Following on the recommendations from the 2005 RFI, CMS wanted to assess the extent to which commercially available PHR products meet the needs of Medicare beneficiaries. As part of the procurement for the FFS pilot, CMS developed a list of requirements that an off-the-shelf PHR product should support for this initiative. The requirements included the ability for beneficiaries to print medication and condition lists, convert medical codes, such as International Classification of Disease (ICD) 9, into plain language, and maintain and track the names of health providers. Additionally, the PHR would be claims-based (e.g. imported data), would allow users or authorized representatives to manually enter information not pre-populated by the claims-based data, and include a link to the Mymedicare.gov site. Including this link to CMS provided another source of support in using the PHR.
MyPHRSC was based on the commercially developed personal health record offered by HealthTrio. CMS selected HealthTrio based on its ability to meet the requirements for PHR functionality with minimal customizations being made to the PHR tool, and in order to be suitable for the Medicare population. Additionally, HealthTrio had prior experience working with Palmetto GBA, and had successfully demonstrated that Medicare Claims data could be imported into the PHR.
MyPHRSC offered many features and functions for beneficiaries, including the ability to add medications, view a health record summary, and view demographic information including a list of providers, most recent health care visits, and emergency contact information. Some functions of the PHR were auto-populated from claims data, whereas others offered users the ability to review, add, edit, and update their health information. Discussions with HealthTrio representatives revealed that, in addition to the functions listed above, the authorized representative functionality was enabled for the purposes of the pilot.
For this pilot, the pre-populated medication data function was not implemented because Medicare Part D data (prescriptions) were not available. TRICARE medication data was eventually added to MyPHRSC in January 2009 but only to those beneficiaries dually insured (CMS and TRICARE insurance coverage). HealthTrio also added a feature not initially available allowing beneficiaries to track specific self-entered health values. One functionality not offered in the MyPHRSC pilot but available within the HealthTrio product included providers’ accessibility for viewing and entering data and secure email capabilities between providers and beneficiaries. Pre-populated medication lists, health tracking and secure messaging were functionalities outside the scope of this pilot.
The following is a list of features offered in MyPHRSC. Screenshots of each feature are included in Appendix 2.
- Health Record Summary. Provides a summary of the user’s health record.
- Illnesses and Conditions. Displays a list of current and past illnesses, symptoms and conditions. Includes the onset date, status and treating clinician for each condition.
- Medications. Contains information about prescriptions, over-the-counter medications, vitamins and supplements.
- Health Calendar. Allows users to add calendar events in the categories of health issue, health journal, immunization, procedure and visit.
- Immunizations. Provides details about the performing clinician, facility and status (completed or pending) of the user’s immunizations.
- Wallet Card. Allows users to print their health information in a handy hardcopy format. Includes fields for emergency contacts, advance directives, current medications, health issues, allergies and provider information.
- Claims. Contains information about claims the beneficiary has made; date of service, claim process date, provider, claim status and the total billed and payment status.
- Authorized Representatives. Allows users to grant permission to others for assessing their record. Beneficiaries may choose permitting each authorized representative the ability to modify PHR data or allowing the representative view-only access.
- Healthwise. Presents a database for referencing medical information.
- Trusted Websites. Features links to relevant sites.
- Health Assessment. Provides tools for creating a social history and a family history.
In order to encourage beneficiaries to enroll in MyPHRSC, a number of outreach events were conducted through the course of the pilot study. QSSI, the prime contractor for MyPHRSC and the entity responsible for all the outreach activities in the pilot, targeted an estimated 100,000 South Carolina Medicare beneficiaries. The state of South Carolina has 714,008 beneficiaries, one of the highest percentages in the nation. Outreach events ranged from attendance at health fairs to presentations and small-group workshops at senior centers. Some outreach events provided information, while other events included the use of a computer to demonstrate MyPHRSC or to allow beneficiaries to register. Seniors were invited to outreach events through a combination of direct mail, newspaper advertising and direct community outreach. Outreach was targeted to eight counties in the Columbia/Sumter core region: Calhoun, Fairfield, Kershaw, Lexington, Richland, Saluda, Sumter, and Newberry.