California Information Exchange

CALINX Vision

Better healthcare through better information exchange.

CALINX Mission

To champion standardization and collaboration in the exchange of electronic healthcare information among California's plans, providers, and purchasers for the benefit of consumers.

CALINX Commitment to Confidentiality

CALINX intends to protect the privacy of individually identifiable patient information while standardizing industry-wide data exchange practices necessary for health care operations to support treatment, quality measurement or payment. CALINX agreements are constructed to facilitate exchange only of data necessary for business operations and all participants are expected to comply with all existing state and federal confidentiality laws. Use of the CALINX data sets contributes significantly to protection of patient confidentiality and to overall organizational compliance with confidentiality laws by establishing clear definition of what information is needed for business operations. Individual health care entities must also establish formal policies and procedures for managing confidential patient information internally.

Background and Overview

• Background
• Addressing the Health Information Crisis through CALINX
• PBGH: Health Care Data Vision 2000 (Paper)
• California Health Care Information Freeway (Draft Paper)
• Initial Summary of Concurrence from CALINX Summit #1
• Original News Release
• Goals and Objectives, 2001

Partner Organizations

• CALINX Oversight Group (COG)
• Partner Organizations

Reports

• Demonstration Project Report
• Laboratory Demonstration Final Report
  • Main Report and Attachment 1
  • Attachment 2
  • Attachment 3
  • Attachment 4
• Health Care Electronic Transaction Data Flow Analysis
• Completeness and Accuracy of Managed Care Administrative Data Sets (CAMAS)
  • Report
  • Summary Presentation
• CALINX Toolkit (contains Guidelines and Rules of Exchange for specific data sets.)

Background

California's leading physician and hospital organizations, purchasers, and health plans have joined forces to improve the quality of California's health care by advancing the quality of health information. This collaborative effort grew out of a shared belief among purchasers, plans and providers that all parties should be committed to better information for better care. No other state in the nation has undertaken such a bold effort to improve the quality of health care.

CALINX (California Information Exchange-Linking Partners for Quality Healthcare) began in late 1996 as a broadly-based effort among California businesses, physicians, health plans, hospitals and health care systems. All stakeholders have agreed to collaborate on standards, cooperate on implementation and compete on quality. The Pacific Business Group on Health (PBGH), NIPAC, and the California Association of Health Plans (CAHP) are managing this effort in collaboration with the American Medical Group Association (AMGA), California Healthcare Association (CHA), and California Medical Association (CMA). Administrative costs were initially supported by a generous grant from the California HealthCare Foundation based in Oakland, CA.

CALINX is a statewide initiative with five principal objectives:

• Improve the completeness and accuracy of health information
• Promote the adoption of data standards and implement electronic data interchange (EDI)
• Encourage stakeholders to share the information needed to make good health care decisions, monitor patient populations, and support value-based purchasing
• Improve inefficient information systems and provide for the open, secure exchange of information among trading partners
• Protect the privacy and confidentiality of individuals while balancing the need to monitor health care performance and quality.
• (Click here to see the CALINX confidentiality statement).

The health care industry lags most other industries in its ability to gather information effectively and use it wisely. For example, consumers are sometimes denied care or required to pay out-of-pocket for services to which they were entitled because insurance eligibility cannot be verified. In addition, health plans and providers do not have ready access to the information they need in order to provide optimal service and care.

Better health care must be based on good information. CALINX stakeholders recognize that much of the data required for accountability and better health care is presently too old, fragmented, inaccessible or inaccurate to be useful. Recognition produced a commitment to change the rules. Competitors agree that they will not compete by manipulating or withholding health care data. Instead, they have agreed to collaborate on defining data standards compatible with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) and to cooperate on implementing those standards so they can compete in providing better quality care.

CALINX will not select specific technical solutions or endorse particular vendors. However, CALINX will create an environment in which technical innovation and a sophisticated infrastructure can thrive.

Work groups, which include representatives from each stakeholder group, are responsible for crafting the changes in information exchange. Based on the efforts of various work groups, CALINX stakeholder organizations have agreed to:

• Adopt national standards for enrollment and eligibility data formats and implement electronic data interchange (EDI) among employers, health plans, and providers
• Establish provider objectives for appropriate capture and standardized reporting of clinical encounter data and foster an environment for their adoption
• Share pharmacy and laboratory data
• Standardize health plan member ID cards
• Develop outreach and educational programs

CALINX partner organizations agree that all who engage in health care business in California must follow these rules and assure that data exchange is secure. California's purchasers, plans and providers are convinced that their commitments, new rules and agreements, and the resulting infrastructure will produce a more efficient, accountable, and higher quality health care system for all Californians.