In the health care process, different groups look for different things. Consumers want improved quality of care. Employers want a way to reduce rapidly rising health care costs. Medical professionals want to work more efficiently with the insurers they deal with, and visa versa.
While these are all unique goals, there is at least one field that can help improve the process for everybody involved, and that is the field of Health Information Technology (HIT).
Despite potentially large productivity gains, the health care sector lags behind other sectors in the U.S. economy in terms of its spending on, and use of, information technology. However, in recent years, there has been a concerted effort to increase the use of information technology in the health care process by both private companies in the health insurance industry and government organizations that deal with these issues. Both sides see the potential for tremendous short- and long-term benefits.
“Advances in health information technology are very promising in terms of addressing the challenges of cost, access to and quality of health care,” says Bill Berenson, vice president of sales and service for Aetna’s Small & Middle Market Business in the North Central region. “This is particularly true, given the consumerism movement and the fact that consumers are now more involved in their health care than ever before.”
Smart Business spoke with Berenson, who answered some questions on the basics of health information technology and how improvements in this area promise to be valuable for consumers, employers, medical professionals and insurers.
What is health information technology (HIT)?
Health information technology refers to computer hardware and software that stores, retrieves and shares health care information for use by health care providers and consumers in decision making.
What is a personal health record?
A Personal Health Record (PHR) is a patient-focused electronic history of an individual’s health and all his or her respective encounters with the health care system. There are generally two types of PHRs: one that relies on the patient to input data into the record (a ‘patient-populated PHR’), and one that is populated automatically by clinical data derived from health insurance claims forms (a ‘claims-populated PHR’). Both types of PHRs are maintained securely on behalf of the individual, usually by a custodian. And in many cases, the health insurer can serve as the custodian, as it already possesses most of the information that would be included.
More advanced PHRs use sophisticated ‘clinical rules engines’ to constantly analyze the clinical data in the PHR and send warnings or alerts if the patient is not receiving the right therapy or medication.
What is an electronic health record? What is the difference between the two?
An Electronic Health Record (EHR) also known as an Electronic Medical Record (EMR) is a physician-focused history of care that is typically operated and populated by doctors and hospital systems.
While claims-populated PHRs contain much of the information relevant to the overall care of a consumer (list of medications, diagnoses, labs tests, etc.), EHRs have more detailed clinical and process information that is generally used by health care providers for medical and/or legal purposes.
Who is working on improving HIT?
Health insurers, employers, health care providers and government organizations are all working on enhancing the use of information technology in the health care process. While both health insurers and employers are involved in developing PHRs for their respective insured members, EHRs are typically purchased by hospital systems and large physician practices.
The federal government is spearheading efforts to encourage local communities to create regional health information organizations that will build ‘health information exchanges’ to share digital health information among various health provider organizations (hospitals, doctors offices, labs, pharmacy benefit managers, etc.) to create more robust EHRs for the patients in that community.
How does the consumer benefit with improvements to HIT?
First and foremost, improvements in this type of technology should result in safer, more effective care. Consumers would also have improved access to health information, enhanced portability of records, and would be likely to be more involved in their entire health care process.
While the cost of these initiatives could be extensive (recent research suggests that installing EHRs nationally would cost $115 billion over 15 years), investments in these areas are expected to generate substantial long-term savings. Some recent studies have even concluded that widespread adoption of EHRs would save the U.S. health care system an estimated $80 billion a year.
Other benefits include: improved operational efficiencies among health care providers; reduced medical errors; increased utilization of recommended treatments; and improved accuracy and privacy of records.
BILL BERENSON is vice president of sales and service for Aetna’s Small & Middle Market Business in the North Central Region. Reach him at (312) 928-3323 or [email protected].