Digital Health Records Get Much Needed Injection

But will the stimulus be enough to boost adoption of costly electronic and personal health records?

Insurance Networking News, 04/01/2010

By Daniel Joelson

As a practicing internist at a county hospital, Charles Kennedy was troubled to find that even though he had a very good idea of what he was doing for his patients, he knew little about what all the other caregivers were doing for his patients. He and the other parties involved did not have the comprehensive, structured data they needed to achieve optimal results for the patient.

Despite vigorous attempts by vendors to peddle digital health care technology for records storage, the systems simply weren't catching on.

"The reason most physicians have not embraced electronic medical records (EMR) in the past is that they haven't found them that useful," says Kennedy, now VP of health IT at WellPoint Inc., an Indianapolis, Ind.-based independent licensee of the Blue Cross and Blue Shield Association.

However, this seems to be changing. The American Recovery and Reinvestment Act of 2009 (ARRA) lifted the prospects of electronic health records (EHRs)-or EMRs (as they are often interchangeably called)-and personal health records (PHRs), which have experienced sluggish growth for years. The stimulus's Health Information Technology for Economic and Clinical Health Act, or HITECH Act, offers $18 billion in incentive payments through Medicare and Medicaid reimbursement systems to prod hospitals and physicians to implement digital health record systems.

The ARRA legislation says providers will be reimbursed for the "meaningful use" of certified EHRs. Though still being fleshed out, such "meaningful use" includes not only ensuring that the EHR system records medical information, but also that it is able to share such data with other systems. Payer-based PHRs also can qualify for some of these funds to the extent that they satisfy the meaningful use criteria. To help build industrywide consensus and standards, the ARRA created the Health Information Technology Policy Committee, an advisory body that provides recommendations on issues such as how to use technology to create a single understanding of the patient shared across all providers.

GROWTH AND THE ARRA

Typically, an EMR is clinician-focused, offering a single place where all medical information related to a patient resides. This can include patient readings, lab results, EKGs and X-rays. In contrast, a PHR generally is sponsored by a carrier health plan, and it gives patients an Internet-based repository for their personal health information so they can keep track of allergies and medications in a fashion they can understand it.

The HITECH Act boosted recognition that patients' information needs to be electronically archived. Still more vital, it underscored the need for health IT vendors to build "shared clinical intelligence" on top of the raw data. To get value from an electronic health solution, behavior needs to be altered; simply providing reams of data to physicians and patients is not helpful. "You have to analyze the data so that it is personal," says Kennedy, who is a member of the Health Information Technology Policy Committee. "You have to get to personal, timely, specific and, most importantly, actionable information in order to get the value from the solutions. And you see the foundation for that kind of thinking reflected in the HITECH Act."

Recent trends for EMR and PHR growth are encouraging, according to some observers. "We are just seeing a dramatic uptake in both PHRs and EMRs," says Larry Leisure, a managing director in the payer and employers markets practice of Ingenix Consulting, an Eden Prairie, Minn.-based health IT subsidiary of UnitedHealth Group. "Health plans left and right are in the process of not just rolling out PHR capabilities, but enhancing the capabilities of those PHRs."

Sophisticated EMRs and PHRs now provide for rich and convenient conversations between physicians and patients. For instance, surging in popularity are e-visits, in which a patient and physician exchange e-mails around a specific set of data, says Leisure. He expects such visits to continue since the patient need not get in his car and the doctor can schedule more efficiently.

With 34 million members, WellPoint implemented digital health record initiatives that use claim data and apply algorithms to identify cost-reduction opportunities, while sending both paper and electronic messages to patients and physicians to increase the quality of care. It also launched EHR pilots that it developed with the Kettering Health Network.

During a one-year period for a WellPoint pilot in Ohio called the DaytonHealthKonnect Individual Health Record, members using the system lowered overall health care trend costs for medical benefits by 7.4% more than non-users, while they also had up to a 40% greater likelihood of receiving key disease screening tests than non-users. The pilot also yielded cost reductions, including a 10.3% decline in cost per employee for inpatient services year to year.

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