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California Needs This Innovative Approach to Help Battle the Pandemic

The health and economic crisis caused by COVID-19 calls for a widespread commitment to a strategy that connects all of California’s hospitals, ambulatory clinics, public health laboratories and health plans

Correction, May 5, 2020: An earlier version of this article said pulse oximeters were available to some members by calling customer service. Members should call their doctors.

This new era of COVID-19, a disease that’s upended health care and the economy, underscores the need for a comprehensive medical health records system in California.

For Manifest MedEx, a nonprofit statewide health information system, COVID-19 might just be the tipping point it needs for mass adoption. The organization is arguing that the health and economic crisis caused by COVID-19 calls for a widespread commitment to a strategy that connects all of California’s hospitals, ambulatory clinics, public health laboratories and health plans.

claudia williams commonwealth_square
Claudia Williams, head of Manifest Medex, addresses the Commonwealth Club of San Francisco, Dec. 11, 2018

While over the last few years the organization has gathered health records for 20 million residents in California, it’s still only roughly half of the state’s population. Getting closer to 100 percent of records could prove crucial towards getting the state’s economy fully functioning again, the nonprofit says. 

“We have the infrastructure to safely connect real-time data for every person in our state,” says Claudia Williams, CEO of Manifest MedEx. “But partial data sharing and gaps make it impossible to provide the insights and tools California needs to safely reopen.”

With an incomplete system, contact tracing—a systematic method of tracking down and monitoring people exposed to those infected—will be much more difficult to conduct, Williams notes. Contact tracing, a key to controlling the spread of an infectious disease, was largely abandoned during the pandemic, but it will now begin to scale, Williams says. Without a centralized network, the critical time spent on outreach to notify possibly infected people could be stymied by incomplete, basic information, such as addresses and phone numbers.

Conversely, a centralized database can help manage many moving parts among patient, providers, and testing facilities, Williams notes. If patients’ care teams have easy access to their health histories and COVID-19 testing results, they can be proactive and ultimately provide better care.

Historically speaking, it’s no secret the healthcare system is a collection of silos, with one doctor’s office not knowing the history of a patient stored at another practitioner’s office. The lack of centralization leads to waste, inefficiency, and errors – that can mean negative health outcomes for patients.

Williams likens the need for a centralized health information network to our dependence on basic infrastructure, such as water, gas, freeways, ports and broadband. “Our state needs a consistent and reliable flow of health information to function at any time,” she says. “It’s even more stark in a pandemic. If we don’t have a robust information infrastructure, our economy will remain shut down.”

That’s because the hurdles are high to get back to normal. Gov. Gavin Newsom announced on April 14 a series of six indicators needed to modify stay-at-home orders. One of them is the ability to monitor and protect communities through testing, contact tracing, isolating, and supporting those who are positive or exposed. That’s where Manifest MedEx hopes to help.

How a health information exchange could help the COVID-19 battle

A robust information exchange could speed the process. A patient diagnosed with COVID-19 could get a follow-up call from a primary care doctor and receive from the health plan a pulse oximeter—a device that measures oxygen levels in the blood (some Blue Shield members are eligible to receive these devices by calling their doctors). Public health teams could follow up by phone, and a home health team could provide additional support. In one location, public health officials could use the data to encourage those who have recovered from COVID-19 to donate plasma. All the information is in one place, so that various parties can monitor patients and be proactive.

A statewide infrastructure also helps reduce the number of connection points that need to be set up. Instead of having a hospital system or national laboratory connect to each county, they can connect to one system. “Few connections means faster sharing,” Williams says. 

It’s already paying off, with the critical systems for security, record matching, analytics, and data distribution are in place. Manifest MedEx shows its member hospitals a daily report of how many patients are showing up at emergency rooms with flu-like systems, serving as an early warning sign of COVID-19 outbreaks. Coming soon will be alerts to California providers in real time when one of their patients tests positive for COVID-19. Riverside County is relying on a daily dashboard of COVID-19 tests and outcomes.

Blue Shield of California invests in companies like Manifest MedEx to help provide real-time access to patient health records. “We believe in the best health outcomes for our members and Californians – period. And access to medical history will allow for the best medical care to be provided,” says Jeff Semenchuk, chief innovation officer of Blue Shield of California.

That kind of centralized access could prove critical in the coming weeks and months as the state wrestles with how to get back up to speed. “We need to act fast to build the data backbone to meet the governor’s requirements,” Williams says. “The good news is that we’ve already begun. But we will need a big push now.”