n 2004, data storage company EMC became one of the first companies to provide electronic personal health records to employees. The goal was to inspire them to actively manage their health and health care costs.
"Consumers drive adoption and consumers drive change. That's been one of our operating philosophies," says Delia Vetter, senior director of benefits for EMC. "When the doctor is sifting through 12 inches of paper, patients will start to question that: ‘Why aren't you electronic?' "
Despite EMC's vision, the country's health care system remains decidedly analog. Only one in five doctors use electronic medical records. The rest harbor cabinets full of color-coded manila folders, each file an island of personal health information.
Still, the conversation has started to shift. Employers are slowly embracing the idea that online personal health records can provide targeted information that helps employees manage their health. Employers and health care providers also are far enough into the experiment to have settled on nomenclature: "Personal health record" refers to the central medical record used by the patient; the digital version of a patient's record on file at the doctor's office is the "electronic medical record."
The employers' early work so far offers a taste of how the federal government's $19 billion investment in health information technology could change the way companies control their health care costs.
Much work to be done
Of the $19 billion in health IT funding in the $787 billion stimulus package signed in February, $17 billion will go toward helping medical providers switch to digital record keeping, with $2 billion to be invested in creating a network that will allow medical providers to share those records. It may not be enough for wholesale change, but it's a definite down payment, health care experts say.
"It sounds like a lot of money, but the work that needs to be done is significant," says M. Eric Johnson, director of the Glassmeyer/McNamee Center for Digital Studies at Dartmouth's Tuck School of Business.
Because of the health system's fragmentation and the steep investment required for medical providers to make their paper records electronic, it will take "years and years and years of work," Johnson says, to create a fully integrated health information system—perhaps as long as two decades. The eventual goal is to have all health care information digitized and accessible online for patients, who can give access to that information to anyone they want: doctors, other medical providers, caregivers and family members, for example.
Total savings to the health care system—and for the employers that pay for it—are hard to measure, but are expected to be significant.
Personal health records that are electronic and connected to a patient's medical providers could save about $19 billion annually in the form of reduced redundancy and errors that stem from poor decision making, says the Center for Information Technology Leadership. Payers of health care would accrue most of the savings. If personal health records are not connected to doctors, pharmacies, labs and hospitals, however, the investment could add to the overall cost of health care, the center says.
Those savings, though, could take a while to trickle down. The Congressional Budget Office says the health IT investments in the stimulus package would reduce the country's annual health care spending by 0.3 percent annually over the next 10 years. In 2008, the health IT portion of the $2 trillion spent on health care was $6 billion.
"Employers are going to benefit because employees are going to have better care, less redundancy and less waste," says J.D. Kleinke, a medical economist based in Portland, Oregon.
Key to the success of personal health records, however, is that electronic record keeping improves patients' health and reduces costs.
While estimates suggest it will cut costs, examples exist of electronic records that have harmed patients. Just as records can prevent duplicate prescriptions or mistakes that occur when a doctor's handwriting is illegible, other mistakes can occur, and indeed get amplified, when incorrect data is entered into a record that is linked across the medical system.
Early start
A growing number of employers, meanwhile, aren't waiting for a nationwide system to be built.
In 2006, five large employers—Wal-Mart, Intel, Pitney Bowes, BP and Applied Materials—launched Dossia, an organization that has developed technology to collect digital health data from the various places where it's already stored. So far the group has tapped into pharmacy and drug claims and plans to use data from on-site heath clinics, labs and doctors.
The number of applications that help consumers store and track their personal health care data has also grown, with the most notable arrivals being Microsoft HealthVault, launched in 2007, and Google Health, which came out in May 2008.
WebMD, based in New York, now provides personal health records to more than 100 employers, including Verizon, John Deere and Pepsi, says Philip Marshall, vice president for product strategy at WebMD. The first company to sign up was EMC.
Employers are tailoring the technology to fit their benefits and wellness programs. IBM gives its employees a card they can use during emergencies so that doctors can access their health records. For employees able to have pharmacy claims data imported into their personal health records, software can alert them to possible adverse drug interactions. Other companies have added applications that provide feedback on ongoing health conditions, such as high blood pressure, offering suggestions on how patients can better manage their conditions.
