You Should Know:
- Despite potentially large productivity gains, the health care sector lags far behind other sectors in the U.S. economy in its expenditures and use of information technology.
- Personal health records (PHRs) and electronic health records (EHRs) are key components of needed technological advancements.
- Health information technology (HIT) is a promising tool for addressing the challenges of cost, access and quality, particularly in an era of growing consumerism.
Background:
Health information technology (HIT) 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. HIT is increasingly viewed as a priority for government and the health insurance industry. Many believe this focus on HIT is appropriate because the health care sector lags so far behind other industries in adopting information technology.
Recognizing potential productivity and quality gains associated with HIT, the federal government has emerged as a central force in the HIT arena, and there is now extensive public and private activity around the development of electronic and personal health records (EHRs and PHRs). An EHR is a provider-centric electronic history of care an individual has received from a particular health care provider or system. A PHR is a patient-centric and patient-owned electronic history of an individual’s health and all encounters with the health care system, securely maintained on behalf of the individual by a custodian.
Why HIT Is Necessary:
Successful HIT implementation will require public-private coordination. Although significant expenditures are necessary to transform America’s outdated medical record keeping (for example, recent research suggests that installing EHRs would cost $115 billion over 15 years), investments in HIT are expected to generate substantial long-term savings.
Benefits associated with EHRs and PHRs include: improved operational efficiencies among health care providers; reduced medical errors; increased utilization of recommended treatments; reduced variability of care in medically underserved areas; and improved accuracy and privacy of records. EHRs and PHRs are also seen as ways to control skyrocketing U.S. health care spending. For example, recent studies have concluded that widespread adoption of EHRs would save the U.S. health care system an estimated $80 billion annually. Importantly, investments in technology benefit consumers in the form of safer, more effective care. Consumers would also benefit from better access to health information, improved portability of records and greater involvement in their own health care.
The Aetna Difference:
Aetna is committed to delivering industry-leading benefits and services that incorporate health information technology. For example, all Aetna members have access to Aetna Navigator™, a secure, interactive and easy-to-use website where members can access personal benefits, claims data and health information as well as perform a host of common transactions involving medical, dental, prescription drug or flexible spending account plans.
Looking forward, Aetna believes that consumers must be the focus and primary beneficiaries of HIT development. Federal government leadership is essential, but Aetna also recognizes that it is critical for the health care industry to deliver innovative and affordable solutions for a national interoperable health care system. Aetna’s commitment to HIT that benefits consumers is consistent with its leadership in consumer-directed health care. Both consumerism and HIT help control costs by giving consumers better access to information allowing them to make informed decisions about treatment and provider options.
Questions and Answers
Q. How do PHRs and EHRs differ?
A. PHRs contain information most relevant to the overall care of an individual, while EHRs contain detailed clinical and process information for medical and/or legal use by health care providers. Many view PHRs as complementary to EHRs, serving as a critical and immediate first step toward a national, interoperable EHR system which is many years from being fully functional. Health insurers could serve as PHR custodians, supporting individuals in maintaining their PHRs, because insurers already possess most of the information to be included. The interoperability of PHRs and EHRs should be a significant focus of the standard-setting process, especially if systems developed are to be compatible with a national network.
Q. Who will fund the development and implementation of HIT?
A. Multiple sources of funding will be needed to pay for the significant costs of developing and building a new EHR/PHR infrastructure. Aetna believes that payers (health plans and employers) should primarily fund the development of claims-based PHRs for their respective insured members. Full development of EHRs, however, will require financial assistance from the federal government. Support could come in the form of interest-free loans, loan guarantees or similar financial vehicles and should be accompanied by incentives (for example, a favorable federal reimbursement rate) to encourage rapid and widespread adoption.
Q. Will EHRs and PHRs be able to ensure provider and patient access while maintaining privacy and confidentiality?
A. Clinical, legal and policy experts must decide how the privacy and confidentiality of health information will be protected, while determining which parties will have authority to enter or change information in PHRs and how access to data will be authorized and monitored. Aetna supports the efforts of the Department of Health and Human Services (HHS) to encourage Congress and the states to rationalize and harmonize federal, state and local laws and regulations governing the collection and distribution of personal health information. Such coordination is a prerequisite to development of EHRs and PHRs under a single set of comprehensive national standards governing privacy, confidentiality and access.
