Washington - America's Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) are working together to grant consumers their wish for portable personal health records (PHRs).
The two organizations, with combined membership of more than 200 million people, are considering what to include in PHRs and have developed and tested standards that allow consumers to transfer PHR data from one health insurer to another when changing coverage.
PHRs are private, secure Web-based tools maintained by insurers and containing a consumer's claims and administrative information. They enable patients and caregivers to view and manage health information. As a result, consumers often play a greater role in their health care.
Because of insurance claims filed on behalf of consumers, insurers already have most of the information needed to provide PHRs. PHRs differ from electronic health records, which providers use to store and manage detailed clinical information. An estimated 70 million people have PHRs through health insurers, with millions more scheduled for the service this year.
Physicians encouraged insurers to adopt a consistent set of core PHR data. Health insurers will continue to innovate in the PHRs they develop, but the goal is to incorporate core data elements into every PHR.
Those elements include patient histories and information on medications, immunizations, allergies, risks and plans of care—elements that physicians have identified as key data. The health insurance community has set a goal of incorporating the core data elements and implementing the standards for portability between insurers next year.
"Efforts such as those by health insurance plans to provide consumers with portable PHRs are a step forward in the national health IT agenda,” says Robert M. Kolodner, interim national coordinator for health information technology at the U.S. Department of Health and Human Services.
A consensus is forming that widespread adoption of health information technology will lead to safer, more effective health care, carriers say. The technology will reduce errors in treatment, increase the use of recommended treatments, improve treatment for people with chronic disease, and contribute to lower health care costs.
"We are continually looking to utilize new information technologies, such as PHRs, to empower our members to receive the highest quality of care,” says William Marino, president and CEO of Horizon Blue Cross Blue Shield of New Jersey. “Developing a model PHR is critical for effective use of this powerful tool by health care consumers."
Ronald A. Williams, Chairman, CEO and president of Aetna Inc., Hartford, Conn., says health plans will provide consumers the tools and information to make well-informed health care decisions. “PHRs may be one of the most important contributions to health care in the United States," says Williams. "PHRs can also simplify and personalize a consumer's health care experience and encourage individuals to take a more active role in their health."
Good health care in the 21st century means having the right information in the right hands at the right time, the carriers say. Individuals need real-time access to health information that may be dispersed among a number of physicians, hospitals, pharmacies and other health care providers.
"Health insurance plans are in a unique position to make a contribution through consumer-focused PHRs," says Karen Ignagni, AHIP president and CEO. "Until now, the information contained in PHRs has not been consistent--a concern that led several physician organizations to urge the industry to identify the core data for PHR content--or portable from health plan to health plan."
Health insurers worked with standards organizations to ensure the health plan-based PHR is compatible with standards being developed to make the health care system interoperable.
According to Scott Serota, BCBSA president and CEO and a participant in the movement toward interoperability, "we undertook the project with the idea that we wanted our work to be in sync with the Administration's priorities and a building block for future efforts.”
The industry also has adopted a guideline that requires an individual's approval before transferring PHR data between insurers and requires the transfer take place after enrollment in the new plan. Consumers have indicated that they favor the guideline.
Much of the work has come together through the efforts of the National Health Council, a private, nonprofit organization of 115 health-related organizations striving for quality health care for all people. Its membership includes 50 of the nation's leading voluntary health agencies, representing 100 million people with chronic diseases or disabilities
Source: America's Health Insurance Plans
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