Health Information Technology Improving Health and Health Care with

							   Health Information Technology
Improving Health and Health Care with
          PHRs and EHRs


                 David W. Sayen
              Regional Administrator
 Centers for Medicare & Medicaid Services (CMS)




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How do you store your health
       information?

            ?

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Do U.S. Households Track Personal
Health Information?
•   Thirty percent of U.S. consumers said their
    households track personal health information;
•   Fifty five percent said their household does not
    track personal health information;
•   Fifteen percent said they did not know.1


1Source  Forrester Research, “North American Technographics
    Healthcare Online Survey” 2008

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How do U.S. Households Track Personal
Health Information?
•   Of the households that track personal health
    information:
•   Seventy six percent said that they use a paper-based
    record-keeping system;
•   Eleven percent use an internet-based service or
    program;
•   Thirteen percent use a personal computer program.1
1Source  Forrester Research, “North American Technographics
    Healthcare Online Survey” 2008


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Why Track Personal Health Information?

•   You should help manage your health and your health
    care.
•   You can become empowered with information.
•   Personal Health Records or PHRs can make your life
    easier by helping you track your medical history.
•   PHRs help you store all of your information in one
    place.




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What is a Personal Health Record?
• A personal health record, or PHR, is a tool designed to
  help you track and manage your health care.
• It is a place to store a collection of information about your
  health or health care services such as doctor visits,
  hospitalizations, medications, medical conditions, and
  additional information about yourself that you choose to
  add.
• You can sort your information in different ways and print
  reports to share with your doctors and others.
• Most PHRs are internet based.



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    What is a Personal Health Record?
•    Sometimes PHRs only contain data entered by you, but it
     can also include information from other sources such as a
     health plans.
•    Web-based PHRs are secure, password-protected sites that
     are accessible from anywhere – all one needs is Internet
     access.
•    Access to the PHR can be shared or restricted – it is entirely
     up to the user.
•    PHRs may help improve the quality of your health care by
     making it easier for you to find and share information. It
     might even help reduce duplicate tests.


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    More Benefits of PHRs
•    PHRs put you in control of your information. You can
     add information about your help that you feel is important
     and you can control who has access to it.
•    PHRs are especially helpful for people with chronic
     conditions who take many medications and visit different
     doctors’ offices frequently. Access to the PHR can be shared
     or restricted – it is entirely up to the user.
•    PHRs can help in a medical emergency by enabling health
     care providers to get information about you.
•    PHRs can give drug interaction and drug recall information
     and provide links to trusted medical sites to help keep you
     up-to-date.

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PHRs vs. EHRs

•   A PHR is controlled by the consumer
    (administrative data).
•   An electronic health record (EHR) is owned by
    and under the control of the provider (physician,
    hospital, health center) (clinical data).




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MyMedicare.gov

• MyMedicare.gov is not a PHR.
  • View claims.
  • View eligibility, entitlement, and preventive services
    information.
  • View enrollment information.
  • Beneficiaries cannot add information.




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MyMedicare.gov vs. PHRs

•   A PHR is different than MyMedicare.gov because a
    PHR has much more functionality and is owned by
    the user.
•   MyMedicare.gov is owned by Medicare and can
    show claims. You can not add other information to
    MyMedicare.gov and you cannot share it with
    others.
•   A PHR can allow the user to track data over a long
    time, collect and sort additional information, track
    health activities and print reports.

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•Information for People with Medicare

• Medicare does not currently offer PHRs.
• Medicare pilots with PHRs:
  • PHR controlled by the beneficiary;
  • Medicare data used to populate PHR (Part A and B);
  • Additional information can be added by the
    beneficiary;
  • Information can be sorted and viewed in different
    ways.



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Functions of Many PHRs

 •   Medication management (esp. refills) plus the ability to
     track prescriptions and over the counter medications.
 •   Links to educational information.
 •   Tracking lab results.
 •   Managing out of pocket expenses.
 •   *scheduling appointments with your doctor.
 •   *secure messaging with your doctor.




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My Personal Health Record South
Carolina (MyPHRSC)
• Medicare Fee-for-Service Pilot.
• Testing outreach to, and adoption of PHRs by
  FFS Medicare beneficiaries:
    • Comprehensive outreach plan;
    • Working with CMS Regional Office and local partners for
      support.


