At a time when Nike's new Air Zoom shoes send fitness data to a runner's iPod Nano, the announcement last week that health insurers would create a portable, Web-based personal health record (PHR) seems 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 a great variety of terms whose meaning boiled down to "first step."
Still, the real significance of the announcement was to spur the software industry to begin cranking out applications which could be used by consumers to maximize the value of these PHRs, and to convince physicians and hospitals to make a long-delayed start at ramping up the office-based electronic health records systems which will be the prime beneficiary of PHRs in the era of real-time medicine.
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 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. A key component 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. AHIP and BCBSA have partnered with the National Health Council whose member groups have about 100 million members with various chronic illnesses. The NHC will conduct pilot projects to educate members on PHRs, and stimulate their use.
A major benefit of PHRs use will be getting information into the hands of a patient's physicians at the time of an examination or to emergency room staff when a patients ends up there, "but we are a ways away from creating an interoperable system," acknowledged Bill Marino, CEO of Horizon Blue Cross Blue Shield of NJ.