Insurers Push Patients Toward E-Health Records

Health insurers, which have troves of patient medical data from the billions of claim transactions they process annually, are hoping that they can help speed adoption of consumer personal health records.

Blue Cross Blue Shield Association and America's Health Insurance Plans, which combined represent companies providing medical insurance coverage to 200 million Americans, said on Wednesday that they've created a "health-plan based" personal health record model and portability standards that will enable consumers to transfer their data when they change insurers.

The organizations also have set a goal for member companies to provide their consumers with new, standard-based personal health records by 2008. The organizations estimate that approximately 70 million Americans have access to personal health records through their insurers right now, with data that's populated by medical claims.

However, the level of data consumers have access to through their insurers isn't standardized, and varies from company to company. The new guidelines include defining the core data elements that all insurers should provide in personal health records for consumers, including patient medical histories, immunizations, allergies, medications, risks, plans of care, and other information that doctors have identified as being key data.

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The insurers are aiming to also enable consumers to add their own subsequent information, such as family history of illness. Much of the information contained in the PHRs are "the sort of information you provide your doctor when you fill out those clipboard forms," says Alissa Fox, VP of legislative and regulatory policy at Blue Cross Blue Shield Association. But instead, a consumer could provide a doctor with a print out of the personal health record, or access the information online. The portability standards also would allow the consumer to transfer that data whenever they change health insurers. "Each insurer can have their own bells and whistles," to their personal health record offering for consumers, such as providing diabetic patients with electronic reminders about getting their medication refilled or eyes checked, says Fox. "Personal health records are great new tools to give consumers access to information that can help them better manage their health care," she says.

However, since the health-plan-based personal health records are based primarily on claims information, those systems "don't eliminate the need for health providers to deploy their own electronic medical records systems" for more detailed patient information, says Fox. But she says, "some providers are using claims data to populate" their records, because the claims data contain information about tests, medication, and other treatments that were ordered for the patient by other doctors.

Indeed, insurers providing their members with digital personal health records aren't a substitute for the use of interoperable e-medical record tools by doctors, says an AHIP spokeswoman. "We hope our work is a building block for when we have a fully interoperable national health information network," she says.

Robert Kolodner, interim national coordinator for health information technology in the Department of Health and Human Services, said in a statement: "Efforts such as those by health insurance plans to provide consumers with portable PHRs are a step forward in the national health IT agenda. We welcome your continued work to achieve interoperable, consumer-centric health information."

In its guidelines for personal health records, the insurers also said they were addressing a couple of key concerns from consumers about privacy and use of their health data. To help alleviate worry that medical data could be used by insurers to deny coverage, the two insurances groups said they would promote guidelines that would offer consumers some control over their medical information. Those guidelines include having consumers grant their permission before transferring the medical data in their PHR to another insurance plan, and also restricting the transfer of that data until after a consumer has been enrolled in new coverage.

Blue Cross Blue Shield and AHIP officials said they were unsure how their proposed guidelines would fit into the work under way by other efforts, such as Dossia, a new framework for Web-based personal health records being advocated by Omnimedix Institute, a coalition of large employers, including Intel, Wal-Mart, and Pitney Bowes.

That group also has ambitious plans to initially provide millions of their own employees, and eventually other companies' workers, with private and portable personal health records with an eye toward reducing health care costs.

From the perspective of Omnimedix member companies, the employer-led effort has the best opportunity of providing consumers with "the most panoramic" view of their health information, says Colin Evans, director of policy and standards for Intel's digital health group.

"I applaud what the insurers are trying to do, but they're trying to provide portability for their captive systems. [Claims data] is just a window into that information" a consumer should have about their health, he says. Omnimedix is "talking with a number" of large health care providers to establish patient data sharing relationships in regions of the country where many of the employers' workers live, says Evans.

Just as the insurers' new portability guidelines aim to address privacy and insurance discrimination concerns of consumers, Dossia also is addressing employee suspicions about how their health data will be used. "Employers will not be able to use Dossia as a new database to mine," he says. "No one will be targeting the 10 most obese employees at their companies," Evans says. Omnimedix member companies realize that "employers and insurance companies are the two least trusted entities" when it comes to potential abuses of patient data, he says.

Meanwhile, while it's estimated that fewer than 25% of the nation's health care providers have deployed e-health record systems in their own organizations, many that have done so also provide their patients with access to their information online.

Approximately 70,000 Cleveland Clinic patients "have access to their medical records 24-by-7," through the organization's MyChart system, says Cleveland Clinic CIO Martin Harris. The clinic is also rolling out new personalized services for MyChart, such as providing diabetic patients with the ability to automatically keep their doctors informed about the condition of their illness.

From home, diabetic patients can go online and enter their daily blood glucose readings into their MyChart record. The information is sent through a software program that determines whether the readings are abnormal. If the readings are abnormal, the patient's doctor receives an electronic alert, allowing the physician to more quickly address a potential health crisis with the patient, say Harris. In 2007, Cleveland Clinic plans to rollout new MyChart services to other patients of chronic illnesses, including asthma and high blood pressure, Harris says.