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11/23/2005
04:40 PM
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Feds Drive E-Health Records In Devastated Gulf Coast

Health-care payers showed the value of electronic records during the recovery



When hurricanes Katrina and Rita hit the Gulf Coast, they destroyed not only homes and businesses but thousands of paper medical records, too. In the storms' aftermath, health-insurance companies were able to re-create basic electronic health records for many customers by tapping into their insurance and drug-prescription databases.

Now the U.S. Department of Health and Human Services seems ready to follow their example and spur the creation of electronic health records that would be accessible to people displaced by natural disasters, wherever they might go.

Lack of technology and data standards, as well as recalcitrant physicians and concerns about cost, data privacy, and security, have hindered efforts to create electronic health-record systems with information that can be shared between health-care providers and payers.

Earlier this month, Health and Human Services established the Gulf Coast Information Task Force, to be operated by the Southern Governors' Association, which brings together local and national experts to help local health-care providers develop E-health records as they rebuild. The task force will help implement and support IT that enables interoperable health-care data exchange. The department also charged Louisiana's Department of Health and Hospitals with developing a prototype electronic health record and a way to share information that would ensure its availability throughout the state.

Records Rebuilt

Following Katrina's devastation, as thousands of people found themselves in shelters and temporary homes without their prescriptions or medical histories, Medco Health Solutions Inc., the largest online pharmacy and administrator of health-plan pharmacy benefits, was able to generate 300,000 individual prescription records based on orders that had previously flowed through its prescription-benefit systems.


An infant is evacuated from a Galveston, Texas, hospital as Hurricane Rita approaches.

An infant is evacuated from a Galveston, Texas, hospital as Hurricane Rita approaches.

Photo by David J. Phillip/AP
A short time later, as Rita approached the Texas and Louisiana coasts, Blue Cross Blue Shield of Texas used three years of claims data to generate individual health records for some 830,000 coastal residents, based on its claims data. The records were made available to Blue Cross-certified physicians who called Blue Cross Blue Shield offices, as well as through MEDecision Inc., which provides online managed-care services and applications.

Prescriptions were one of the things that could be easily derived from existing records, say Medco and Blue Cross Blue Shield of Texas IT executives. A typical call would come from a chemotherapy patient who was due for another treatment and wasn't sure what type of treatment he or she had been receiving, says Joe Taylor, VP of enterprise business processes at Blue Cross Blue Shield of Texas. As for medications, "even if they took three days supply with them, what happens on day four?" he says.

Both Taylor and Medco CIO Mark Halloran say their existing systems had all the data they needed to generate useful individual health records. But they had to apply advanced data cleansing and rules-engine checking to ensure accuracy. If a patient once was diagnosed with diabetes, it's important that the diagnosis be double-checked to make sure that it didn't change later, Taylor says. Only about 500 subscribers used the records because Rita's damage wasn't widespread, he says.

"The payers were able to respond more rapidly than the providers," notes Eric Brown, a health-industry analyst at Forrester Research. While the records weren't as complete as those created by doctors and hospitals, Blue Cross Blue Shield of Texas and Medco could produce health-care records indicating previous treatments for which a patient had been billed or prescriptions that they had filled. In a case where a storm victim is displaced from his or her home and can't remember much about a prescription other than the color of the pills, Brown says, "50% of a medical record is better than nothing."

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