This document discusses an integrated clinical engagement model for personal health records (PHRs). It describes key drivers for this model including efforts to increase efficiency, wellness, medical management, and consumer experience. The model includes a clinical data repository that integrates various types of patient data. Challenges include a lack of standards for transferring all types of PHR data between health plans and representing elements such as alerts and physiological information. Alignment with existing standards and expanding PHR data domains are suggested for moving forward.

1. PHR in an Integrated Clinical Engagement model Saji Salam MD,MBA Clinical Transformation Group Cognizant Healthcare Practice TEPR Conference May 20, 2008, Florida

2. Integrated Clinical Engagement model

3. Key Drivers Integrated Clinical Engagement Model Employers Health Plans Providers Members Industry - Creating efficiencies in health benefits vendor management by limiting choice to a few plans - Focus on medical management capabilities of plans - Wellness focus as a way to reduce costs - Competition is using Integrated Healthcare Management as differentiator - Customers buying into the same P4P driving increased cooperation from providers - Forrester (and other analysts) - Leading Health Plans -Vendors such as Microsoft, Google,Quicken Demand for better “consumer experience” CDH pushing for more responsibility for healthcare to members

4. Integrated Clinical Engagement-Data model Clinical Data Repository Payer / Purchaser Info Pharmacy Data Encounter/Clinical Data Labs / Imaging Data Family/Social History/ Demographic data Provider quality/cost data Medical Management Info (HRA, DM, CM etc) Claims Data

5. PHR

6. PHR in an Integrated Clinical engagement model

7. Member/patient view Clinical Demographics Social/Family History Allergies/Alerts/Immunizations Clinical Information Diagnoses Lab/imaging results Rx history Inputs from home monitoring devices Discharge summary/ Financial HSA related information Benefits -Co-payments/deductibles etc User friendly statements (Explanation of Benefits) Medical expense management Other Provider information Plan information Calendar/Schedule management

8. Challenges

9. AHIP- BCBSA Implementation guide: P(B)HR Data transfer between health plans Not Included HL7/ASTM CCD Plan of care Not Included HL7/ASTM CCD Alerts Not Included HL7/ASTM CCD Health Risk factors Not Included HL7/ASTM CCD Benefit information Not Included NCPDP Immunization Not Included HL7/ASTM CCD Physiological information Not Included HL7/ASTM CCD Family History Included ASC X12 N Subscriber information Included ASC X12 N Health Plan information Included ASC X12 N Facility Included ASC X12 N Provider Included NCPDP Medication Included ASC X12 N Encounter Included ASC X12 N Patient Information Plan to Plan transfer Alignment with existing standards PHR data domain

10. Way forward? Source: Dr.William Gerardi - HCSC

11. Q & A Contact:saji.salam@cognizant.com