Dell is tying WebMD's personal health record system to the records kept at its online health clinic. It's a preview of how the system might one day work with all doctors. Notes made by a doctor in that patient's electronic medical record are designed to sync with the personal health record, so the patient can have the benefit of the doctor's insight.
In free personal health records provided by Microsoft and others, patients must manually input their personal health information. That is beginning to change. Google Health patients can now import claims data from certain providers, such as lab company Quest Diagnostics and pharmacy benefit manager Medco. Employers are using their leverage as payers to demand that medical and pharmacy claims data and lab results automatically populate personal health records they provide.
Meanwhile, the health records can give people feedback on their conditions and make suggestions on what they should do to better take care of their health and save money. Patients can make informed health care decisions, avoid redundant tests and avert adverse drug reactions.
As Jay Sanders, president and CEO of the Global Telemedicine Group in McLean, Virginia, put it recently: "Patients need to be their own primary care provider." While the promise of technology's ability to provide a patient with evidence-based feedback on their health status, some research has shown that doctors are less receptive to computerized care suggestions. In a 2005 study in the Health Services Research Journal, researchers concluded that computer-generated care suggestions "had no effect on the delivery or outcomes of care for patients" with asthma.
But companies like EMC believe patients may be amenable to care suggestions even if their doctors are not.
‘Eye-opener' for consumer
Laura Burns, a communications manager with EMC, uses a personal health record portal to track her family's health and health care costs. By looking at her husband's record, for example, she learned that there were lower-cost generics available for the asthma drugs he used.
Burns also uses the portal to manage her high cholesterol. Every time she gets blood work done, she puts the results into her personal health record; the lab results soon flow into her record, according to EMC. Her personal health record interprets the numbers for her. She can also track whether her cholesterol level is improving and what changes she can make if it's not.
"I just feel it's been an eye-opener to all the costs associated with health care," Burns says. "It makes me feel I've got a handle on things I wouldn't normally think I can control."
EMC is also using other technology to improve its employees' health. Over the past two years, 400 employees have volunteered to take their blood pressure three times a week, using special blood pressure cuffs that plug into a computer. The information automatically populates their personal health records, allowing patients to track the changes. Personal health records can provide patients feedback on what they can do to improve their blood pressure.
Some of Burns' colleagues worry that their employer may be able to access their health records, but both EMC and WebMD say that is not the case. Patients control their personal health records and it's up to them to give access to others—such as a doctor or spouse. Information that EMC has about its employees' health overall comes from the pooling of anonymous health claims data. The large sets of data help paint a portrait of employee health.
Closing the loop
Burns, for her part, is less worried about company snooping than about suffering a heart attack and ending up in an emergency room where the doctors are unable to access her medical history.
Kleinke, the Oregon medical economist, is also concerned about that. The patient's personal health record has to be integrated with a doctor's or hospital's electronic medical record, he says. Part of the problem with the personal health record industry, he says, "is that it's a cul-de-sac; it doesn't connect with anything." The personal health record "has to find a way to hook into the electronic medical record," Kleinke says.
Eventually, a nationwide electronic health network would close those gaps. Until then, Dossia is trying to help solve some of the connectivity problems. Last year, Wal-Mart became the first of the group's member companies to offer personal health records to its employees. The remaining founders are expected to put the records in place this year, Dossia president Colin Evans says.
Dossia works by collecting data from the various places where it is already stored, Evans says. It then plugs that data into a personal health record portal provided by companies such as WebMD, San Diego-based Medikeeper and CapMed of Waltham, Massachusetts. Evans envisions a day in the near future when Dossia's data-assembling capabilities can plug into many other applications, such as those found on iPhones, to help people manage their diabetes or maintain an exercise regime.
Like EMC, Dossia is developing ways to connect disease management tools such as home glucose-measuring devices to computers and, ultimately, to health records. Employers that have invested in personal health records hope the technology will inspire more people to get involved in managing their health. But their ability to do so will be limited until the personal health records can sync with the electronic medical records that the stimulus package will help place in doctors' offices and hospitals.
"Bringing doctors online," says WebMD's Marshall, "helps employers close the loop."
Workforce Management, April 6, 2009, p. 23
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