WellPoint, the nation's largest health insurer, announced Monday, July 17, that its 34 million members will be able to access their health records online in one of the largest private-sector efforts to move personal medical information into the digital age.
The online health records would be composed of claims data plus any other information an individual chooses to provide. To comply with federal patient privacy laws, WellPoint members must first allow the creation of an electronic record and then consent to sharing it with doctors and hospitals.
WellPoint touted the electronic health records as a key component to a new Web-based service that will be part of its core benefit package called 360-Degree Health, which provides personalized information on health care services and counseling an individual may need. Those needs are determined by a health risk assessment members fill out.
The service will be rolled out to all WellPoint members within two years and follows a similar effort begun at the end of 2005 by UnitedHealth Group to make personal health records available for the company's 25 million members.
The push to create electronic medical records for most Americans is a widely supported national goal, with President Bush having given a 10-year deadline to accomplish the task. Online medical records can reduce medical errors and avoid unnecessary procedures by communicating instantaneously with doctors about an individual's medical needs and history, which is particularly important during an emergency, advocates say.
WellPoint plans to work through some of the security logistics of connecting personal health records with hospital systems as part of a pilot program with the Greater New York Hospital Association.
"We don't take [privacy issues] lightly," says Joan Kennedy, senior vice president for WellPoint. "We want to be thorough about how we do it and make sure those security checks are in place."
But how to achieve a wholesale switch to electronic medical records remains fraught with concerns about protecting people's privacy. And without a universal health system to foot the bill, estimated to be about $150 billion, the open market has been left largely on its own to sort out the issue of who will pay for electronic medical records networks.
The WellPoint initiative serves as a counterpoint to a failed pilot program the company began several years ago to entice doctors to adopt software that would digitize their patients' medical records, says Peter Waegemann, CEO of the Medical Records Institute, an advocacy organization. Though WellPoint offered incentives, the cost was prohibitive for doctors and too few of them bought into the project, says WellPoint spokeswoman Shannon Troughton.
Currently, WellPoint is looking at the other end of the market, the patient side, to see whether online medical records can gain traction. A pilot program with employees of Xerox Corp. who were persuaded to fill out the health risk assessment in exchange for a $200 deduction on their health care premiums was well received, says Lawrence Becker, the company's director of benefits.
WellPoint has spent nearly $100 million and several years developing 360-Degree Health, but the savings generated by streamlining care, reducing redundancy and increasing patient participation could be many times that, experts say.
There are risks, of course. Some technology experts say companies who put personal medical information online are naive about the gullibility of patients to be suckered into giving away personal information to criminals, for whom each medical record is valued on the black market at $50, compared with 10 cents for a stolen résumé.
"When you have a large number of people going online for something using a Web browser as an interface, you have a lot of fraudsters," says Pam Dixon, executive director of the World Privacy Forum. "The medical sector has not taken a hit like the financial sector; they haven't learned their lessons."
Dixon, an expert on medical identity theft, could not comment specifically on the security of WellPoint's Web-based initiative.
Perhaps the biggest questions that observers are asking is whether members will consent to have their information online.
"History has shown that it's about 10 percent who take it up," says Waegemann, of the Medical Records Institute, an advocacy group. He said of the WellPoint initiative: "It's a good start, something which is to be applauded."
Technology experts have been working to create a system that draws people to the Web, where they would conduct their medical business.
"Uptake is the key word here," says Will Ross, project manager with Mendocino Informatics, a group that is working on a pilot study for the Nationwide Health Information Network, a federal initiative. "It's great to announce a project … but you don't know if your release is the next iPod or just another MP3 player."
Another issue, beyond security and whether people will consent to having online records, is whether those records are portable and easy to use. WellPoint says the records, which are translated from medical language into layman's terms, are owned by the individuals.
But a glaring technological gap, emblematic of the shortcomings of private efforts, remains. If individuals leave the insurer, they will have to download their records, print them out and bring them with them to a new insurance company or doctor.