When our personal health records are available to the people who care for us, care can be better and more cost-effective. One health insurer has taken major steps to make that data more accessible.
Why share health data?
Right now, most of our health data lives in silos. Test results from a visit to an ER at one hospital stay in that database. Records from visits to a primary care doctor live in that physician’s online system. Health insurers keep claims data. Securely sharing health records across systems and providing access to patients could:
- Help doctors make better treatment decisions in the moment.
- Avoid repeating tests and treatments, keeping costs down.
- Empower patients to be better advocates for their own health.
- Help healthcare providers and insurers monitor quality trends.
Getting all of these systems to talk to each other is complicated. But Blue Cross and Blue Shield (BCBS) companies are playing a critical role in the effort. More than one in three Americans are covered by a BCBS plan, making BCBS data a vital part of the health data landscape. BCBS companies are working with public and private entities to get closer to this ability to share data - something called interoperability.
Identifying the right records is key
Anthem Blue Cross and Blue Shield (Anthem) has cleared one of the fundamental hurdles along the way. The health plan has just completed work on one of the building blocks of interoperability: being able to identify a unique patient record.
“If you don't have a unique way to identify a person,” says Ashok Chennuru, Anthem’s chief data and analytics officer, “nothing else matters.”
Imagine there are a million patients or members in your system named Peter Johnson. How do you make sure the right test results and treatment notes and claims are tied to the right Peter Johnson? How do you make sure the health information you're exchanging with a hospital or doctor's office includes only one Peter Johnson's records? Anthem has been working for nine years to solve that problem. The health plan has now linked the correct records to millions of individual members.
Helping systems talk to one another
Next, says Chennuru, “It’s one thing to have the data. It’s another to make it exchangeable with other healthcare partners.”
So now, Anthem and industry partners are working on converting their data into a standard format everyone can use to communicate with each other. The standard, called FHIR (Fast Healthcare Interoperability Resources), is one many healthcare groups have agreed to use. Using FHIR will mean that, “when exchanging data, healthcare institutions and companies won’t have to convert it to another format to be able to read or use it,” says Chennuru.
For health insurers, that data could include a member’s claims data, lab results, and even hospital admission and discharge data, among others. The latter, called admit and discharge data, could be critical in an emergency. If a patient is admitted to and discharged from a hospital in one state, and then falls sick and is admitted to a hospital in another state, records could be quickly and easily exchanged to save doctors time diagnosing or ordering tests.
What comes next: testing exchanges of specific kinds of health records
Chennuru says there are many other pieces to the interoperability puzzle, but he believes the industry is about two years away from being able to make it a reality.
Anthem is currently testing data exchanges with a hospital system partner. One involves sending the hospital real-time notifications when one of its patients checks into another hospital. The information exchanged could give doctors vital information in an emergency. Anthem is also testing the exchange of data that shows when a hospital or doctor's office has achieved a number of quality measures. In the near future, Chennuru says Anthem will test the ability to send alerts to doctors about gaps in care, which include things like cancer screenings or immunizations recommended for patients at different ages.
Anthem Blue Cross and Blue Shield is an independent licensee of the Blue Cross Blue Shield Association, an association of independent, locally operated Blue Cross and Blue Shield companies.