When information culled from claims and pharmacy data revealed that one enrollee of Partners National Health Plans of Indiana had been diagnosed with hyperlipidemia and prescribed lipid-lowering drugs, a red flag went up. He received an e-mail via his online patient health record reminding him to schedule a liver function test. A treatment alert, sent by postal mail, notified the patient's physician that he was a candidate for the screening.
WellPatient.com offered by San Jose, Calif.-based Health Resolution Strategies is a new Web-based service that has enabled Partners to address the needs of patients with many different chronic diseases whose treatment is not consistent with evidence-based guidelines.
WellPatient initially was offered in a pilot to the plan's employees and was rolled out to enrollees in August. Health Resolution Strategies has signed up two other health plans.
Simply put, says Sheldon Dorenfest of Sheldon I. Dorenfest and Associates in Chicago, this new breed of health record augments patient-reported information.
Such input can come from insurers, as in the case of WellPatient, or as data from physicians captured at the point of care and entered into an electronic medical record (EMR). A third option, the simplest level, is a stand-alone, patient-reported health record.
What all electronic records have in common is a password-secured site and fire wall encryption to protect the confidentiality of users, along with patients' control over the information and the right to decide who can access it.
In its model, WellPatient creates a treatment history of self-reported patient information: family history, medical conditions treated and untreated, prescribed and over-the-counter medications, allergies and other pertinent health profile data, medical and prescription claims history data, and new claims submissions.
"Better informed members will make them more effective managers of care, resulting in better outcomes," says Bruce Greenberg, CEO of the physician-owned, 77,000-enrollee Partners plan based in South Bend, Ind.
"WellPatient enables doctors to ensure that their patients are receiving appropriate treatment, promotes coordination between providers, prevents drug interactions and saves time--(it) eliminates the rigmarole of patients trying to reconstruct patient histories for their physicians--and eventually leads to cost savings," adds Health Resolution Strategies CEO Harry Soza.
Research by both Partners and Health Resolution Strategies has indicated cost savings when enrollees' treatment follows clinical guidelines.
No common terminology exists to label and define the diverse EMRs available (see related story, page 76). Long Beach, Calif.-based First Consulting Group (FCG) refers to the new Web-based products as computer-based personal health records and defines them as software that stores patient-specific information accessible by the patient at a subsequent time.
A research study by FCG found that the most valuable patient health record is information entered and maintained by both providers and patients and supported by an integrated care delivery organization, employer or health plan. "The patient alone may not remember all of the information about physician encounters and medications, although they do a good job of detailing family history and self-reporting between doctor visits," says Jane Metzger, vice president of emerging practices for FCG. "The addition of information from an electronic medical record lends credibility to the data."
Tom Handler, M.D., research director for the Gartner Group, a Stamford, Conn.-based consulting firm, agrees with Metzger that the co-existence of a personal health record and an EMR will result in better care. "It gives clinicians access to all patient medical data anytime anyplace, promotes more consumer involvement and accountability, enhances patient-doctor relationships and links information between physicians," he says.
Pleasanton, Calif.-based PersonalMD.com offers its version of a personal medical record. It is comprised of information--such as demographics, physician information, current medications, allergies, hospitalizations, surgeries, immunizations, advance directives, and diseases and conditions--reported by the enrollee. The patient input is supplemented by patient encounters, lab reports and physician notes faxed into the personal medical record by physicians if provided with a PIN and fax ID.
"It can be more than an EMR since members can fax advanced directives and a list of alternative/integrative medications, along with paper-based documents including physician notes and EKGs," says Alan Zwerner, M.D., senior vice president for strategic planning for PersonalMD.com. It can be accessed anytime from anywhere in the world, he adds.
Unlike an EMR controlled by physicians or health plans and often unavailable to patients, the PersonalMD record, which went online last year, gives patients responsibility for the information and for deciding who may access it. If it is made available to physicians prior to visits or treatment, physicians can make more effective decisions, Zwerner says.
PersonalMD's record is currently being used by more than 130,000 individuals and is paid for by health plans and employer groups on a per member basis.
Executive Health Group (EHG), a 23-physician, four-facility practice headquartered in New York City, has been using PersonalMD since early this year, offering it as a value-added benefit at no additional charge along with its comprehensive physical examinations for corporate executives.
EHG has converted lengthy written reports of exam results and moved them, along with copies of blood work and EKGs, to the online patient record. The patients, many of whom travel extensively, can access the information about their medical exams, histories and status on a personal home page from anywhere. They also can fax or input online additional information, such as patient encounters with other physicians, to give the EHG physician a complete picture.
"PersonalMD empowers patients to take a more active role in their health and improves communication with doctors," says William Flatley, president and CEO of the medical group. "For physicians, it offers a permanent and accessible patient medical record and helps them know their patients better."
Both MedicaLogic/Medscape, based in Hillsboro, Ore., and Madison, Wis.-based Epic Systems Corp. offer EMR applications for physicians. But they also have developed consumer-oriented, patient-reported records that interact with the EMR. Through a personal page called 98Point6, MedicaLogic/Medscape users can access their online medical records created by their providers and self-reported personal and family health information free of charge. Mark Leavitt, M.D., chairman of the board of MedicaLogic/Medscape, refers to it as a "digital health record" since it can be accessed by handheld devices, cell phones or a PC.
Future enhancements will enable patients to receive advice, send messages to their physician, schedule appointments and request a prescription refill or referral, while physicians can remind patients about annual check-ups and immunizations. Patients in clinics piloting the product have reported experiencing both improved service and quality of care.
Epic's MyChart lets patients access their online medical records, review test results, request or cancel appointments, send messages to their providers, refill prescriptions, print out immunizations and enter home test results or personal medical information. If a doctor orders a prescription or treats a patient, the information is entered into MyChart.
It is marketed to physician groups and health plans for a low set-up fee and a per member per year fee for those who actually access MyChart.
Brad Eichhorst, M.D., director of clinical informatics for Epic, says MyChart is a subset of the full EMR containing medications, lab results, health reminders, and family and personal medical histories. "It's still early in the era of e-commerce to really know the benefits of a patient health record," Eichhorst says. "But it should improve relationships and efficiency by increasing accessibility and opening up discussions between doctors and patients."
Through its use of EpicCare, one of Epic's products, Geisinger Health Systems in Danville, Pa., has embraced MyChart. "It addresses the need to review lab tests, schedule appointments, request refills and seek medical advice," says Joe Bisordi, senior vice president and chairman of medical informatics for Geisinger, which includes a multispecialty physician practice, hospitals and a health plan.
"We are working hard to become an integrated health system, offering the right care in the right place at the right time," Bisordi says. "MyChart helps break down barriers of communication by making relevant information--medications, allergies, medical problems, summary of office visits -- available to anyone the patient chooses." He says he anticipates that referring doctors will gain the same access to the records with permission of the patient. "Just as the phone helped decrease office and ER visits, we expect the same benefits from the Internet," he adds.
Portland, Ore.-based WellMed, New York City-based medicalrecords.com and VirtualMedicalGroup.com in Morrisville, N.C., offer stand-alone models.
WellMed's WellRecord, largely a self-reporting tool, serves as an "foundation for lifelong storage of data which must be more than a repository for self-reported, static information," says Philip Marshall, M.D., director of clinical operations.
"All of our tools help physicians take better care of their patients who are better informed and more engaged," says Brad Bowman, M.D., WellMed's founder and chief science officer.
If patients use Virtual Office Visit, an Internet-based physician consultation offered by the company, or see any other physician, the interactions are documented in the record, making doctors more familiar with new patients.
Mari Edlin is a Mill Valley, Calif.-based writer.