I’ve suspected for a while that one reason why personal health records haven’t taken off was because the “untethered” kind that are not tied to a specific provider organization’s electronic medical record or portal tend to be built with claims data. That is, an insurer or employer combs through billing codes to piece together records that ostensibly contain clinical records.
There are numerous problems with this, of course. First off is the workflow issue. If the doctor doesn’t have an EMR to import PHR data, then the PHR represents an extra step that the typical physician isn’t willing to take.
Then there is the reputation of managed care. Health insurers often are just slightly above oil companies, politicians and Bernie Madoff on the public’s trustworthiness scale. I imagine they’re even lower from the perspective of doctors who are asked to accept these claims-based records and use them in the practice of medicine. I’m sure there are some payer-sponsored PHRs that are fairly accurate, but they don’t ever get much of a chance because of this perception.
That said, claims-derived PHRs can never be fully accurate representation of health status because the ICD-9 (and soon, ICD-10) billing codes are completely different than CPT diagnosis codes. Don’t believe me? Ask Dave deBronkart, aka E-Patient Dave.
DeBronkart’s story is widely known among health IT types, but he was featured Monday in the Boston Globe. That article tells something I didn’t know, that there was inaccurate data in a Google Health PHR that had suggested cancer had spread to his brain or spine, as well as a few other false alarms.
The Globe quotes many of the usual suspects, notably deBronkart’s personal physician, Danny Sands, as well as Drs. Paul Tang, David Kibbe and John Halamka. While this may not be news for those in health IT, I think this story should be required reading for anyone considering a personal health record.