TECH: Cindy LeRouge on using claims data in PHRs

Cindy LeRouge is from Washington Univ in St Louis, and has been working with Wellpoint on a study of integrating claims and chart data….there is some chart-type data (i.e. lab tests) around so some chart elements (electronic) can be put together.

Insurers are not yet seeing costs savings or consumer push for this, but there might be a competitive first mover advantage (if you can delay first mover as much). Insurers would like to see some chart data (e.g. getting lab data or blood pressure for DM). So there are reasons at the margin for plans to do this (although I might have to pick a fight with her later about this!). So out of claims they can start to generate reports that patients can view, and emergency rooms.

Running a test in Missouri, which will integrate data from certain hospitals in Missouri, and will eventually allow Wellpoint claim data to post back into some hospital forms and reports.

Oh, but of course the internal data at Wellpoint is a mess, so that data scrubbing issue remains a problem…and legal is getting in the way.

And then what about moving records between plans (UPIN and all that)? Do we go to a credit bureau-type reporting structure?

And why would providers want to share their chart data? (Good question!). Why are they going to the brain damage of working with providers to get that part of the chart in? Apparently there’s something in the chart that they need for UM that they can’t get out of the claims (but it’s not in the attachment either). And it’s all been driven by the marketing department.  Strikes me that the Blues yet again need more consulting help!

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4 replies »

  1. I believe patients have a right to copies of their data, but they don’t actually own it. If patients could demand that their records be destroyed, providers would, presumably, have to destroy their claims information used for accounting.

  2. I thought under HIPAA, the legal standard was that patients owned their data, and not physicians. It’s a strange kind of ownership, to be sure, but I think it rests ultimately with the patient. Not sure if patients can demand it be destroyed or turned over to them.

  3. > Why are they going to the brain
    > damage of working with providers
    > to get that part of the chart in?
    Well, ideally you’d like your providers to fill in their chart information electronically in an e-health application. The trick to this is for payors to purchase a turn-key application that does both the PHR, for the patients and the administrative functions, for the payors and providers–all off the same data.
    This is the approach my company (HealthTrio, Inc.) takes and it works for new payors, but large existing payors don’t want to give up their legacy systems for administrative, yet they want a PHR. So, they buy a PHR solution and run into data issues because a majority of their charting data isn’t even electronic or the payor won’t allow them to scrape the claims. A PHR without claims data is utterly useless because patients rarely enter their own data and if they do it is prone to input errors.

  4. > And why would providers want to
    > share their chart data?
    This is a peeve of mine — who says it is “their” chart data? I think it should be considered the patient’s chart data, pure and simple. The patient paid for its development (dearly, I might add), it is about nothing but the patient, and useful in detail to none but the patient. It is worth asking what belongs in the “chart” (e.g. the hourly BP from the PACU, probably not but the last observation or two before discharge probably).
    I do not understand why patients are content to leave their charts locked-up in doctors’ offices, and are content never to even look at them. I do understand why doctors want to keep charts under wraps and discourage their examination by patients (and others)…