Health Records for the Poor Driven by the Indigent Care Collaboration

Ann Kitchen, executive director of the Indigent Care Collaboration, is driving e-health records for the poor.

by / July 31, 2008
Ann Kitchen

Texas Technology Contributing Writer Patrick Michels wrote in this issue about the state's push to develop online electronic health passports for foster children in Electronic Health Records Document Foster Children's Medical Histories. But another underserved population suffers from some of the same issues resulting from gaps in health history information - the poor.

Among the leaders in the drive to provide portable health records for the poor is Ann Kitchen, a former one-term state legislator who is now the executive director of the Indigent Care Collaboration (ICC). She has worked for nearly 20 years in health-care-related jobs - starting as a social worker and working up to a policy adviser for the State Medicaid Office. Kitchen now leads the ICC, a government alliance of "safety-net" health-care providers that serve the poor in Hays, Travis and Williamson counties.

Among the ICC's successful projects is a data repository for sharing the electronic health records (EHRs) of 3.3 million encounters that include data for more than 700,000 low-income and uninsured patients.

"We call them a shared health history because they don't have all the data they would have for the actual electronic medical record at your doctor's office," Kitchen said. For example, a doctor in a clinic doesn't need to know everything that happened to a patient in the emergency room (ER), but there are some data elements that are useful.

It's a Master Patient Index/Clinical Data Repository created using an application service provider (ASP). The data hooks into the database via electronic interfaces, and the database is Health Insurance Portability and Accountability Act-compliant, she said. The shared health history includes: the type of medical facility, provider, who the doctor was, payer, diagnosis, prescriptions and procedure codes, among other data categories.

There are three reasons for keeping track of the data, Kitchen said. No. 1 is that when a patient visits a hospital or a clinic, he or she might not remember details about a prior doctor's office visit, or particulars such as what drug was prescribed. The ICC's electronic health history helps doctors fill in the gaps of a patient's health history, which results in better care.

"The second use is to provide reports to the community. These are aggregate reports, not [individuals'] names. So people can see what is happening in the community: how many people are going to the ER, how many people don't have a doctor to go to, how many people have asthma or diabetes - that kind of stuff," she said. "Then the third use is for actual academic-level research."

Currently there's debate around the country about who exactly should take the lead in developing an EHR for all Americans. Should it be insurance companies, doctors, consumers or even Google?

Kitchen said being in the Legislature taught her that when it comes to EHRs, the state government should provide guidance and resources while the records themselves should be developed from the bottom up, community-driven. No matter who develops them, Kitchen said the data is vital.

"Our focus is on part of the health-care community and that focus is on improving access to care for people who don't have insurance. Having the data available to measure whether we're making any difference, and also to measure the scope of the problem, is essential," she said. "Having this technology is invaluable."


Matt Williams Associate Editor
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