Google Health and claims data
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.
Neil,I think your post needs some clarification… YOu write “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” THe accuracies of PHR’s has nothing to do with the fact that ICD-9 codes and CPT codes are different. The ICD-9 (and ICD-10) are different from CPT codes clearly because one represents a diagnosis code and one represents a procedure code. THe difference between this data has nothing to do with a phr’s accuracies and even more important the differences between this data has nothing to do with the accuracy of a phr..Both data are necessary forms of data that payors need to have to provide payment to providers…And, this data should be part of the overall picture of a personal health record..the key to this data is that it must be identified as to the source so that the user/consumer and the user/physician understands where it originates and the possibilities for error. For instance, as a physician and CEO/Founder of PassportMD, we work with Medicare as part of their PHR pilot program to create phr’s using 2 years of claims data but at PassportMD we identify that source of data…just like we would identify the source if it were a doctor , or consumer or pharmacy…but the key to the success of PHR’s does not lie in excluding source rather in including all sources but with proper tags and identification as to the source so the users can interpret accordingly and even more importantly correct mistakes. The Google incident is just a small hiccup that illustrates the danger in not editing your phr…in the same way that if you received an EOB from an insurer that had the wrong data on it (incidents that happen daily)…ONe more point of clarification that needs to be emphasized to your readers as I think your blog is misleading…that is…and let me say first, I am not an insurer and have no fiduciary responsibility to an insurer, but what is key to realize is that the source of ICD 9 codes and CPT codes originates from the provider, ie the doctor selects these codes and submits them to the insurer..so if they are inaccurate aside from computer error, the inaccuracies can stem from erroneous coding..that being said this can happen and does by accident with doctors all the time, however, currently this is the best way to standardize procedure and diagnosis codes for providers and payors and this information should be part of the PHR. We have to be careful to not label PHR’s as dangerous because of mistakes in claims data over time systems will check this for accuracy …and to your point regarding health insurers…the coding of the ICD 9 and the cpt code has nothing to do with the perception by doctors of insurer corruption – that is more an issue of payment amounts based upon the codes doctors submit (but that is an entirely off subject issue too) and we dont want to let that issue be a distraction to the importance of portability of online health records.Steven M Hacker, MDCEO and FounderPassportMD, INcPassportMD.com
Point taken, Dr. Hacker. But do you really think the average primary care physician, already under a severe time crunch, is going to take additional time to open up a PHR, then differentiate between different sources of data? Perhaps some will as EMRs become more prevalent, but absent true interoperability between EMR and PHR and absent real reform in how healthcare is paid for, this will remain a predominantly academic exercise.
PCPs are very busy (plus many aren’t that computer-efficient). Perhaps the nurse will open the patient PHR and pull up all the relevant data. Joseph Kim, MD, MPHhttp://www.medicineandtechnology.com/
Or perhaps the software will know the difference between the two type of codes? Interesting how often the discussion is based on cost and efficiency vs quality and outcomes. This is the same industry that responded to the recent announcement that Kaiser Hawaii was able to cut their primary care visits by 25% by using an EMR with “oh the private doc’s can’t do that we would lose too much money”. Bottom line is that we need integrated clinical data for provider use and a PHR is really just extra information for a patient not the providers except for those with chronic conditions. As a brilliant health IT consumer advocate friend of mine often says, a PHR without an EMR is like when we had Quicken before our Banks were online and you could download them. Your bank never takes up your quicken entries and your EMR will rarely need to include patient data from your PHR (nor billing codes from I guess what we would call our Financial Health Record).
[…] clinical information because it’s all based on billing claims. (Don’t believe me? Just ask “E-Patient” Dave de Bronkart.) It is for this reason that I don’t much trust “quality” ratings based on claims […]