Major insurance companies have come a long way in making it possible for federal employees and retirees to access their own personal electronic health records.
But two important goals are far from realization:
While insurers report a growing willingness of federal enrollees to tap into their systems to make use of their medical information, the size of the growth is mixed. It’s still small for most carriers, with the large majority of their federal membership still balking at using the health records system, even though electronic records advocates insist they offer widespread benefits to users.
The dream of a nationwide network of interoperable systems, with doctors, hospitals and insurers able to access any patient’s clinical and personal health records — with the patient’s approval — is still a long way off. The idea envisions instant, need-to-know access by health care providers, insurance companies and patients to two types of records: electronic health records, which refer to clinical data, such as X-rays, lab test results or a physician’s report; and personal health records, which include claims information from the insurer and relevant entries by patients themselves.
The Office of Personnel Management has been pushing insurers to offer federal members access to their PHRs for several years, “as aggressively as they can,” said Jena Estes, vice president of the federal employment program at Blue Cross Blue Shield Association.
In a September 2011 report, OPM said that 97 percent of all Federal Employees Health Benefits Program carriers, representing 98 percent of all enrollees, were offering some form of PHR access to their members, up from 51 percent in 2007, and three-fourths of FEHBP carriers include medical claims or health record information.
However, OPM added, “the majority of FEHB plans continue to report that less than 5 percent of their members have actually used their PHRs.”
“Our experience with electronic health records is that their importance to our own plan members remains fairly limited,” said Dan Swartzwelder, marketing manager for the Mail Handlers Benefit Plan. They seem to be “of much less importance than the cost of coverage and the level of benefits offered.”
Lately, the Health and Human Services Department has lent its considerable weight to the effort. Its Office of the National Coordinator for Health Information Technology has issued requirements for the electronic records technical capability physicians and hospitals must achieve in various stages under the 2009 American Recovery and Reinvestment Act. Stage 2 requirements must be met between 2014 and 2017.
And HHS’ Centers for Medicare & Medicaid Services launched an incentive payments program for all Medicare and Medicaid providers who make significant progress in complying with the requirements of the electronic records effort. HHS has reported that 3,300 hospitals, more than half of those eligible, and more than 120,000 professionals, mainly doctors, have qualified to receive incentive payments, and the progress continues to accelerate.
Meanwhile, strides taken by large insurers to make PHRs available to the individual are impressive, even where members’ usage lags behind expectations.
“More and more members are learning about having this ability,” said Dr. Douglas Van Zoeren, chief of adult medicine for Kaiser Permanente’s Mid-Atlantic region.
By providing ready access to a patient’s PHR and quick email access to his doctor, barriers to care are removed and patient safety is enhanced, he said. Physicians can respond by email to inquiries from a patient concerned about a potential medication side effect, for example. The patient might otherwise stop taking the medication until he can be seen in the office. “That’s the last thing we want,” Van Zoeren said.
Using electronic records facilitates safer electronic prescriptions and faster notice of laboratory results and X-rays. Referrals and appointments are also handled fast and efficiently, Kaiser officials said.
Scheduling a visit to a specialist, for instance, is done on average within a few days, compared with a three-week industry average, said John Patrick, director of federal sales and account management for Kaiser’s FEHBP line of business.
“We are able to schedule members with a specialist much faster, so they get the care when they need it,” he said.