PHILADEPHIA, Pa. - When patients insured by Independence Blue Cross are discharged from the hospital, discharge reports are added to medical records at their primary doctors' offices less than 50 percent of the time.
It's a common example of the gaps in information-sharing among hospitals, doctors, and others in the health-care system.
In a bid to close such gaps, insurers IBC, AmeriHealth Mercy, and Health Partners and 37 of the 45 general acute-care hospitals in Southeastern Pennsylvania have teamed up to form a health-information exchange, which is expected to start this summer with a first wave.
Initially, HealthShare of Southeast Pennsylvania, which is chaired by Richard Snyder, chief medical officer at Independence Blue Cross, will allow insurers and health-care providers to send patients' discharge histories and medication information securely to the primary-care physicians and specialists responsible for picking up their care.
Longer term, the plan is that HealthShare will allow, for example, a hospital to pull patient information from a massive database to see whether someone in its emergency room with a heart problem was in another ER recently with the same issue.
That could speed care and help save money on duplicate tests at the 36 hospitals, which account for 90 percent of patient visits in this region. Information will be shared unless a patient opts out.
HealthShare's annual operating costs are expected to be about $2 million to start. The insurers will pay two-thirds, hospitals one-third, officials said. IBC has agreed to pay up to $650,000 annually for three years.
The organization's 11-member board will meet for the second time Feb. 27, when it will hear from two finalists for the contract to operate the system.
One is a partnership between NaviNet Inc. and Orion Health Inc. IBC is part-owner of NaviNet, and IBC executive Steven Udvarhelyi is NaviNet's chairman.
Snyder said he could not identify the other finalist.
Aetna, the second-biggest insurer in Southeastern Pennsylvania behind IBC, is not participating.
"Aetna is a national insurer, and we're looking at a wide range of health-information exchange options around the country," company spokesman Walter Cherniak Jr. said. Even so, information on Aetna customers will be in the system.
HealthShare is one of at least 11 health-information exchanges in Pennsylvania. The exchanges, and electronic medical records generally, were pushed by the American Recovery and Reinvestment Act of 2009, which allocated $19 billion nationally to help hospitals and doctors purchase electronic systems for medical records, as opposed to computer systems used for billing.
Though HealthShare is off to a later start than most of the other health-information exchanges -- not to be confused with health-insurance exchanges -- in Pennsylvania, it has a key advantage, some industry observers said.
"This is a rare model, to have both the plans and the providers at the table. It's unique, and unique in a good way," said Martin Lupinetti, a consultant in the Princeton office of Northhighland Co., which was hired to help start HealthShare.
"The payers are adding some intelligence" to the information system, said Lupinetti, referring to the insurance companies. They know which doctors have seen which patients, he said, and which medications the patients are taking (or are supposed to be taking), and which tests they've had.
"This is absolutely the new paradigm in health information, payers and providers working together," said Andrew Cohen, a vice president at consulting firm Kaufman, Hall & Associates Inc. "Is it unique? Probably today."
In a highly fragmented health-care market such as Philadelphia's, Cohen said, it's difficult for providers to get together and share information, but they must to survive the demands that government and private insurers will put on them to control costs.
"It's time for this region to get on board with it," said Curt Schroder, regional executive for the Delaware Valley Healthcare Council, which played a key role in shepherding normally competitive health systems through the collaboration process.
Asked whether the NaviNet-Orion partnership has an inside track on the contract, Karen Thomas, Main Line Health's chief information officer and vice chairwoman of HealthShare, said: "I don't think so."
The choice will come down to capability, track record and costs, she said.
Main Line Health has spent more than $50 million during the last five or six years building its own system for sharing electronic medical records with its doctors, Thomas said, adding that she is excited about HealthShare.
"We have been working very hard to automate the electronic medical records within the different providers," she said. "Now, this is an opportunity to let this information flow with the patient."
Contact Harold Brubaker at 215-854-4651 or firstname.lastname@example.org. ___