More plans offer online community records

Blues plans operated by the Health Care Services Corp. (HCSC) in Illinois, New Mexico, and Oklahoma are offering physicians in those states online patient records based on claims and other payer data. When Blue Cross and Blue Shield of Texas, another HCSC plan, rolls out this clinical summary, known as the Blue Care Connection, next summer, data on 11.5 million patients will be available to doctors for free on the four plans' web portals. Plan members will also be able to view their personal health records (PHRs), including information on their hospitalizations, physician visits, lab visits, and medications.

The idea of using claims-based records as a basic kind of EHR in doctors' offices and emergency departments is not new. Blue Cross and Blue Shield of Tennessee has had such a community record for a couple of years (Medical Economics, "The rocky road to RHIOs,", Feb. 17, 2006). Also, America's Health Insurance Plans and the Blue Cross and Blue Shield Association recently announced the creation of a standardized, portable PHR that plans can make available to patients and doctors (InfoTech Bulletin, Dec. 22, 2006).

But HCSC isn't using that PHR. Its Blue Care Connection is based on the Patient Clinical Summary developed by MEDecision, a Wayne, PA-based company that collects and analyzes payer data for use in care management and utilization review programs. According to Joe Capobianco, president and chief operating officer of MEDecision, a study by his company showed that use of the Patient Clinical Summary saved Blue Cross and Blue Shield of Delaware an average of $545 for each visit to the emergency department at Christiana Care in Wilmington, DE. That level of savings, he argues, is enough for health plans to invest in this kind of claims-based record and provide it to physicians for free.

Capobianco maintains that the claims data in MEDecision's Patient Clinical Summary is reliable, because it has been "scrubbed" and cross-referenced with other data, such as lab results. But he admits that physicians are reluctant to use data from health plans. To overcome that resistance, he says, HCSC plans will "push" the claims-based records to physicians every time they do an eligibility check online. "Their intent is to pass to every treating physician a copy of the Patient Clinical Summary, so their members can get the best care," he says.