challenge for [Williams] is getting the lay of the land and developing those relationships with health plans, Medicaid, doctor groups, public health,” said Mostashari, now CEO of the health technology firm Aledade Inc.

Mark Savage, vice chair of the Cal INDEX board, said Williams was the ideal candidate for CEO.

“I’m also mindful of setting reasonable expectations, and it will take her some time to come in and build a combined company,” he said.

Cal INDEX only shares patients’ clinical data, not their financial information, with participating providers, hospitals and insurers. Users cannot sell any of the data, release it publicly, or use it to set provider rates.

For now, consumers can’t review their own records in the database. There’s an opt-out provision for consumers on the Cal INDEX website, which if selected would mean their information would not show up.

Savage said it’s important that patients eventually gain access to their full medical records through this statewide organization, but he isn’t sure when that would occur.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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