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Insurers Urge Creation of Portable Databases to Improve Care

MAY 1, 2006 -- BlueCross BlueShield local health plan leaders made the case on Monday for health insurers to establish uniform portable health databases to ease the burden on doctors and patients.

The meeting held in Washington was the first in a series the association will hold on the topic as lawmakers consider legislation to integrate health information technology nationwide.

"It's really just an extension of what we already do," said Mary Nell Lehnhard, the association's senior vice president of policy and representation. "It's really the best chance for wide-scale and quick adoption because consumers don't have to do very much."

Efforts to shift from paper records to electronic ones are already under way in Louisiana, New Jersey, and Alabama, and have allowed insurers to pair clinical information with family history and administrative data, panelists said.

BlueCross BlueShield leaders from those states said they are using technology to do things such as trigger patient reminders for check-ups and make personalized suggestions for low-cost medications targeting specific ailments.

Technology also can ensure that records are ready for a patient to examine and update when visiting a new doctor rather than documenting medical history from scratch. The insurance officials also said electronic health efforts can notify doctors which patients are not filling their prescriptions.

In June, Alabama's BlueCross BlueShield will begin an initiative whereby doctors can transmit prescriptions directly to a pharmacy of their patients' choice via handheld electronic devices. A pilot "e-prescribing" program also will be introduced this year in BlueCross BlueShield's Louisiana system.

Hurricane Katrina accelerated efforts to make data more accessible, said W. Ob Soonthornsima, senior vice president and chief information officer of BlueCross and BlueShield of Louisiana. On Oct. 1, 2005, the group started a claims-based health record system for providers to access patient data.

For example, the system could document that a patient has had four different doctors treating the same problem, outline all procedures performed, and detail the prescriptions the patient has subsequently filled.

According to Lehnhard, 72 percent of those surveyed said they would use a personal health record and research showed they would prefer their insurance carrier to provide that record instead of a doctor.

But Ed Harris, vice president of senior products and information services for BlueCross and BlueShield of Alabama, emphasized that getting doctors to use the systems is the real challenge.

"It has to be in a way that doesn't interrupt their daily routine," Harris said.

Health plan providers also disagree with some aspects of Congress' efforts to fuel health information technology. For example, one bill (HR 4167) intended to help disseminate secure patient records would require all payers and health care providers to switch to a new billing code system by Oct. 1, 2009.

An April 5 letter that America's Health Insurance Plans (AHIP) sent to Rep. Nancy L. Johnson, R-Conn., explains that the transition would replace the existing 23,000 codes for describing medical diagnoses and procedures with more than 200,000.

BlueCross BlueShield is among many organizations that called the timeframe for that transition unworkable and recommends extending it by three years, to 2012.

Privacy remains the other significant hurdle.

Dr. Deborah Peel, founder and chairman of Patient Privacy Rights, said that while her organization sees the merits of portable electronic records, "They'll only be realized if patients really, really trust that only the people they want to know about them do."

Peel said legislation should include elements such as audit trails for disclosures and meaningful criminal penalties.

"Because we have a new technology, [why] would we eliminate the ethics that have been the foundation of medicine?" Peel asked.

Dr. Richard Popiel, vice president and chief medical officer of Horizon Blue Cross Blue Shield of New Jersey, likewise emphasized the importance of "technology embedded with clinical rules and clinical guidelines."

Soonthornsima maintained that in its early local and collaborative stages, those principles are adhered to. "We share a lot of knowledge," he said. "We don't share data. We share practices."

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