CALINX Setting the Standard for Lab and Pharmacy Data in California
Something in it for all of us
CALINX Standards Oversight Committee and
Integrated Healthcare Association
Kathy Kim, MBA, MPH
“While there may not be a documented business case for adopting any
standard on its own, the case for high quality data needs to fit into your
--- Dr. Fiona Wilson, Brown & Toland Medical Group
When the California Healthcare Foundation reinvigorated the attempt to
standardize data exchange three years ago, it was with an end in mind: to improve care
by offering all of California’s providers accurate and timely clinical information. The
challenges were numerous and previous attempts by various organizations had not been
successful. This time around however the collaboration between providers, lab and
pharmacy vendors, and insurers was solidified first, and the initiative thrived. Today,
there are six health plans, over 200 provider organizations, and two national labs sending
and receiving CALINX standard data. CALINX pharmacy (CALINX Rx) has achieved a
critical mass of adoption and CALINX Lab is gaining ground. The hope is that both will
be adopted across the state by 2008.
CALINX Rx Status CALINX Lab Status
• Began in 2004 • Began in late 2005
• 6 health plans sending • 2 national labs sending monthly
monthly/quarterly files: Aetna, files: Quest and LabCorp
Blue Shield, CIGNA, Health Net, • 3 health plans are receiving
Blue Cross, PacifiCare • 55 provider organizations are
• 50 to over 200 provider receiving
organizations receiving from each • 1 hospital system piloting
health plan. • CALINX Lab v1.1 in use, v1.2
• CALINX Rx v2.0 in use. approved and in transition.
What is CALINX?
The key to data’s usefulness and accessibility lies in its standardization.
Unfortunately, most standards are more like guidelines allowing a great deal of flexibility
in how they are implemented. Allowing for local customization has its uses; however,
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this flexibility also causes problems for larger organizations that want to share data
efficiently across organizational boundaries. It’s no secret that even the same version of
HL7 from one health plan does not automatically integrate with another’s. You would
still need to map the data with each one’s implementation guide in order for it to make
sense. As a medical group, the cost of maintaining seven to 10 health plans’ formats and
data mappings becomes burdensome.
CALINX has addressed these problems through a statewide consensus process.
Rather than designing new standards, CALINX started with nationally-accepted HL7
formats, LOINC lab vocabulary and NCPDP prescription standards, then added a
uniform implementation manual, agreed-upon business rules, and software tools to assist
with adoption. The commitment of all stakeholder groups assured that the data was
Demonstrated Benefits to Stakeholders
Each group of stakeholders in the collaborative process that gave birth to
CALINX expected to see benefits from it. Over the last three years, these benefits have
been demonstrated to providers, health plans and national labs.
Brown & Toland Medical Group and HealthCare Partners Medical Group were
two of the early provider organizations to adopt CALINX. In addition to participating in
the committees that set the standards and implementation guides, they leveraged the
resulting data to further their strategic goals. Brown & Toland Medical Group is an IPA
of 1,500 physicians in the San Francisco Bay Area, while HealthCare Partners Medical
Group serves more than 500,000 patients in the Los Angeles and north Orange County.
Dr. Fiona Wilson, Vice President of Quality Initiatives, was motivated by
CALINX’s potential to improve the quality of data. “Lack of data can take a physician
from a high performer to a low performer. The more complete and accurate the data, the
greater the level of comfort we can provide for our physicians.”
While most doctors were not even aware of CALINX, the Brown & Toland staff
knew that its use allowed them to process data from the health plans more efficiently.
Ann Hardesty, Manager of Reporting and Analysis, noted that they didn’t always feel
confident about managing quality via claims data alone. CPT codes and text descriptions
were not specific enough. For example, a lab claim would identify a lipid panel but
CALINX which includes LOINC codes, would identify LDL cholesterol specifically.
This specific information is needed for both comprehensive diabetes care and cardiac
management. Ms. Hardesty’s motivation to adopt CALINX was the improved
consistency and specificity of data from all the health plans that could improve their
disease management, case management, and quality improvement programs. She also
said that prior to CALINX the lag time for obtaining clinical information was sometimes
five or six months and the files were not received on a regular schedule. Now, it’s less
than two months lag time, the health plans are committed to monthly file transfers, and
she is able to distribute reports to physician in a more timely fashion. Brown & Toland’s
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implementation of CALINX Lab is 99% complete and Ms. Hardesty anticipates they will
achieve additional benefits from lab data standardization as they did with pharmacy.
HealthCare Partners Medical Group and HealthCare Partners IPA is comprised of
more than 2,500 primary care physicians and contracted specialists who care for more
than 500,000 patients in Los Angeles and north Orange County. Ed Kasch, Director of
Ancillary Systems, credits CALINX with helping make HealthCare Partners’ electronic
physician portal more efficient and useful. In the past, paper Pay for Performance reports,
with lab and pharmacy data, were distributed approximately three times per year;
however, this was too infrequent to allow point-of-care reminders to help physicians
manage their patients.
