There are both administrative and consumer benefits to adopting and mandating personal health information and records which in some cases could be the difference between life and death. The administrative benefits of eHR between providers and payers are all well documented, and include electronic transaction cost savings, fraud prevention, etc. The consumer’s benefits of eHR would include ease of information sharing during natural disasters and other public health emergencies, improving public safety, reducing medical errors, avoiding duplicative and unnecessary medical procedures and improving coordination of care among health care professionals.
Electronic connectivity to healthcare data is generally a more efficient and less costly means of delivering quality healthcare by providing a centralized inter-operative environment accessible to healthcare providers, payers, employers and patients.
Although adopting personal health information and records is a goal of most national and state efforts, virtually all HIE’s, community health networks, hospital systems and provider practices continue to fall short of adoption due to disparate systems, lack of vision, varying data formats, data sharing issues, etc.
The healthcare payers would deny payment for any medical claim submitted without being accompanied by an electronic attachment that sets forth: test results, finding, laboratory values, images, diagnostic codes, or does not permit immediate electronic access to said test results by the patient and properly authorized providers.
Once the use of such a process is enforced, the model below would be adopted to share or deliver the electronic health records between healthcare trading partners:
Administrative rules to establish a secure Internet based ORBIT PHR, where all eHR information for covered persons can be accessed. The ORBIT PHR will consist of participating entities, Payers, Labs, PBM, IDN etc. connected over a secure network. The ORBIT PHR core system will be consist of a Virtual MPI Search Engine, MPI Database, Health Routing Engine, Translation and most importantly the Member Sharing and Provider’s Secure Access component.
The above mandates will allow Payers to become eHR data aggregators. A payer can mine and warehouse the collected medical results from trading partners, as well as claims from their Adjudication system.
Healthcare professionals will access the ORBIT PHR portal via a secure sign on and will have the capability to request information for a given patient by Member ID, Last Name, First Name, Middle Name, Date of Birth, Gender and State of Residence.
The Electronic Health Record will be built dynamically by collecting the information from all the participating entities.
The provider can request Patient Historical or Current information for:
- medical results, X-Rays from Labs
- medical prescriptions
- diagnosis and procedures from Medical Claims
- The patient’s entire Electronic Health Record available in the network
Providers can request the information from a specific participating entity, or let the system poll all entities and build a record set with all the associated eHR information.
The eHR information can also be provided, without the PHI fields, to research firms, employers, government and approved agencies to analyze the health of a specific city, state, geographic region or the entire country. The data can be used to determine consumer health and wellness. Health patterns and risks can be identified and analyzed, and care plans can be derived for the benefit of all residents of NJ, thereby providing higher quality care at point of service and reducing total spend on healthcare. This also helps eliminate healthcare fraud, and provides a true consumer-driven healthcare model.
