America's Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association recently kicked off a pilot test of portability of standardized personal health records (PHRs) so individuals can take records with them when they switch health plans, and so PHRs eventually can be integrated with more comprehensive electronic health records (EHRs).
The pilot will focus on 13 data categories the insurer groups identified in response to a letter AHIP received last year from eight medical specialty societies, including the American Academy of Family Physicians, the American College of Obstetricians & Gynecologists, and the American Osteopathic Association. "This really responds to this issue, which is the need for uniformity," says Karen Ignagni, AHIP's president and chief executive. "There's a real need to standardize quality data."
AHIP estimates that as many as 70 million Americans potentially have access to payer-provided PHRs—though actual usage is much less. With portability standards, health plans could simply transfer information each time a member changes insurer.
Currently, the vast majority of payer-provided PHRs are derived from claims data rather than actual clinical documentation, and in testimony to the American Health Information Community in July, AHIP acknowledged that this type of record is meant to offer a consumer-centric snapshot of patient encounters, not replace an EHR from healthcare providers.
"The way they think of a PHR, it's a good start," says John Halamka, M.D., chairman of the Healthcare Information Technology Standards Panel (HITSP) a federal contractor charged with harmonizing the many disparate data standards in healthcare. However, Halamka adds, "You'd really, as a patient, like to get the rich clinical data from a hospital information system."
Halamka says that the payer groups have agreed to work with HITSP on PHR standards.
Next year, Blue Cross and Blue Shield of Louisiana plans to begin integrating claims-derived health records into the PHRs it currently offers its members as part of a four-part strategy for enabling interoperable EHRs: health information exchange, claims-based records, electronic medical records from providers, and PHRs that members can control and update.
This integration will allow the Louisiana health plan to make its PHRs portable by permitting individuals to maintain their records even if they leave Blue Cross—though former members may be charged for access. "To encourage adoption, we want ... to integrate it so that if they leave, they have access to it. It's there and it's there permanently if they continue to pay for it," explains senior vice president and chief information officer W. Ob Soonthornsima.It is an uphill climb, however, as Soonthornsima reports that only a few thousand records have been accessed among the health plan's one million enrollees to date.