San Francisco health board raises privacy concerns, defers action on new statewide data exchange

President Scott and other members of the Health Service Board of the City and County of San Francisco pressed Cal Index and Blue Shield on Dec. 9 over a new statewide clinical information exchange that will combine payer and provider records.

Cal Index director of strategic accounts Jennifer Pacheco told the board the system will normalize clinical and payer data to produce longitudinal patient records intended to improve medication adherence tracking, emergency care and analytics. "When data is combined, payer and provider, you can improve the quality of care and lower costs," Pacheco said during the public presentation.

The board’s concerns focused on notice to members, governance and whether the exchange’s use of an opt-out model — rather than opt-in — was appropriate. President Scott said many members received an opt-out letter from Blue Shield without the board’s prior knowledge. "I am profoundly concerned on behalf of the members of the City and County of San Francisco Health Service System that this step ... has been undertaken with minimum notification of our members or to this board," Scott said when proposing a motion to defer action.

Simon Jones of Blue Shield said founding payers designed Cal Index to address gaps in statewide data sharing and that the entity is structured as a mutual-benefit nonprofit governed by a board of directors. Jones told the board the system had gone live with initial records and that large-scale notification had been sent in advance, but he agreed to provide exact timing and documentation requested by the board.

Multiple commissioners and public commenters questioned the decision to use opt-out enrollment and asked whether data retained for matching and master-person indexing could be used for research or third-party analytics. Claire Zvonsky, who identified herself as a retiree representative, argued the outreach should have run through the board and urged the board to block further data gathering until the program was vetted: "They have no right to do that," she said during public comment.

Cal Index representatives said HIPAA permits use of de-identified and clinical data in exchanges and that the organization has privacy controls, an opt-out mechanism and planned policies for research access (including Institutional Review Board review). They agreed to return to the board next month with details on board composition, funding sources, the IRB arrangements, the exact timing and content of member notices, and metrics on opt-out uptake.

The Health Service Board voted unanimously to record its strong concern, to defer any endorsement or approval, and to require Cal Index and Blue Shield to supply the requested information before the board considers next steps. The motion repeats the board’s expectation that vendors coordinate such outreach with the Health Service System to avoid member confusion.

The board did not take further action; Cal Index representatives said they would provide the requested documentation and return at the board's next meeting.