Online Medical Records Close to Reality in California

Nearly a quarter of all Californians could soon have their medical histories accessible to doctors and emergency rooms all over the state with just a few strokes on the keyboard.

Two of the state's largest insurers are launching perhaps the biggest health information network anywhere in the country, putting California at the center of the decade-long push to digitize medical records.

Supporters say the project could mean faster and better healthcare, with less spending on unneeded tests — if it can clear a thicket of technical challenges and privacy concerns.

Dubbed Cal Index, the system is set to launch by the end of the year, connecting the nearly 9 million patients of Anthem Blue Cross and Blue Shield of California with doctors, hospitals and other healthcare providers.

The two companies are providing $80 million in seed funding to a nonprofit group that will run the exchange, and hope to eventually sign up more rivals to build a seamless statewide network.

“We need to bring healthcare into the digital age, and by doing so you can really improve the quality and cost of care,” said Paul Markovich, chief executive of San Francisco-based nonprofit Blue Shield. “What you ultimately want for every patient is an evidence-based, personalized care plan, and you can only do that if you have real-time digital information.”

That real-time information would make the full medical history of a patient from Irvine available to, for instance, an emergency room doctor in Eureka. And it would give a patient's full spectrum of providers — including family physician, surgeon and pharmacist — access to the same set of basic facts.

But some privacy advocates worry that those medical details could be spread too wide for comfort.

The healthcare industry has been trying for more than a decade to replace paper charts and fax machines with electronic records, with mixed results. Some big HMOs — like Oakland-based Kaiser Permanente — have built these systems within their closed networks.

But for thousands of other doctors and hospitals, linking up has been more cumbersome. There are fledgling data-sharing networks all over the country, but so far, they're mostly local and limited to providers.

Adding major insurers, with their large patient rolls and deep pockets, could start to tie these scattered efforts together, said Mark Savage, director of health information technology policy at the National Partnership for Women and Families.

The promise of a seamless electronic system is huge. Supporters say it would improve care by giving doctors a clearer look at a patient's entire medical history, instead of starting from scratch each time a person visits a new provider. It would help avoid repetitive testing. And it can help doctors better track a patient's care over time, in the hospital or anywhere else.

“I find this to be incredibly exciting,” said David Feinberg, chief executive of UCLA Health System and the new chairman of Cal Index's board of directors. “The real power is to be able to use the data to make decisions.”

But there are pitfalls. The nuts and bolts of connecting countless networks of medical records has stymied some regional exchanges in the past.

“It's very difficult,” said Donald Crane, chief executive of the California Assn. of Physician Groups. “Everybody's got a different kind of data, with different definitions, different fields.”

Another huge challenge: data security. Personal medical information of more than 29 million people nationwide has been improperly exposed since 2009, according to federal data.

And last year, Woodland Hills-based Anthem, a unit of insurance giant WellPoint Inc., said it accidentally posted online Social Security or tax identification numbers for nearly 25,000 California doctors as part of its online provider directory.

Even beyond data breaches, many patients simply don't want their sensitive health information spread on a wide network, said Pam Dixon, executive director of the San Diego-based World Privacy Forum.

People who suffer from rare diseases, domestic violence victims and people who have had abortions or miscarriages all routinely contact her office asking how to keep their records private, she said.

“Health information exchanges have the potential for good,” Dixon said. “But right now, the opt-in/opt-out needs to be perfected and sensitive information needs to be protected. There are a whole lot of people with a lot of concerns, and most don't know how to exercise their rights. It's not easy.”

Cal Index organizers say any patient who wants can opt out of the system. Doctors, they say, will have access only to records of their own patients. And state and federal privacy laws will help protect consumers. They spent a year working on privacy issues, said Mark Morgan, president of Anthem Blue Cross.

“We've spent a lot of time assessing the challenges,” he said. “We feel, frankly, quite confident we've got a solid foundation.”

They aim to grow Cal Index over the next few years by partnering with more doctors and with regional networks that already share records. They see big potential customers in the new Accountable Care Organizations — networks that agree to treat large numbers of patients for a flat rate. And they plan to partner with more of their rivals, adding insurance providers such as Medi-Cal and, potentially, Kaiser.

“We want everyone to play,” Blue Shield's Markovich said. “If everyone plays, then we're going to have every single Californian with a record that's portable.”

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