Why Haven t EHRs Changed the Life Insurance Industry (Yet)?

Transcription

1 Why Haven t EHRs Changed the Life Insurance Industry (Yet)? July 30, The Sequoia Project

2 Goals of this Session Attendees will: Gain an understanding of what constitutes an Electronic Health Record (EHR), and how EHRs differ from traditional medical records Learn about opportunities that EHRs offer for the underwriting process Understand the challenges that exist in realizing these opportunities, along with strategies that individual insurers, and the industry as a whole, can take to address these challenges The Sequoia Project

3 What is an EHR? From the Electronic Health Records Association (EHRA): A longitudinal electronic record of patient health information produced by encounters in one or more care settings anywhere along the continuum of care; including patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and From radiology the Dept. reports of Health with the & ability Human to Services: independently A real-time generate patient a health complete record with of a access clinical to patient evidence-based encounter decision and sufficient support data tools that can be granularity used to to support aid clinicians clinical in decision support, making. quality The EHR management, can automate clinical and reporting, streamline interoperability, a clinician's population workflow, health ensuring management, that all clinical and data information is analytics, communicated. aligned with but It not can limited also prevent by regulatory delays in programs. response that result in gaps in care. The EHR can also support the collection of data for uses other From Dave Cassel: than clinical care, such as billing, quality management, outcome A software application that supports doctors, nurses, and their support staff in both providing and documenting a patient s treatment. reporting, and public health disease surveillance and reporting The Sequoia Project

4 EHRs vs. Traditional (Paper) Medical Records Obviously, an EHR provides on-line access to a patient s records, vs. relying on paper forms and transcribed reports. Reading a physician note on a screen isn t fundamentally different from reading a transcribed report on paper. The real power of an EHR is in its collection of codified data The system stores coded information on allergies, medications, surgical procedures, lab results, and even social determinants of health. This coded data can drive clinical decision support, quality reporting, population health initiatives and life insurance underwriting The Sequoia Project

5 Expectations Started High We will make wider use of electronic records and other health information technology, to help control costs and reduce dangerous medical errors. - President George W. Bush, State of the Union Address Jan. 31, 2006 Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, and save lives. - President Barack Obama, Address to Joint Session of Congress Feb. 24, The Sequoia Project

6 And Have Been Tempered Over Time On top of that, EHRs still don t do the necessary job of making patient records easily available to providers and patients. So in many ways, EHRs have merely replaced paper silos with electronic ones, while providers, and the patients they serve, still have difficulty obtaining health records. - CMS Administrator Seema Verma HIMSS18 Conference Mar. 3, The Sequoia Project

7 So, What Happened? EHRs have now been widely (but not universally) adopted within US hospitals and clinics/physician practices Within these organizations, there is evidence that an EHR does, in fact, reduce costs, prevent errors, and even contribute to saving lives Administrator Verma s assessment reflects the fact that many different organizations play a role in maintaining a patient s health, and these organizations typically use different EHR systems Sharing information across these different systems interoperability is a work in progress If healthcare providers aren t always able to access records for patients they re treating, you can imagine that life insurance underwriters often can t access these records electronically, either The Sequoia Project

8 Interoperability Challenge #1 Standards Consider a light bulb: It has a few attributes: size of base, supported voltage, wattage, height, width, etc. Consider an individual medical record element, like an allergy: It also has a few attributes: allergen, reaction, severity, noted date, etc. The light bulb s attributes are generally numeric and well defined: 50 watts, 110 volts, 26 millimeters The allergy s attributes are less clear: what does a severity of high mean? If I m allergic to penicillin, does that mean I should avoid amoxicillin? The Sequoia Project

9 Interoperability Challenge #1: Standards (cont.) An individual allergy is a very small portion of a patient s overall medical record. It s not just one light bulb The health IT community has been chipping away at the necessary technical and terminology standards, but it s a big job. The existence of multiple standards that serve similar functions increases the complexity The Sequoia Project

10 Interoperability Challenge #2: Legal/Compliance Healthcare providers have a responsibility to maintain the privacy and security of their patients records They won t release those records to just anyone who comes (virtually) knocking via the Internet They generally require: Contractual commitment to agreed-upon policies and procedures for information handling Proof of identity (at the organization/system level) Digital certificate, use of a specific IP address, etc. Workflows for obtaining, transmitting, validating, and auditing patient consent and authorization forms are often unwieldy and/or not aligned with electronic exchange processes The Sequoia Project

11 Interoperability Challenge #3: Prioritization Historically, each connection between two EHR systems (or between an EHR and some other system, e.g. an underwriting system) has constituted a non-trivial project Legal teams sign off on contracts Technical staff negotiate standards and security mechanisms Compliance and privacy officers weigh in on acceptable data use Users perform acceptance testing Two large health systems that share a lot of patients may have the motivation, and the resources, to take on such a project to connect with each other Smaller, more distant, or more tangential organizations are much less likely to warrant such an individual connection The Sequoia Project

12 Mitigating the Challenge Data Sharing Networks Communities have come together to form data sharing networks, in which each participant makes one connection to the network and then can access records from all participants. Some are geographically based, but many other types of data sharing communities also exist. No single network has been able to provide truly comprehensive, national connectivity The Sequoia Project

13 Carequality s Role Carequality creates a standardized, national-level interoperability framework to link all data sharing networks Carequality is creating a web of interconnected communities The Sequoia Project

14 Carequality Members The Sequoia Project

15 So We re Good Then, Right? Well For provider-to-provider data access, we re making great progress Over 4 million clinical documents (patient records or individual encounter summaries) were exchanged via Carequality in May 2018 With millions more being exchanged internally within networks or through individual connections We estimate 50% of US physicians are Carequality connected, and that about 90% will be on Carequality-capability EHRs by Jan. 1 But, there are two very important caveats: Purpose of Use matters Scope and breadth of accessible content varies The Sequoia Project

16 Recommendations for Life Insurance Recognize that patience will be needed It has taken well over a decade to reach the point where interoperability for treatment purposes is commonplace We have started the push for other purposes much more recently Engage in the health IT interoperability community: Standards development (e.g. HL7) Policy development (e.g. Carequality, TEFCA) Evangelize to provider organizations Evangelize to data sharing networks (e.g. CommonWell, ehealth Exchange, regional HIEs) Consider demonstration projects and perhaps incentivized pilots The Sequoia Project

17 Thank You! The Sequoia Project