California Insurance Commission: Personal Health Records: A Helpful Tool for A Healthier You


From their report [pdf]:

Executive Summary:

A Personal Health Record (PHR) is an evolving consumer tool for health record-keeping that is available to many members of California insurers or Managed Care Organizations (MCOs). Different from Electronic Medical Records (EMRs) which aggregate detailed clinical information, PHRs generally operate like a “calendar of medical events” and have data auto-populated from insurer/MCO claims files with other personal medical information typed in by the consumer. Some versions of PHRs will also include clinical data auto-populated from the insurer/MCO’s clinical system or EMR. Because much of the PHR is filled in automatically by the consumer’s insurer/MCO, the PHR is likely to be up-to-date (within a month or so) and robust (data entered is likely to be accurate since it was generally used first for claims adjudication). Data from EMR-linked systems may be available much quicker (e.g., within days in many cases).

This survey gathered information from representatives of seven large California insurers or MCOs: Aetna, Blue Shield of California, CIGNA, HealthNet, Kaiser Health Plan, United/Pacificare and WellPoint (Blue Cross of CA). Knowledgeable representatives were made available and were generous with their time and input.

Key findings include:

  • All seven insurers/MCOs had PHRs that were either operational or in an operating pilot stage, having made excellent progress in making PHRs available to all members.
  • PHRs generally included detailed auto-populated data on hospital admissions, hospital outpatient procedures, physician visits, lab test and prescription drugs. While all insurers/MCOs had plans to incorporate these data, not all types of data were operational at the time of the survey.
  • Many of the insurers/MCOs had methods available to fax records, provide the PHR to physicians with appropriate permission or make the PHR/EMR available through its delivery system (Kaiser).
  • Awareness of the PHR and use of it by consumers appears to be limited. For some insurers/MCOs, the PHR was in a pilot or beginning phase with very limited use. At the top end of usefulness, one MCO had close to 30% of its members activate a PHR. More commonly, usage by members was under 5%.
  • Key applications of PHR by members appeared to be:
  • Tracking services and prescriptions over several years of history
  • Faxing or providing a paper copy of the PHR to a personal physician
  • Having the PHR available to Emergency Room physicians for clinical use
  • Scheduling physician appointment in one MCO
  • Ordering prescription refills or obtaining routine lab test results
  • Managing health care claims cost data
  • Data from the PHR was frequently retained and could be re-activated if an individual returned to an insurer/MCO.
  • Progress has been made by an industry consortium (America’s Health Insurance Plans, AHIP, and the Blue Cross Blue Shield Association) towards establishing a standard for plan-to-plan transfer of records. This would allow an individual to “roll-over” a subset of PHR information to a new insurer/MCO upon changing employer or insurer/MCO in the future but is not operational today.
  • The Centers for Medicare and Medicaid (CMS) is conducting a PHR pilot with several Medicare Advantage plans and will be starting a Fee For Service (FFS) Medicare pilot in South Carolina in 2008.
  • Various non-insurance company vendors (e.g., Microsoft, Google, Quicken) are working on related applications. WebMD was being used as the PHR “engine” by several of the seven companies.

In short, there has been much progress in establishing PHRs and making them useful and available for consumers. Actual usage at this time appears to be low, but awareness by consumers may be limited and barriers to use are unknown. It may require another three to five years before PHRs are widely recognized as useful and become commonly used by individuals. As PHRs and their uses evolve, consumers are likely to become more adept at using them.

Several insurers/MCOs had working examples of cost savings potentials (e.g., through cost reductions from eliminating duplicate tests in Emergency Room visits) or clinical effectiveness improvements (e.g., by connecting Emergency Room physicians to medical histories in the PHR or by providing complete PHRs to a personal physician). More awareness and usage of the readily available PHR may be possible in the future.

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