2 big health insurers aim to create, share huge records database

A doctor and nurse treat a patient in the ER of Mission Community Hospital in Panorama City. Blue Cross and Blue Shield say Cal Index would give ER doctors instant access to the medical histories of patients they have never seen before.
A doctor and nurse treat a patient in the ER of Mission Community Hospital in Panorama City. Blue Cross and Blue Shield say Cal Index would give ER doctors instant access to the medical histories of patients they have never seen before.
David McNew/Getty Images

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Two of California’s largest health insurers are coming together to create a new, massive database of electronic medical records that would be accessible to health providers throughout the state, in an effort to improve patient care and save money.

Competitors Anthem Blue Cross and Blue Shield of California on Tuesday announced they’re creating one of the largest non-profit health information exchanges in the nation.  They hope to launch the California Integrated Data Exchange, or Cal Index, by the end of the year. 

The new exchange initially would contain medical records of about nine million Californians gleaned from claims data held by the two companies, officials said. 

"Although Blue Shield and Anthem Blue Cross are fierce market competitors, we realized we needed to work together to bring the health care industry into the digital age," Blue Shield President Paul Markovich said Tuesday.

The two firms will invest $80 million to provide three years of data integration assistance to 30 large provider organizations statewide, including Dignity Health.

Competing health insurers and other providers who wish to participate would be able to do so upon payment of yet-to-be-determined fees. By 2018, all participants, including the original 30 providers, would be subject to subscription fees based on the number of customers or patients they've included in the database. 

"Providers in health plans must collaborate to ensure that Californians receive the safest, highest quality health care at a sustainably affordable price," said Mark Morgan, CEO of Anthem Blue Cross.  "A fundamental component is sharing comprehensive patient information broadly and efficiently."

Among the goals of Cal Index, he said,  is to give any doctor, nurse or other health provider immediate access to a patient’s medical history.

"Imagine for a moment you’re recovering from a heart attack and your cardiologist has prescribed you a number of medications and lab tests," said Lloyd Dean, President and CEO of Dignity Health System. "Once you’re discharged…your primary care physician would be able to see, exactly, what kind of medications you took. This can greatly reduce complications and drug interactions and would mean you would receive safer and better care, whenever you decide to seek it."

The insurers say Cal Index could be lifesaving in emergency situations. For example, it would give a doctor in an ER instant access to a patient’s medical history, even though the doctor had never seen the patient before.

Supporters say the database would also save money when patients change providers or see a specialist, because the new doctor wouldn't have to order tests that have already been done by another practitioner. 

The federal government has provided stimulus funding for health insurance exchanges since 2009 in an effort to spur their creation nationwide, but most attempts have failed. 

Besides the technological challenges of linking so many disparate computer systems, there is the need to protect patient privacy. The U.S. Department of Health and Human Services recently disclosed that medical records of 32 million Americans, including 4.6 million Californians, have been breached or stolen in the past five years.

"California has strict privacy laws and patients have expectations that their records will be private," said Diana Dooley, secretary of the California Health and Human Services Agency.   "At the same time they want their providers to have access to enhance their medical options and outcomes."

Californians who wish to opt out of the Cal Index system may do so.

Health Net spokesman Brad Kieffer told KPCC the company considers the exchange "a good idea."

"And we’re always open to evaluating good ideas," said Kieffer. 

Cigna spokesman Mark Slitt said his company "is actively engaged with health care professionals and health care organizations" to address the issue of medical records. "However," he added, "confidentiality agreements prevent us from disclosing any details."

A spokeswoman for Aetna said the company had no comment on the Cal Index project.

Kaiser Permanente did not respond to requests for comment.

This story was updated on Aug. 6, 2014.