The Wal-Mart Way Of Handling Big Healthcare

By Bob Violino  |  Posted 03-31-2009

Dossia Versus the Healthcare Monster

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Reducing healthcare costs and inefficiencies by providing electronic health records to individuals has long been one of those goals that keep receding into the future.

Now Dossia, a non-profit consortium of large companies committed to providing electronic records to employees, has begun working with its founders to provide their employees with access to their medical records via the Web. Retailer Wal-mart Stores Inc. is already offering the service to employees, and other companies are likely to follow.

Proponents say electronic records can help eliminate duplicate medical tests and incorrect or lost information, while reducing administrative costs and helping to  prevent numerous serious illnesses or deaths that result from prescription or other medical errors each year.
The Dossia consortium, based in Cambridge, Mass., gathers health data from multiple sources, such as doctors and clinics, at the request of employees and other eligible individuals who are part of the program. Employee participation in Dossia is voluntary, and users have complete control over who sees their information.
Once information is gathered and securely stored in a database, it's continually updated and available to users for life, even if they change employers, insurers, or doctors.

In addition to Wal-mart, Dossia founders include AT&T, Applied Materials, BP America, Cardinal Health, Intel, sanofi-aventis and Pitney Bowes. The Dossia project has been endorsed by such organizations as the American Academy of Pediatrics, the American Academy of Family Physicians, the Centers for Disease Control and Prevention and the National Association of Manufacturers.

The organization operates a highly secure data center in Massachusetts, storing healthcare records on Hewlett-Packard blade servers running the Linux operating systems and operating in a virtualized environment, says Steve Munini, chief operating officer of Dossia.

Virtualization gives Dossia the level of flexibility it needs to move workloads around to different servers depending on load and configurations, Munini says.

Building the Health Care Beast

Although Dossia is not subject to HIPAA regulations, it is subject to consumer protection laws that govern sensitive health information outside the scope of HIPAA, and much of the data that it stores comes from organizations that must comply with HIPAA regulations. The consortium has made information security a high priority, Munini says. For example, all health-care data is encrypted and there are several layers of firewalls in place, he says.

Dossia has also implemented infrastructure components, such as redundant servers, backup storage systems, uninterruptible power supply systems and generators, to ensure that its data center is highly available to users who need access.

"It's important that no single failure of a device should have an impact on customers," Munini says. "We've done a tremendous amount of benchmark stress testing and performance testing. We effectively handled the open enrollment at Wal-mart, which is one of the largest employers in the country."

Employees who are signed up for the program can access their health records via a user name and password. An employer, such as Wal-mart, is responsible for authenticating that an individual is actually an employee of the company. Personal health records are available to the individuals but not to employers, Munini says.

Users decide exactly what information is stored in their personal health records and who can send information into their file and who can gain access.

Employers can offer an "enhanced experience" to users, Munini says. For example, Wal-mart offers access to tools and applications on the WebMD site, and specific information on WebMD can be catered to individual users based on their health-care needs.

Munini wouldn't say which other companies he expects to launch access to the Dossia service. But he expects others to follow Wal-mart's lead this year. "We're quite happy with Wal-mart as the initial customer," because of the company's large size and influence in the business community, he says.

The Wal-Mart Way Of Handling Big Healthcare

The giant retailer began offering access to electronic health records to employees in the fall of 2008. The partnership with Dossia "helps Wal-mart provide our associates with the tools they need to become more engaged in their own health," says a spokesman for the company. "We know that if we give our associates the information and the tools to manage that information, they'll make better, more informed decisions about their health care."

Through Dossia and Wal-mart's health IT initiatives, "we believe that many of the current system's inefficiencies can be reduced, if not eliminated," the spokesman says. "For example, tests or x-rays don't need to be repeated because the original results haven't been lost or misplaced."

More than 50,000 Wal-Mart employees have enrolled in personal health record (PHR) accounts through its partnership with Dossia and WebMD. "We've only offered PHRs for six months, so we're pleased at the response from our associates and we expect enrollment to continue to rise in the months ahead," the spokesman says.

Wal-Mart IT performed a "complete security review" of the
Dossia system. But other than certifying that an individual is eligible for a PHR account, Wal-Mart holds no other functional role in the process. While Wal-Mart has no access to individual health data, the company is able to view reports on aggregate data from WebMD, which enables Wal-mart to better target employees' health needs.

Another company, mailstream technology and services provider Pitney Bowes Inc., is in the planning stages of a Dossia deployment. "We see this as a continuation of our investment in the health of our employees, filling a gap and helping to drive the transformation of healthcare delivery as it's done today," says Andy Gold, executive director, global benefits planning, at the company.

Gold says he expects that employees using Dossia will have more complete information to share with their healthcare providers. "The information is in one place so a physician will be able to get up to speed relatively quickly by [accessing] that information," he says. "This will have huge value to our employees."

While the Dossia service is currently available only to individuals based in the U.S., Munini expects there will be worldwide access in the future. "We will follow the desires of our founding organizations and other customers," he says. "The goal is to really help drive down costs over time by giving people the tools they need to manage their own health information."