  • Initial target - 100k beneficiaries in South Carolina.
  • Use existing commercial PHR – HealthTrio.
  • Medicare contractor provides claims data – Palmetto.
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MyPHRSC

• Collaboration with the Department of Defense (DOD):
  • Working with the DoD to add additional data for 65 TRICARE
    and TRICARE For Life (TFL) beneficiaries residing in South
    Carolina who participate in the MyPHRSC pilot;
  • Those targeted are Medicare beneficiaries first and have
    TRICARE as their secondary payer;
  • DoD wants to make medical information such as active meds,
    allergies, and other information contained in their medical IT
    systems available to their TFL participants to supplement the
    Medicare information in MyPHRSC.




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Medicare PHR Choice



   Helping beneficiaries have access to
   their health information online, anytime.



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Medicare PHR Choice
•   Pilot program for 2009 in Arizona and Utah.
•   Medicare is partnering with four private PHR companies to encourage
    PHR use – designed to give people choice of tools.
•   Medicare will auto-populate up to 2 years of Part A & Part B claims
    into a PHR and continue to add new claims as they are available in
    2009.
•   Medicare can not access any information in an individual’s PHR.
•   Individuals keep claims data and PHR after pilot is over.




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Who Can Participate in Medicare PHR
Choice?

•   Only people with Original Medicare with a primary residence in
    Arizona or Utah can participate in the pilot.
•   Individuals need to select one of the participating companies in the
    Medicare PHR Choice program to have their claims automatically
    added to their PHR.
•   Snowbirds can use a PHR – have records when away from home.




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Medicare PHR Choice
•   Pilot: January 13 – December 31, 2009 (may be extended).
•   Go to http://www.medicare.gov/phr - Homepage.
•   Select Medicare PHR Choice “green” button.
•   Compare the available PHR tools – link outside of Medicare.gov to go
    to their sites and view demos, etc.
•   Sign-up for a PHR tool on the company site you selected.
•   Once signed-up – access their PHR through the company’s website.




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Participating Vendors




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Medicare PHR Choice




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Medicare PHR Choice
•   People with Medicare should have their Medicare card with them when
    they sign-up for their PHR.
•   Once signed-up for their PHR, the company will link the individual to
    Noridian Administrative Services.
•   The individual will then provide key information/Medicare number and
    agree to allow Medicare to input their claims data into their PHR
    automatically. Noridian will verify the information before claims are
    transferred into a PHR.
•   The data is not shared with anyone else and it is not kept or stored by
    the PHR. The claims are the property of the individual, just like all
    other information in their PHR.
•   If someone decides to delete their account, the claims data is deleted
    with their PHR file. Claims cannot be transferred to another PHR.


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Comparing PHR Companies
•   Encourage beneficiaries to explore all of the vendors’ Web sites.
•   The individual’s comfort with navigating a site should be a key
    consideration in selecting a PHR.
•   All offer a Free PHR, however some companies offer extra services and
    features for a fee.
•   Some PHR companies are discounting their fee during the pilot – check
    with company to see if there will be a cost to maintain the PHR after
    the pilot is over.
•   See the compare chart for a listing of basic and specialized features and
    costs.




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Comparing PHR Companies
• Some things to consider when selecting a PHR include:
  • Can the PHR import my claims or medical information from my health
    plan and/or doctors?
  • What kinds of features does the PHR offer, such as the ability to print a
    list of my medications or conditions?
  • Can I give permission to my doctors or family members to look at my
    PHR for me?
  • Does the PHR offer links to other websites that provide educational
    information about health issues?
  • Is there a monthly or annual fee to use the PHR? Is there a cost for
    “extra” features?
  • What will happen to my information if the company that provides the
    PHR goes out of business or becomes part of another company?
  • What are the PHR's privacy and security policies?

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Security & Privacy

•   PHR accounts have similar security policies and standards
    to other online functions, like banking and shopping.
•   Individuals have a unique ID and password for their PHR
    account.
•   Each PHR company in the Medicare PHR Choice had to
    include security and privacy policies to keep individual’s
    information safe.
•   Each PHR company uses a different security and policy
    system – it is important to look at them before selecting and
    signing up for a PHR.
•   Medicare will not have access to any individual’s
    information in their PHR.
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Stay Informed-
Region IX Stakeholder Call
        Every 3rd Thursday of the month, 2-3pm
         PST
        Next call, July 16th, 2009 at 2 PM PST.
        Toll Free: 1-888-452-0273
        Pass Code: Stakeholder Call
        Leader: David Saÿen
        Register for “CMS Region IX
         Stakeholder” listserv for notification and
         details about calls, please contact:
         nicole.lockey@cms.hhs.gov
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