Standardizing the Exchange of Clinical & Administrative Data (CALINX)

Problem: The health care industry lags behind most other industries in its ability to gather information effectively and to use it wisely. According to a recent study, only 2.2 percent of the industry’s revenue is spent on information technology. As a result, consumers are occasionally denied care or required to pay out-of-pocket for covered services simply because eligibility cannot be verified. Health plans and providers do not have ready access to the information needed in order to provide optimal service and care. And, serious medical mistakes can result when providers of health care to the same individual are not electronically linked.

Prior to preparation for the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), the California Information Exchange (CALINX), comprised of California health plans and physician organizations, agreed not to compete by withholding health care data. Instead, it was agreed to collaborate on defining data standards so competition is based on better quality care. Many CALINX efforts are now instrumental to health plans and medical groups as they work to implement HIPAA.

PBGH Role and Project Description:

Impact: After identifying major health information priorities, CALINX made headway in 'harmonizing' existing data standards for use by multiple stakeholders. For those transaction sets included in HIPAA, these efforts were important prerequisites to individual organizational implementation plans. For transaction sets not addressed in HIPAA, there now exist workable data guidelines and rules of exchange for reference by trading partners.

Since the launch of CALINX, other efforts have commenced that represent a similar commitment to improved information management:

.

• Markle Foundation’s Connecting for Health addresses the challenges of mobilizing information to improve quality, conduct timely research, empower patients to become full participants in their care and bolster the public health infrastructure.
• The eHealth Initiative strives to drive improvement in the quality, safety and cost-effectiveness of health care through information.
• The Integrated Healthcare Association’s ‘Pay for Performance’ initiative rewards physician groups for information technology improvement.
• The California HealthCare Foundation is sponsoring a data integration project that leverages electronic data exchange to develop and make feasible effective disease management programs.
• The Departments of Health and Human Services (HHS), Defense (DoD) and Veterans Affairs (VA) have agreed to a set of uniform standards for the electronic exchange of clinical health information that will be adopted across the federal government.

Current Activities: The CALINX development efforts have been concluded. Important documents and programs that grew out of the initiative are available via the links below.

Since the original CALINX work was completed, the California HealthCare Foundation has brought together key health care organizations in California to develop and implement uniform lab and pharmacy data standards.  To find out more about these new standards, CALINX Lab 1.0 and CALINX Rx 2.0, visit www.calinxstandards.org.

Return to Top

The following are the work products of the CALINX initiative.  

If you need to download Acrobat Reader, click here.

Press Release: August 2000

CALINX-HIPAA Overlap: HIPAA and CALINX address several transaction sets in common. This diagram illustrates the interface of CALINX and HIPAA.

CALINX Toolkit - contains Data Guidelines and Rules of Exchange for specific data sets

Enrollment

• Data Guidelines
• Rules of Exchange

Member ID Card

• Data Guidelines
• Rules of Exchange
• Sample Card

Eligibility

• Rules of Exchange
• Single Member Response
• Full Roster
• Data Template

Encounter

• Rules of Exchange
• Data Guidelines
• Encounter HMOIS Standard

Pharmacy

• Rules of Exchange
• Data Guidelines
• Pharmacy Implementation Guide
• Sample Intent and Contract Language

Laboratory

• Rules of Exchange
• Lab Procedure for Plan/Patient Contact
• PMG DSM Refusal Algorithm

Download the entire CALINX Toolkit.

Health Care Electronic Transaction Data Flow Analysis: This paper was commissioned to outline the flow of health information. Its purpose is to define how the different transaction sets relate to each other.

Testing the Ability to Link Patients Across Different Data Collection Systems: This study was commissioned to test the use of a common set of data elements for matching patients in disparate databases. The study is important given the challenges associated with non-standardized patient identifiers in our health care system.

Completeness and Accuracy of Managed Care Administrative Data Sets (CAMAS): This ground-breaking study was commissioned in concert with CCHRI to assess the challenges associated with transmission of encounter data from the physician organization to the health plan. It identifies a number of problems with the process.

• Report
• Summary Presentation

Demonstration Project Report: CALINX undertook a pilot to test the use of guidelines and rules of exchange. This report summarizes the findings of that demonstration project.

Laboratory Demonstration Final Report: In collaboration with the California Cooperative Healthcare Reporting Initiative (CCHRI), CALINX experimented with exchange of laboratory results data.  This report summarizes that experience.

• Main Report and Attachment 1
• Attachment 2
• Attachment 3
• Attachment 4

Return to Quality Measurement