EMRs: Brass Ring for Insurance Companies

A brass ring is a small grabbable ring that a dispenser presents to a carousel rider during the course of a ride. Usually there are a large number of iron rings and one brass ring that can be exchanged for a prize. An opportunity to achieve wealth or success.

There are values to electronic medical records (EMR) in a standalone system. Those benefits have been available for years and have provided only limited incentives for doctors to use them. There are significant additional values from sharing the information in these systems but most of the networking has been motivated by good intentions, not market forces. This post describes a way to bring a combination of good intentions and market forces together to hasten the adoption of networked EMRs.

This proposal plays on the interests of two participants at the edges of most of the current work being done on EMRs: consumers and health insurance companies. Consumers have been given only limited tools with limited links. Insurance companies haven’t seen, or at least haven’t exploited, the opportunities.

The initial step is for insurance companies to recognize the benefits of better patient care and potential cost reductions through networked medical record systems and then offer two new services, one for consumers and one for doctors.

In neither case will the insurance company access, store, or transmit personal health information (PHI.) In the scheme of doctor/patient relationships there is no reason for the insurance companies to take responsibility for this information and, as a practical matter, the level of public distrust of large corporations is so high that direct participation by insurance companies would probably be more of a hindrance than benefit. The consumer will own their data and any data they receive from their doctor; the doctor will own the data from their EMR system including the data they receive from their patient.

The proposed services for consumers and doctors provide new ways for insurance companies to differentiate their service offerings. One of the reasons for me as a consumer to chose company “A” could be they let me know which of my doctors is able to access my personal health record (PHR) to improve the information available for decisions about my health or, if I am looking for a doctor, which affiliated doctors offer those services.

As a doctor, affiliation with company “A” could give me access to better information about some of my patients and provides incentives for new patients to call me. The insurance company that moves first will gain a first mover advantage; the others will have to play catch up.

consumerThe service for consumers will allow me to contact my insurance company and inquire about affiliated doctors and their EMR systems and services. I can then use that information as part of the process of selecting a doctor.

I will also be notified by my insurance company if a doctor I have used in the last n months improves their EMR related services. This will allow me to take advantage of those improvements or allow me to feel better about recommending my doctor to a friend.

From a patient perspective, the primary advantage will be that I can contact my insurance company and inform them that I now have a PHR and specify which doctors will have access to it and under what conditions.From the insured’s point of view it might look like this: I log on to a secure Web page provided by the insurance company (think of a home page for online banking).

  • I indicate my desire to participate in the medical record exchange program sponsored by the insurance company and specify the terms of my participation. This could includeAuthorization to send a notice to an affiliated doctor that I have a PHR and want to share information: (a) if the doctor inquires about a covered service, (b) or inquires about a service whether covered or not, (c) or if they have provided services to me during the last n months, (D) or if they are on the following list, etc.
  • As part of that notice include the name of my PHR, e.g., Google Health, Health Vault, and provide instructions to gain access.

Options to gain access could include: call me, call a trusted third party in case of an emergency, remind me during my next visit to provide this information, access the insurance company’s secure site and log on to get more information, etc. There are a number of ways the options for access can be expanded to include access to all or parts of my PHR for emergency medical services, or for doctors overseas if I am on a trip, etc. The providers of PHR systems will almost certainly develop additional options.

doctorThe service for doctors will allow a doctor to log on to a secure Web page provided by the insurance company (again, think of a home page for online banking) and authorize the company to let current and/or prospective buyers of insurance know that the doctor has an electronic medical records system for his practice and will make test results and medical records available to patients in (a) an electronic format, (b) hard copy, or (c) both.

When any doctor’s office contacts my insurance company to confirm coverage, the company’s response will include information about my PHR if I have authorized the company to share that information.

The doctor will get the same number of messages from the insurance company as they get today. They will get a message about my PHR only when they inquire about my coverage and the message will be a bit longer only if I have a PHR. Doctors who do not have an EMR will get a sense of the potential value of having one and they will be able to access my PHR, print a copy, and add it to my paper file in their office. Whether or not the doctor has an EMR, this is an added service for me and my doctor.

When one of my doctors gets a new or upgraded EMR and is ready to share information, they will have the information they need to get copies of my medical records and to send test results and medical records to me. Neither they nor I will have to register with the insurance company or do anything else to share information. Nobody has to remember to do anything or wait for action by anyone else. A doctor who makes an inquiry about my coverage will get the information they need to access my PHR, get information, and post information.

Doctors who find benefit in the networking capability will encourage their patients to get PHRs and will recommend the services that provide the best interfaces to and from the doctor’s system. Providers of PHR services will have incentives to interface to popular EMR systems. More subscribers will give providers of PHR systems additional incentives to continue developing features and functions. EMR system providers will have incentives to provide interfaces to the leading PHR systems to support their efforts to sell new or upgraded systems to doctors. Market forces will be aligned to support the wider adoption of EMRs.

Solving the problems with America’s medical delivery systems will require a number of changes. This is one that can be implemented fairly quickly without regard to any regulatory requirements other than HIPAA security and with limited investment. Many of the required capabilities are in place already. Required changes to computer systems can probably be accommodated through additions to existing systems rather than costly new system development. Most system and operating changes can be implemented incrementally to spread costs and minimize risks.

Insurance companies that provide these two services will contribute to better medical services and lower cost and earn a public relations brass ring.

One small step for electronic medical records; one giant step for better health care at lower cost.

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4 responses to “EMRs: Brass Ring for Insurance Companies

  1. Nice content. Waiting for you to continue the topic.

    Julia Swenson
    polish escort in warsaw

  2. I am currently doing some research on EMRs and how disability and life insurance companies might be changing their practices or preparing for EMRs as a result of the HITECH Act. I know that you indicate above that Health Insurance companies that get on the leading edge of connecting their customers to those providers who have this capability. Do you foresee a benefit to Disability/Life Insurance companies that might be on the leading edge of being able to accept EMRs? My anticipation is that it would potentially enable quicker claim processing times if records could be accessed/provided to the insurance carrier electronically. I would be interested to know if you have thoughts on this.

    • One of the basic premises of EMR’s is that data can be extracted as needed and used in the billing process. I am not quite sure how Disability/Life Insurance companies would use a doctor’s billing information.

  3. Disability/Life Insurance companies would be looking for Electronic Medical Records to review actual patient documentation on their condition in the claim review process. The EMR would not be from the billing standpoint, it would be more to capture notes on diangnosis and such.

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