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Insurer Personal Health Records (PHRs): Can They Bridge the Information Gap?

Health Affairs Study Examines Potential Benefits and Challenges of Wider Insurer PHR Adoption

News Release
March 10, 2009

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—While many major health insurers have created personal health records (PHRs) to allow enrollees to electronically store and organize their health care information, whether patients and physicians will embrace the new electronic tool remains an open question, according to a study by the Center for Studying Health System Change (HSC) published today in the journal Health Affairs.

A PHR is a centralized place for people to electronically store and organize their personal health information, separate from electronic or paper medical records maintained by their health care providers. Many advocates believe that PHRs have the potential to revolutionize health care by engaging patients in their care, improving patient-clinician communication, and, ultimately, improving health outcomes and reducing costs.

While there are many different types of PHRs, including stand-alone and provider-sponsored products, the study focuses on PHRs offered by health insurers. Typically, health insurers automatically fill PHRs with medical and pharmacy claims data and allow patients to enter additional information. Some insurers offer features to facilitate data sharing with physicians via the PHR or through a separate portal of claims-based records.

Health insurer PHRs are relatively new, and the evolving products vary greatly in design. Many insurers initially offered a basic PHR in response to employers’ demands. Nonetheless, nearly all the insurers in the study were enhancing their PHR offerings, primarily as a competitive strategy. For example, in addition to claims-based information, insurers are adding selected laboratory results and care management applications, such as clinical alerts and reminders and identification of patients for disease management programs.

Insurers’ ability to put claims-based data into PHRs was seen as an advantage, but consumer representatives suggested that enrollees’ concerns about data security and confidentiality could hamper adoption, while physicians question the use of claims data for treatment purposes and have concerns about incorporating use of PHR information into practice workflows.

"To date, most insurers haven’t actively marketed PHRs to enrollees and physicians, and patient take up and physician awareness of insurer-sponsored PHRs appears to be low," said Joy M. Grossman, Ph.D., HSC senior researcher and coauthor of the study with Teresa Zayas-Cabán, senior manager of health information technology at the Agency for Healthcare Research and Quality; and Nicole Kemper, M.P.H, an HSC health research analyst. HSC is a nonpartisan health policy research organization funded in part by the Robert Wood Johnson Foundation, which funded the study.

The Health Affairs article, titled "Information Gap: Can Health Insurer Personal Health Records Meet Patients’ and Physicians’ Needs," is based on 35 interviews conducted in July and August 2008 with executives at health insurers offering PHRs, consumer representatives, physicians, PHR experts and insurance trade associations.

Key study findings include the following:

  • Control of PHR data. Insurer PHRs varied greatly in data control, access and sharing features. Insurers typically give enrollees control over third-party access to patient-entered PHR data but gain consent for insurer access to the data as a condition of participation.
  • No data portability. Currently, insurer PHRs do not serve as portable, lifelong records. None of the insurers offered features to transfer a patient’s PHR data electronically to another insurer PHR or to download data to another type of PHR or software program, although a few were developing these capabilities.
  • Consumer representatives’ views. Insurer PHRs with auto-filled claims-based data from all of an enrollee’s providers would address a major hurdle to increasing PHR use-the burden of data entry. Although claims data were viewed as a good starting point, respondents noted that such data have inherent weaknesses relative to clinical data. Consumer representatives also expressed concerns about insurers’ sponsorship of PHRs. In their view, consumers’ general distrust of sharing personal health information with insurers and employers and concerns about Internet security could pose major barriers to wider use.
  • Physicians’ views. Most physicians had serious concerns about the validity of claims data for treatment purposes. Instead, physicians viewed claims data as a starting point to engage patients or, less commonly, to direct searches for more data. However, most physicians acknowledged that having access to information about medical care and prescriptions from other providers would be useful, saying that claims data were "better than nothing." Physicians most valued PHR medication lists, lab results, and information about major procedures and hospitalizations. A major barrier to PHR data use among physicians is integrating access to multiple PHRs or portals into practice workflow.

According to the study, public and private payers could consider various strategies to reduce barriers to PHR use, including: (1) developing clear, understandable privacy policies, for example, specifying how the data will and will not be used; (2) providing real-time audit tools that allow enrollees to identify who has accessed the PHR; (3) supporting portability of PHR data to patient-controlled data platforms and applications; and (4) developing unique insurer-specific tools to help enrollees navigate the health care system, understand insurance benefits and manage out-of-pocket costs.

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.

 

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