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Insurers join employers in health records push

Insurers join employers in health records push

A project to develop personal health records, announced by America's Health Insurance Plans in concert with the Blue Cross & Blue Shield Assn., demonstrates the growing interest in creating electronic medical records, health benefit experts say.

Although its timing closely follows another PHR initiative launched earlier this month by an employer group, industry experts say it will put pressure on all PHR developers to build more competitive products more quickly.

"What this shows is that stakeholders across the board agree that consumers need PHRs, that there's consensus about that," said a spokeswoman at the Washington-based AHIP. "I think that we'll see a variety of projects and, as we go forward, there will be standards so that things will work together. But basically what it shows is that everybody's in agreement that if you're going to optimize your health, you're going to need some basic information about your health and health care" in an electronic format, the spokeswoman said.

AHIP and the Chicago-based BCBSA on Dec. 13 announced a partnership to create a standardized PHR model that can be accessed by consumers, medical providers and health plans. It would be portable so that plan members could take it with them from plan to plan or to administrators of self-funded health benefit plans.

The industry model PHR would contain, at a minimum, patient information, encounters, medications, lab results, providers, facilities, subscriber information, benefit information, family history, physiological information, immunizations, health risk factors, advance directives, alerts such as allergies, plans of care—all of which would be derived from claims and administrative information.

Both AHIP and BCBSA have committed to having all member health plans offer a PHR to participants by the end of 2008.

Because AHIP and BCBSA member companies collectively control claims data on nearly two-thirds of the nation's insured population, it made sense for them to lead the effort, said Alissa Fox, vp-legislative and regulatory policy at the BCBSA in Washington.

"We have a panoramic view that already exists about a consumer," Ms. Fox said. "We know if you went to four doctors, if you went to a rehab clinic or a hospital, if you have five prescriptions. We have that information already, so we are perfectly positioned to put that in a user-friendly way so the consumer has access to those records in a way they can use it."

The AHIP/BCBSA project was announced shortly after five major employers unveiled their jointly financed project. Dubbed Dossia, the employer effort will provide a common technological framework to facilitate sharing PHRs over the Internet, according to its developer, J.K. Kleinke, chairman and chief executive officer of Omnimedix Institute, a nonprofit based in Portland, Ore. Its participants are Applied Materials, BP America Inc., Intel Corp., Pitney Bowes Inc. and Wal-Mart Stores Inc. (BI, Dec. 11).

Having various development projects in the works could encourage greater acceptance of PHRs among employees and their dependents, many of whom have been reluctant because of security concerns to use the first generation of electronic health records their employers and health plans have made available, said Delia Vetter, director of benefits at EMC Corp., a technology company based in Hopkinton, Mass.

EMC has provided PHRs through WebMD to its employees since 2004 and will offer them to dependents in early 2007, Ms. Vetter said.

"The ideal would be for everyone to operate collectively and collaboratively," she said. "But we're still in the innovation period. You're creating demand from consumers and you're also creating a sense of security that this is the way the world is going. If it becomes the norm, it will facilitate consumer acceptance of PHRs."

Ray Brusca, vp of benefits at Black & Decker Corp. in Towson, Md., expressed concern that the separate efforts would create only partial PHRs and that additional work is needed to create a truly comprehensive PHR.

Though it may seem like many groups are inventing the same wheel, "they're inventing half a wheel as far as I'm concerned," Mr. Brusca said. "Insurers may have more information than just traditional claims data, and it's better than nothing, but it is not a true electronic medical record."

Mr. Brusca said insurance companies don't have all the data needed to create a PHR that provides a complete picture of a person's health history.

"Doctors are still going to be as much in the dark as they are today. They may not order duplicate tests if they can find out if they've already been done. But they won't know a person's complete health history from an insurance company claims database. Unless something has all your health history—not just claims history—I don't think it's a real health record," he said.

Omnimedix's Mr. Kleinke agreed.

"What (insurers) have in their database is paid claims. Paid claims is not the entirety of a person's health record. They actually have mangled clinical detail, specifically because of adjudication," he said.

Mr. Kleinke said distrust and incomplete or inaccurate claims data are among the reasons that the five employers are financing the Dossia project.

"Health plans have been offering PHRs for several years now and nobody uses them, Mr. Kleinke said. He went on to say that the inability to transfer records from insurer to insurer is not the reason that people are not using them.

"All the market research we have either conducted or seen is that people don't trust their health plan. Health plans have to threaten them with perjury to volunteer information about their own medical conditions," Mr. Kleinke said.

But an industry-led PHR development project will provide the upfront investment and resources that are necessary to make PHRs a reality, according to Black & Decker's Mr. Brusca.

"A true electronic health record that really is all-encompassing is not free. It may pay for itself over time by eliminating medical errors and redundancies, but there is still an upfront development cost," he said. Insurer involvement in transferring information also may be necessary because most employees have been reluctant to share their personal health information, he said.

"If you rely on the employees pulling the data along with them, I don't think that's going to happen. Insurers will have to do the pushing," Mr. Brusca said.

Good first steps

Taken together, both the employer-supported and industry PHR development projects "are good first steps," Mr. Brusca said. "It's in its infancy. And we need it. We're never going to get rid of some of the waste, some of the defensive medicine, some of the excess of things that go on unless we have" PHRs.

"We're not going to have better health care. Most doctors are operating blindly. At least when my car breaks down, I can go from Mechanic A to Mechanic B and he can hook it up to a computer and tell what has happened to it" based on information from embedded computer chips in the vehicles, Mr. Brusca said. "Nothing similar exists in the medical world."