‘Personal Health Records’ May Get Big Boost From New Standards
By John Reichard
CQ HEALTHBEAT NEWS
December 13, 2006
As the years go by, the task of compiling one’s personal medical history grows more daunting with each visit to a new doctor. Arguably, it also grows more important, given the possibility that a new prescription will interact badly with existing medications, or that an expensive test is superfluous because it has been done before. Under an agreement announced Wednesday, however, that task may soon get much easier for virtually every privately insured American.
The breakthrough comes in the form of an agreement on standards for “personal health records,” or PHRs. Announced by the nation’s two largest health insurance lobbies, the standards are expected to spur insurers to widely offer PHRs, abbreviated medical records controlled by patients that are stored on the Web and that can be taken with them when they switch insurers.
PHRs are distinct from electronic health records, the ultimate goal in IT, in which providers electronically store and manage detailed clinical information in one place, or with links to one place.
An estimated 70 million Americans already have access to PHRs, but their ready use by consumers and doctors has been hindered in part because their content varies and can’t be transferred when the patient switches from plan to plan.
“It is important for consumers to be able to conveniently take the information in their PHRs with them if they change jobs, switch health coverage or become eligible for Medicare,” said an issue brief prepared by the lobbies, America’s Health Insurance Plans (AHIP) and the Blue-Cross Blue-Shield Association (BCBSA).
The standards call for insurers to automatically cull the following kinds of information from claims and put it in the PHR: a rundown of visits to the doctor or the hospital and diagnoses, procedures, and drugs prescribed in those visits; medication history including the name of the drug or drugs, their dosages, prescription dates, and pharmacy information; information on current insurance benefits such as co-pays, deductibles, and eligibility status; and information specifying which clinicians have provided care.
The insurer also must specify the facilities where the patient received services, and list any reminders, orders, or prescriptions recommended by any care management or disease management programs in which the patient is enrolled.
The standards also call for giving patients the opportunity to include the following types of information in the PHR: family risk factors associated with disease; physiological characteristics such as blood type and height and weight; information regarding immunizations and when they were given; habits such as smoking, alcohol consumption, and substance abuse; allergy and adverse reaction information; and advance directives governing life support technology and other extraordinary forms of care.
“I think it’s a big step in the right direction,”Michael Zamore, an aide to Rhode Island Democrat Patrick Kennedy, said of the standards. Kennedy is a leading House advocate of health information technology. “People are not going to want to invest the time to build the records up if they go poof when they switch plans.”
Zamore noted that if patients consent to a new provider seeing them, PHRs can bring an end to the “medical clipboard,” the constant filling out of new forms with each new visit to the doctor. And having a detailed listing of medications and lab results also is a major advantage for patients trying to better manage their health, he added.
Insurers in some cases plan to build on the PHRs to improve care. Aetna CEO Ron Williams told reporters at a Washington, D.C. briefing on the standards that his company will add a “Care Engine” that will alert doctors and patients if a prescribed procedure or drug is at odds with recommended practice. The Care Engine feature “actually scans your information for opportunities to improve care,” he said.
But apart from such extras, the core elements agreed to in PHRs will improve care by putting more data in one place , the lobbies said. “Personal health information is often dispersed piecemeal among a number of physicians, hospitals, pharmacies, and other health care providers,” the issue brief noted. The lack of coordination “results in preventable medical errors, inefficient and inappropriate care, and duplication of tests and procedures.”
Because of the data they compile on patients across medical settings, insurers say they are in a unique position to provide PHRs. They depict them as a first step toward building electronic health records for all Americans, a goal established by the Bush administration.
The two lobbies say their goal is to have all their members offering PHRs by the end of 2008, and that by early 2007 they will be well on the way, with the records available to more than 100 million enrollees. But currently low take-up rates for PHRs won’t improve until doctors and patients are more comfortable with them and they become the basis of an active exchange of information between patients and doctors, Zamore said.
Portability of PHRs will help, but “I have some question whether PHRs tethered to the health plan are going to be the big market winner,” he said. Patients may be reluctant to have some forms of medical data in the PHR if the insurer is the sponsor, he said.
But insurers aim to ease consumer concerns by saying the information will be secure and can only be transmitted to a new plan after the patient is enrolled and gives the okay. That standard will protect against use of the data by the new plan to deny or limit coverage, insurers say.
And to promote consumer acceptance, the lobbies have formed a partnership with the National Health Council, a consortium of patient and industry groups, to educate the public about the advantages of PHRs.
