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Health Insurers to Expand Offerings of Personal Health Records

December 2006 Digital Healthcare & Productivity.com

At a time when Nike's new Air Zoom Moire shoes send fitness data to a runner’s iPod Nano, the announcement on December 13 that health insurers were creating a portable, Web-based personal health record (PHR) was hardly revolutionary. In fact, speakers from the America’s Health Insurance Plans (AHIP) and Blue Cross and Blue Shield Association (BCBSA) at a press conference in Washington, D.C. used an infinite variety of rhetorical versions of the term “first step.”

The real significance of the announcement was as an impetus to the software industry to begin cranking up applications which could be used by consumers to maximize the value of these PHRs, and as a spur to convince physicians and hospitals to make a long-delayed start on ramping up office-based electronic health records systems which ultimately will be the prime beneficiary of these PHRs in a new era of real-time medicine.

The PHRs to be made available by AHIP and the Blues will cover 200 million individuals by the end of 2008. The data will be based primarily on claims received by the insurance company and consumer inputs on such things as immunization and family medical history. Scott Serota, CEO of the BCBSA, emphasized that the PHRs offered by individual companies will have tweaks beyond the core data elements, and will be “branded” for use as marketing tools. The PHRs depend for their portability on Health Level 7 and ANSI X12 protocols.

A plan member will be able to dictate what data is transferred from one health plan to another, or if that data should be provided to his or her physician. The data in the PHR will have all the privacy protections authorized by HIPAA and relevant state laws.

These PHRs are seen by the insurance industry as a way to help consumers improve their own health care, and as a way for the companies to cut costs associated with medical care that could otherwise be avoided. So a key component of these PHRs will be a constant sifting of medical claim, laboratory and pharmacy data against best practices and evidence-based guidelines, a process Aetna will do via what it calls its CareEngine. Aetna has actually offered that service, provided by a company called Active Health Management, to plan sponsors since 2002.

The challenge, of course, will be to get consumers to use these PHRs and, maybe more importantly, give physicians access to them, which is not technologically possible at the moment, given the low rates of electronic health record infrastructure adoption by the nation’s physicians and the absence of interoperability standards. As to the first challenge, AHIP and BCBSA have partnered with the National Health Council, which through its member groups has about 100 million members with various chronic illnesses. The NHC will be conducting pilot projects in an effort to educate its members on these PHRs, and stimulate their use.

The major benefit of the PHRs, however, is getting them into the hands of a patient’s physicians in real time, at the time of an examination, or when someone ends up in an emergency room. “But we are a ways away from creating an interoperable system,” acknowledged Bill Marino, CEO of Horizon Blue Cross Blue Shield of NJ.