No health record left behind
It’s not quite Dickensian, but the health care world that parentless children inhabit can be pretty forlorn. Because of the transient nature of the foster care system and a lack of information sharing among the Medicaid programs that pick up the tab for their health care, such children spend an inordinate amount of time bouncing from home to home and from one doctor to the next.
Some children mistakenly receive immunizations for diseases they’ve already been inoculated against or prescriptions for medications they’re already taking because new providers have no way of knowing — other than trying to jog the child’s memory — what diagnoses or treatments they’ve already received.
“In a very real sense, they were getting lost in the system,” said Kay Ghahremani, deputy director of the Medicaid/Children’s Health Insurance Program at the Texas Health and Human Services Commission (HHSC). She added that foster children are more likely than other children to have physical, mental and behavioral health needs.
Beyond the social and personal consequences, there is also a significant financial burden for taxpayers. According to the Centers for Medicare and Medicaid Services (CMS), the average monthly Medicaid cost for a foster child is five times higher than for a non-foster child. For behavioral services, the cost for foster children soars to 40 times that of non-foster children.
Texas’ foster care rolls are expected to swell from 30,000 children in 2007 to 43,000 by 2009, prompting officials to decide that it was time to improve the system for what Ghahremani calls the state’s most vulnerable population.
In April, Texas will launch its Star Health program for children in foster care, a landmark project that will bring foster children into a managed care system and give health care providers easy access to summaries of children’s medical histories.
Health Passports will give clinicians, pharmacists, caseworkers and caregivers Web-based access to children’s relevant medical records, including provider information, recent diagnoses, treatments, prescriptions, immunizations and allergies. Providers will be able to fill out official Medicaid wellness and behavioral health forms and record a child’s vital signs and allergy information.
Texas officials say they expect foster children and the Medicaid system to see a number of benefits, such as more timely care, fewer duplicative tests, a reduction in medical errors, more accurate diagnoses, and enhanced recordkeeping and data sharing.
“Bottom line, this is simply going to provide a better level of quality of services to these kids just in terms of the overall health care that they’re now going to receive,” Ghahremani said.
Mobile medical home
Texas lawmakers gave HHSC $500,000 to develop the Health Passport system. HHSC officials also applied for and received a $4 million Medicaid Transformation Grant from CMS.
Jessica Pollak Kahn, a project officer at CMS, said the Texas project is likely to be a model for other states struggling with continuity of care for vulnerable populations, including patients with chronic illnesses and infirmities that force them to rely on a variety of health services.
To oversee the Star Health program, HHSC chose Superior HealthPlan, a Texas-based health maintenance organization. The company will enroll foster children in its provider network and assign each child a dedicated coordinator to help caregivers navigate the system more easily.
Superior will manage Health Passport’s development and launch. Cerner, a large health information technology solutions firm, will provide technical services, and although Cerner will host the application at its data center, Superior will be responsible for data feeds and data integrity.
Superior will control security through a single-sign-on, role-based authentication and application process, and the company worked closely with Cerner to set up 19 user role groups. The approach tightly controls what information and actions each user can take within the system, said Sloane Cody, Superior’s Health Passport manager.
Another security measure calls for the system to audit and put a date and time stamp on every piece of every record. “That way we actually have an electronic fingerprint on what position or what caregiver or what person may have touched the record and what piece of it was viewed,” said Jay Linney, vice president of state and regional health strategies at Cerner.
Initially, Health Passports will be populated with up to two years of data from medical and pharmacy claims filed under Medicaid. Once under way, the system will add to each child’s summary using new data filed with Superior and its participating mental health, vision, dental and pharmacy claims administrators. As a result, “there will be some time lag to the system,” Ghahremani said.
HHSC officials hope to introduce an interoperability function that will allow the electronic medical record systems of health providers and hospitals to send data directly to the Health Passport system.
Holly Munin, chief executive officer of the Texas Foster Care Program at Superior HealthPlan Network, said a Health Passport is not a formal EMR and never will be. Instead, she described it as a communications tool. Others call it a community health record, or EMR lite.
A formal EMR would contain all of a patient’s information collected by a physician practice or hospital system. It would include X-rays, test results and in-depth notes on every visit. It would also integrate with other internal IT processes, such as billing and scheduling.
Munin said the nature of caring for children in foster care demands an information system that is more horizontal and can give providers an overarching view of a child’s health status no matter where the child lives or has lived in Texas and what type of care he or she has received, whether it was in an emergency room or a psychiatrist’s office.
“A physician really needs to be able to get some high-level information quickly on the patient’s critical health information, not look at the notes of every single doctor they’ve ever seen,” she said.
Superior will offer training on how to use the system, but based on initial contacts with a sampling of providers, caseworkers and caregivers, Munin and her colleagues are not expecting any cultural resistance.
“Just knowing that they’ll have this kind of information at their fingertips and that it’s being supported by a health insurance service coordination model is very exciting to people we’ve talked to,” Munin said. “We hear anecdotal stories all over the place where having the Health Passport could have made a huge difference.”