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Keeping a personal health record

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Until last year, the personal health record was the bailiwick of a small number of health-conscious patients who purchased Web space and entered their own health care information, obtained from doctors and hospitals.

Now this device is being reformatted and adopted by some of the nation's largest health insurance plans. Since June 2005, six health plans have launched Web-based PHRs for a potential audience of more than 65 million members (see chart).

Unlike the original PHR sites, health plans' sites cost users nothing and are populated automatically with claims data on doctor visits, hospital stays, procedures, medications and in some cases laboratory test results. Like their predecessors, new PHRs allow users to add and revise their own data and use passwords for security.

The race to introduce these new PHRs is in full swing. Four major U.S. managed care organizations--WellPoint Inc., UnitedHealth Group Inc., Health Care Service Corp. and Kaiser Permanente--are spending tens of millions of dollars apiece to set up PHRs for their members.

These plans are responding to a growing demand to create a central repository for each patient's health care record, says John Asencio, senior vp at The Segal Co. in New York.

"The health care system is very fragmented," he said. A patient's records are split between doctors, hospitals, labs and other sources. "The nice thing about a personal health record is that it accumulates information in one place. You can print out the record and give it to your provider."

Joseph Marlowe, senior vp at Aon Consulting in Philadelphia, says a unified health record addresses the problem of duplicated services and medical errors that occur when caregivers are not aware of the full medical record.

He says this also explains the plans' interest. "The health plans benefit from PHRs because they can help avoid duplication," Mr. Marlowe says, noting that 20% of services are considered unnecessary.

The rush to PHRs is also a response to a 2004 executive order from President Bush calling on all doctors and hospitals to adopt electronic health records by 2014--a deadline many insiders believe will not be met. So far, less than one-fifth of providers have EHRs.

PHRs, which use claims-based data, are different from EHRs, which use provider-based information.

Even though EHRs are far richer than claims data, "for EHRs to work, everyone must have the capabilities," says Patrick Kennedy, president of PJ Consulting Inc. in Rockville, Md., which is helping health plans set up PHRs. "If I see five doctors, how long do I have to wait until all five have it?"

Personal health records serve as "an interim step on the way to an EHR," Aon's Mr. Marlowe says. "It's a very good step, especially if physicians are able to populate that record with meaningful clinical information."

Meanwhile, Mr. Kennedy says health plans are directly providing doctors and hospitals with claims-based information on each patient, similar to a PHR, as a proxy for an EHR-based record. He said Chattanooga-based BlueCross BlueShield of Tennessee was a pioneer in this and in September started providing the data to members as well.

Consumer-driven trends

PHRs also are following the trend toward consumer-driven health plans, says Mindy Kairey, global health and welfare outsourcing leader at Hewitt Associates Inc. in Lincolnshire, Ill.

"When employees assume more of the burden of administering their own health care, tools like the PHR become increasingly critical, not just beneficial," she says.

In fact, Ms. Kairey says "more employers are talking about PHRs than about CDHPs," perhaps because it's easier to offer a free PHR than to introduce a consumer-directed product.

Some employers, such as Dell Inc., the Round Rock, Texas-based computer manufacturer, have been creating PHRs for employees. But to do so, employers have to spend money to import health plan claims data into the PHRs.

Regardless of who sets up the PHR, Ms. Kairey warns that "there is a very steep learning curve" before many members will actually use them.

Surveys, including one by UnitedHealth Group, have shown that consumers do not want to spend a lot of time maintaining their PHR. Some health plan members worry that their employer can access the site, which consultants say is never the case, and some worry that sensitive information will be put on the site. In fact, many PHRs automatically suppress behavioral health and HIV information and allow patients to suppress other information, health plan officials say.

Health plans expect PHRs will net employers substantial savings by reducing duplicative tests and by improving health care so workers are more productive. New York-based Empire Blue Cross Blue Shield, one of the first plans to launch a PHR in June 2005, reports that customers including employers and trade unions have yielded a 2-to-1 return on investment on members enrolled in its PHR program.

The overwhelming majority of Empire members, however, still have not signed up. Company officials report that 40,000 of the plan's 3.5 million members have activated a PHR, but say this is an encouraging rate for a new service with which members are not familiar.

Empire recently was acquired by Indianapolis-based WellPoint and its PHR became a model for WellPoint's new 360° Health program--an Internet-based program of services, provider and wellness information that includes a PHR component. WellPoint says it has invested $100 million in 360° Health, which started in August with members in Georgia and Virginia and is being rolled out this month in California, Colorado and Nevada.

Sheila McPhillips, who helped start the Empire PHR and is now vp of 360° Health and Wellness at Health Management Corp. in Richmond, Va., a WellPoint subsidiary, says the program gives WellPoint a competitive edge. With an online PHR, "we believe that we will be able to improve patient safety, reduce the number of tests performed and the delivery of more efficient care," she says.

Minnetonka, Minn.-based UnitedHealth Group launched its PHR in November 2005. In August, UnitedHealth Group announced that next year it will release a digital membership card embedded with patient information, including portions of the PHR. However, providers will need to have a card-swiping mechanism to read the card.

Hurdles to be cleared

Personal health records face some major hurdles, such as doctors' continued wariness of the data. In a recent UnitedHealth Group survey, physicians objected to patients' ability to block and change information, thus limiting data available to physicians.

Also, pure claims information lacks key data such as lab test results. However, plans such as WellPoint have been adding test results by working directly with the labs. WellPoint officials also plan to add X-rays, but they say automatically adding the doctor's chart won't be possible until there is much wider adoption of EHRs.

But above all, the major problem facing this new phenomenon is the inability to automatically transfer PHRs when members change plans. Member turnover rates are thought to be 10% to 20% per year, and transferring a member's PHR does not have past claims history unless he or she enters it manually.

Health plans are so worried about this problem that they have set aside competitive differences to devise universal portability standards.

Working through Washington-based trade group America's Health Insurance Plans and the Chicago-based Blue Cross Blue Shield Assn., plans have agreed on a set of 13 data categories that would be transferred, such as medication history, doctors' visits, family history and advance directives.

No date has been set for universal portability because plans still have to work out data transmission standards, says Tom Wilder, vp for private market regulation at AHIP. "The appropriate standards are not all in one place," he says. "We need to bring them all together."

In a pilot study running from July to November, seven member health plans have been testing transmission of PHR datasets. The plans include UnitedHealth Group and Chicago-based Health Care Service Corp., which owns Blues plans in Illinois, New Mexico, Oklahoma and Texas, and is about to introduce PHRs.

An AHIP spokeswoman said standardization will not stop plans from offering diverse products. "Companies will still innovate with certain elements," such as member notifications or tools to manage health, she said. "The work is only limited to the ingenuity of the health plans."