In September 2006, HealthCare Partners implemented full Pay for Performance
reporting through its physician portal, supported by CALINX-fed pharmacy data and a
proprietary lab results feed. In addition, full patient pharmacy history was added to the
physician portal in July 2007. HealthCare Partners is now working on providing
comprehensive lab data based on the CALINX lab feeds received from its contracted
labs. These developments allow HealthCare Partners to provide electronic data,
including lists of patients requiring disease management and non-compliant patients, to
their physicians for action on an on-demand basis.
The efficiency with which HealthCare Partners’ IT department was able to
process monthly files from health plans was a factor in the feasibility of the physician
portal. “Where it used to take two to three weeks each month to process these files, now
we are able to automate the data loads and the information is available as soon as the
medical group receives it.” Mr. Kasch credits the tools provided by CHCF and the
reliable CALINX standard with making the implementation process straightforward.
“We were able to implement this automated process with CALINX-formatted files with
existing data warehouse staff. It didn’t require additional staff or a new programming
In addition to making the collection and integration of data more efficient,
CALINX can also help provider organizations improve their responsiveness on pay for
performance (P4P) and other quality programs. Take the example of a medical group that
collects Hemoglobin A1-C results for comprehensive diabetes care, both a HEDIS and
P4P requirement. Generally, these results are not available through administrative data
alone. This requires health plans and provider organizations to conduct manual chart
reviews. For HEDIS, organizations conduct a sampling of member’s charts to
supplement their electronic administrative data. However, P4P requires data on the entire
patient population, and manual chart reviews are unfeasible and therefore not allowed.
Hence, providers’ performance on these measures in the past has been quite paltry. With
the advent of the CALINX standard and adoption by two national lab companies, the
industry now has the opportunity to use electronic data to fulfill this requirement. This
benefits both providers and health plans.
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The benefits of CALINX for health plans are similar to those for providers. First,
health plans can make better use of the data they collect for quality improvement since it
is uniform. Second, they are able to respond to the increased requests from purchasers to
provide comprehensive clinical data such as lab results for disease management.
Blue Shield of California led the way in promoting adoption by asking provider
organizations to submit their lab results data only in CALINX format in 2007. Michael
Higgins, Blue Shield’s Director of Medical Informatics, was concerned that smaller labs
and hospitals might find integrating clinical data from laboratory information systems
with administrative data from billing systems a challenge and a barrier to converting to
CALINX. So, he started testing the use of CALINX on large data sets with just one
reference laboratory. When this proved successful, three more were added, and another
five will implement this summer. On a small scale at least, it seems these smaller labs and
hospital labs were prepared to undertake this conversion.
Wellpoint is another health plan supporter. Director of Health Informatics Peter
Lee became involved at the onset and helped launch the pharmacy standard which is now
widely used. He noted that the need for CALINX is even more critical to lab data
because there are numerous tests and varying ways of reporting results. “For health plans,
it would be difficult to store all available results given such variation. Since the national
labs have already implemented CALINX, this will make the job much easier for those
who need to make use of the results. But there are numerous smaller volume labs, such
as hospitals, that are not using CALINX today. We would have to do a manual process
for incorporating those results, and that is just not feasible.”
Two national laboratory vendors, Quest and LabCorp, have voluntarily adopted
CALINX, providing files in this format at the request of their customers. LabCorp noted
that it takes only a few weeks to fulfill a request once a medical group makes it and there
is no additional cost. They have also found that customers are able to use the CALINX
implementation tool quite easily, and since it applies to lab data from any vendor, it is
very beneficial. Pam Sherry, LabCorp’s Senior Vice President of Communications said,
“Being on the ground floor of this initiative to standardize data in California is important
for us because it sets the stage for what may happen nationally.”
CALINX has achieved key milestones in the path to statewide health information
exchange: endorsement by over 65 organizations of a uniform standard for lab and
pharmacy, a critical mass of adoption by over 200 organizations for pharmacy, and an
ongoing push for lab to increase the number of adopters beyond the first 35. The
California Healthcare Foundation and Integrated Healthcare Association, along with the
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endorsers of CALINX encourage all provider organizations, health plans and labs to join
in adopting CALINX to reap the benefits of standardized lab and pharmacy data.
To assist provider organizations in adopting CALINX, CHCF provides tools and
technical assistance available at www.iha.org/calinx/entry.htm.
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CALINX at a Glance
Statewide collaborative with hospitals, medical groups, insurers, lab and
pharmacy vendors, sponsored by California Healthcare Foundation and
coordinated by Integrated Healthcare Association. Six health plans, over 200
provider organizations, and two national labs have implemented CALINX lab or
Statewide adoption of data exchange standards for batched, electronic lab results
and pharmacy data leveraging national HL7, NCPDP, LOINC standards with a
uniform implementation guide, agreed upon rules of exchange, and software to
assure standards compliance.
To improve provider access to accurate and timely clinical information.
• Data from all participating sources is in the same format and vocabulary
• Agreed upon business rules ensure data arrives on a regular schedule
• Potential to automate data improves staff efficiency
• More timely and accurate data
• Improves credibility with physicians
• Responsiveness to pay for performance, quality reporting, and proactive
disease management or population management programs.
To assist provider organizations in adopting CALINX, IHA provides tools and
technical assistance with implementation at www.iha.org/calinx/entry.htm. For
questions or to learn more about CALINX Standards Oversight Committee please
contact Dolores Yanagihara (firstname.lastname@example.org).
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