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AHIP Looks to Standardize Personal Health Records

America's Health Insurance Plans (AHIP) has taken steps to standardize key data elements within Personal Health Records, making them more portable for consumers.

As more and more health insurers introduce personal health records (PHRs) to help improve care, reduce errors and lower costs, the industry is working to establish standards that would make those PHRs portable. "Once you can establish a core set of information that is portable with you over your lifetime, powerful benefits will come from all the different tools you can use with that data," says Jeanette Thornton, director of health informatics at America's Health Insurance Plans (AHIP). The Washington, D.C.-based industry group is pushing the adoption of standard data elements and a portability model for PHRs -- consumer-facing, Web-based histories of an individual's health data.

The industry hopes to have the standards in place by December 2008, and insurers that are creating PHRs independently are moving in the right direction, according to Thornton. At least two PHR programs that incorporate the AHIP guidance have been announced recently. Cleveland-based Medical Mutual of Ohio ($2 billion in annual revenue) will collaborate with its 23,000-physician network to promote its PHR, iHealth -- which is powered by Medem (San Francisco) -- to its 1.6 million members. Meanwhile, Indianapolis-based WellPoint's ($51.5 billion in assets) Anthem Blue Cross and Blue Shield is working with Kettering Health Network in Ohio on an Individual Health Record (IHR) pilot program supported by technology provider CentriHealth (Nashville, Tenn.).

"That's what we want -- for health plans to take what we've done and incorporate it into specific product offerings," Thornton relates. "We developed a common set of data elements and a standard to make it portable. Each health plan is still going to compete on which functionalities and which features to include in the PHR."

AHIP's efforts have come in two parts, Thornton says. First, it determined the particular data sets that should be a part of any PHR through provider and insurer research and consumer focus groups. The Blue Cross and Blue Shield Association was a key collaborator, Thornton notes. "We didn't develop a new standard -- we basically listed data elements and referenced the existing health IT standards that they should use for those elements," she says, referring to existing IT standards required under HIPAA.

Records On the Go

The organization also established and tested, with 10 insurers, a portability model that would make it easier for insureds to migrate their PHRs from one health plan to another. "A PHR wouldn't be very valuable if [a consumer] changed jobs or if an employer decided to change insurers, and all that information in the PHR would be lost," Thornton explains.

In Anthem's pilot, a participating member's IHR is automatically updated with claims information and network provider data, such as physician notes and lab results, as well as pharmacy information. The IHR includes functionality that can alert consumers to specific health events, such as required exams. "We're engaging the member now to be an active participant [in his care]" says Rich Gunza, executive director of Anthem Blue Cross and Blue Shield for the Dayton, Ohio, region, where the IHR is being piloted.

While Anthem's IHR and Medical Mutual of Ohio's iHealth PHR integrate with healthcare provider networks, AHIP's guidelines are, for now, focused on PHRs populated primarily with claims data, AHIP's Thornton says. "We view getting at least this basic set of information to consumers as an important first step in getting them used to interacting and getting their information online," she explains.


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Right now, PHRs can be sources for competitive differentiation for a health insurer by aggregating data from different sources such as surgical centers, hospitals, insurance claims and primary care providers and then presenting it an easy accessible way.

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