Electronic Health Records Document Foster Children's Medical Histories

To anticipate the future, take a look at the past. It makes particular sense in health care when critical decisions are based on patients' medical history. However, for foster children who arrive at new homes with little or no record of treatment, knowing the past poses a major challenge. Documented allergies, immunizations and illnesses are often shrouded in mystery when foster parents take in a child.

That changed for Texas foster children on April 1, when the state Health and Human Services Commission (HHSC) rolled out the online Health Passport. Today more than 30,000 foster children have electronic records that update most information automatically and follow the child when they move to a new home.

The Health Passport, one feature in an overhaul of Texas' foster child health-care system, is the latest program in a larger trend toward electronic health records. It's the first program of its kind in the country, but project developers say other states may soon follow Texas' lead.

From insurance claims to food allergies, a foster child's medical data is housed by an array of companies, state agencies and practitioners. Texas' Health Passport draws these data sources together and presents them side by side. Through a Web-based interface, each child's guardian, doctors and "medical consenter" (a legal designation often awarded to the foster parent) can access the passport, review the child's medical history and make necessary updates. Meanwhile, insurance claims, lab results and most other medical data update automatically. The result is a more complete and accurate snapshot of the child's medical history.

Rooted in Negotiation
The Health Passport is rooted in SB 6 from the 2005 state Legislature. The bill is loaded with measures to improve programs under the state's Department of Family and Protective Services (DFPS). The bill included a mandate that foster children's health care be streamlined under a single management program, and included a "Medical Passport" section covering information the electronic passport should contain. Once the bill passed, the HHSC held sessions with the DFPS, foster care providers, advocacy groups, health-care providers and technology companies, to sketch a blueprint of the passport.

Yvonne Sanchez, senior health policy analyst of the HHSC, said the Health Passport that's online today is the product of a long negotiation among all stakeholders. "Those were really intense sessions because we have two different agencies, different providers. Everyone has different needs, different things they wanted to get out of the Health Passport," Sanchez said. "Ultimately we were just steering the process, trying to come up with a design and a model that would really work to benefit the users."

Texas received a $4 million federal grant from the Department of Health and Human Services to build the system, as part of a larger push to advance health-care IT countrywide. In March 2007, the HHSC awarded the blanket contract for foster child health-care management to Superior HealthPlan, operated by St. Louis-based Centene Corp. The management solutions Superior developed under the contract, including the Health Passport, formed a new program called Star Health.

Superior's Health Passport program manager, Sloane Cody, said her team had a short learning curve because the company was already managing parts of Texas' Medicaid and Children's Health Insurance Program. "We're lucky - we had worked with a lot of the vendors before and had a relationship with the community we cover in Texas," said Cody. "We were lucky that SB 6 gave a fair amount of detail and the contract we went into offered a lot of detail."

To build the passport, Superior assembled groups of four or five full-time staff members to handle specific project areas: data interface management, access security, integrating whole assessment forms and reports into the system, demographics, and integrating the child's and caregiver's personal information. To build the framework technology, Superior contracted with Cerner Corp., a Kansas