As the nation continues debating how to transform health care, many ideas for improving patient care have surfaced. One solution is letting patients access their medical history via personal health records (PHRs), which are repositories of individual health information culled from multiple sources.
Most PHRs and electronic medical records (EMRs) are managed and controlled by medical personnel, rather than the patient, and are based on industry standards. So data can be transferred easily from one system to another. While EMRs are just beginning to permeate doctors' offices, PHRs are picking up steam with insurers and other health providers, which offer PHRs to the populations they serve. Anyone can sign up with a provider for a PHR -- some insurers offer them, as do Google and Microsoft. The federal government's Centers for Medicare and Medicaid Services (CMS) has launched several pilots involving PHRs. The programs are aimed at tech-savvy baby boomers who are rapidly approaching retirement age, and many of whom will enroll in Medicare. PHRs may prove useful for boomers trying to stay healthy through their golden years.
"CMS is interested in people getting the best health care they can get," said Elizabeth Holland, a health insurance specialist with CMS, "and this is really a step toward empowering people and helping them make the best decisions about their own health care."
According to Holland, CMS began exploring the use of PHRs in 2005 when it released a request for information. "The overwhelming response was that CMS should provide data to PHRs, but we should not build our own PHR," Holland said. "So we proceeded with that in mind."
That led to a pilot in which the agency worked with its claims processor for South Carolina to populate PHRs provided by HealthTrio with Medicare data. The pilot showed it was feasible to transfer Medicare claims data to a PHR.
Now, CMS' newest pilot is geared toward giving patients a choice of PHR providers. "We knew that we wanted to be able to share Medicare data with multiple PHRs," Holland said. "What we didn't know is how beneficiaries would make that choice."
Working with Noridian Administrative Services -- the Medicare claims administrator for the U.S. region that contains Arizona, Utah and several other states -- the agency launched its PHR Choice pilot in January. Through this pilot, Original Medicare (fee-for-service) beneficiaries in Utah and Arizona can have Part A and B claims data transferred automatically to a PHR provided by PassPortMD, Google Health, HealthTrio or NoMoreClipboard.com.
Noridian handled the solicitation, while Medicare laid out the basic criteria that the PHR providers had to meet. CMS pays Noridian to transfer the data to the PHR providers, but the providers aren't paid for their involvement. The basic PHR is free for beneficiaries too, although some of the providers offer add-on services for a fee.
The providers offer different ways of viewing data and various tools to help users manage their health data. "All of them have different bells and whistles," said Holland, who is the pilot's director.
Holland said the agency is still experimenting with how best to reach and inform beneficiaries about the different PHRs. "Honestly we're finding that they are a little overwhelmed by the choice," she said.
Some beneficiaries aren't sure what to make of the program, she said, based on feedback the agency receives from its regional offices and the state senior health insurance assistance programs (SHIPs), which use volunteers to help beneficiaries understand and sign up for programs.
"The SHIPs are getting a lot of questions: 'Is this really Medicare? Can I trust these
vendors? How do I make a choice?'" Holland said.
Utah Senior Health Insurance Information Program Manager Darren Hotton said when letters announcing the program first were mailed, the most common concerns among beneficiaries were the potential for fraud and whether it was a legitimate program. "They didn't want to start putting personal health information into a place that they weren't sure was going to be a secured place and that was truly from CMS," he said. Others wondered where they could find information and how to set up a PHR.
Citizens have asked fewer questions in recent months, Hotton said, most likely because those who wanted to sign up already have done so. "I think most people who were interested went online and were up and running, and set themselves up and moved on," he said. "People who were not computer savvy read the letter and promptly threw it away."
Online programs aren't always as helpful for older Medicare beneficiaries, Hotton said.
"It's still a face-to-face or phone conversation to help them with their needs and provide services to them," he said. "But Medicare and state and local governments are preparing for baby boomers, and these baby boomers who are coming into Medicare are ready for this."
Even if the pilot isn't getting the amount of people signed up that CMS hoped for -- Hotton said he hasn't seen the numbers -- he thinks it's valuable anyway.
"Even though Medicare might not be getting the best results from this particular program it doesn't mean it's not going to be a success, because it shows that Medicare is preparing for these groups of people who are coming in who might possibly overload the system," he said. As more tech-savvy baby boomers start using Medicare, Hotton said their in-person interactions with government representatives will likely be reserved for more complicated problems because simple queries will be handled online.
According to CMS' Holland, the agency needs more enrollees in the program to gain meaningful data from the pilot. She said CMS is working with providers to see how to get more people on board, possibly by building an outreach program that would approach people in a different way.
Medicare sent out letters informing beneficiaries of the pilot and advertised it on its Web site. Holland said the solicitation required the PHR providers to perform their own outreach.
PassportMD CEO Steven Hacker said representatives from his company will travel the states in an RV to demonstrate the PHRs at venues like senior communities, senior centers and hospitals.
NoMoreClipboard.com will also do a second round of outreach, said Jeff Donnell, the company's chief marketing officer. He said the company plans to increase its public relations efforts with the media. "The other thing that we're planning is to do more physician outreach, because we've found that to the extent that a physician recommends this to a patient, you have much greater adoption," he said.
Donnell asserts that doctors who encourage patients to build a PHR benefit from more accurate information and no longer have to rely on data from forms that are filled out by patients and entered by hand into an EMR system -- if the doctor's office even has one.
"While the holy grail is every doctor will have an electronic medical record, today 85 percent or so of doctors are still using paper charts," he said.
In the meantime, Donnell said PHRs give doctors a more accurate method of collecting patient data while the EMR deployments catch up.
PassportMD's Hacker suggested that it's also in the interest of governments to encourage PHR adoption because it's a good way to ensure patients' data are accessible in the event of disaster -- when paper charts could be destroyed.
Hacker, who is a physician, said PHRs are a more realistic way to quickly put health records online. "I think it will be a lot quicker than waiting for the physicians to all adopt EMRs," he said.
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