1 Health Information Technology Improving Health and Health Care with PHRs and EHRs David W. Sayen Regional Administrator Centers for Medicare & Medicaid Services (CMS)

2 How do you store your health information? ?

3 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 1 Source Forrester Research, “North American Technographics Healthcare Online Survey” 2008

4 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 1 Source Forrester Research, “North American Technographics Healthcare Online Survey” 2008

5 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.

6 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.

7 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.

8 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.

9 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).

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

11 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.

12 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.

13 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.

14 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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17 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.

18 Medicare PHR Choice Helping beneficiaries have access to their health information online, anytime.

19 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 Medicare can not access any information in an individual’s PHR. Individuals keep claims data and PHR after pilot is over.

20 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.

21 Medicare PHR Choice Pilot: January 13 – December 31, 2009 (may be extended). Go to - 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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24 Participating Vendors

25 Medicare PHR Choice

26 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.

27 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.

28 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?

29 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.

30  Every 3rd Thursday of the month, 2-3pm PST  Next call, July 16th, 2009 at 2 PM PST.  Toll Free:  Pass Code: Stakeholder Call  Leader: David Saÿen  Register for “CMS Region IX Stakeholder” listserv for notification and details about calls, please contact: Stay Informed- Region IX Stakeholder Call

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