Tuesday, August 5, 2008

Electronic Health Records Really Could Be Used Against You

Ok. Set aside the fact that I have multiple sclerosis and rheumatoid arthritis for just a moment and imagine this scenario.

I apply for a new health insurance policy and I've been fairly healthy, nothing major I think. The insurance company saves time and money and checks my "health credit report" which determines my 'risk' to the insurer rather than gathering medical records from physician offices.

Since the credit report is drawn from prescription records, perhaps the fact that I've used Valtrex indicates a higher risk. Valtrex is a drug used by patients who have genital herpes. But it can also be used by patients who develop shingles. Can you tell me which of these is a chronic illness and which is not? To a computer it hardly matters.

So based on my "health credit score" insurance could be denied or assessed at a very high premium level.  But the good news is that the decision was made in on the spot.

What's not to love about that?

Yesterday Carole highlighted an article in The Washington Post.

Premium Info: Prescription Data & Health Coverage
Records Aid Insurers but Prompt Privacy Concerns

by Ellen Nakashima
Monday, August 4, 2008
Health and life insurance companies have access to a powerful new tool for evaluating whether to cover individual consumers: a health "credit report" drawn from databases containing prescription drug records on more than 200 million Americans.

Collecting and analyzing personal health information in commercial databases is a fledgling industry, but one poised to take off as the nation enters the age of electronic medical records. While lawmakers debate how best to oversee the shift to computerized records, some insurers have already begun testing systems that tap into not only prescription drug information, but also data about patients held by clinical and pathological laboratories.

Traditionally, insurance companies have judged an applicant's risk by gathering medical records from physicians' offices. But the new tools offer the advantage of being "electronic, fast and cheap," said Mark Franzen, managing director of Milliman IntelliScript, which provides consumers' personal drug profiles to insurers.

The trend holds promise for improved health care and cost savings, but privacy and consumer advocates fear it is taking place largely outside the scrutiny of federal health regulators and lawmakers.

Ingenix, a Minnesota-based health information services company that had $1.3 billion in sales last year -- and Wisconsin-based rival Milliman -- say the drug profiles are an accurate, less expensive alternative to seeking physician records, which can take months and hundreds of dollars to obtain. They note that consumers authorize the data release and that the services can save insurance companies millions of dollars and benefit consumers anxious for a decision.

"Some insurers can make a decision in the same day, or right on the spot," Franzen said. "That's the real 'value-add.' "

But the practice also illustrates how electronic data gathered for one purpose can be used and marketed for another -- often without consumers' knowledge, privacy advocates say. And they argue that although consumers sign consent forms, they effectively have to authorize the data release if they want insurance.

"As health care moves into the digital age, there are more and more companies holding vast amounts of patients' health information," said Joy Pritts, research professor at Georgetown University's Health Policy Institute. "Most people don't even know these organizations exist. Unfortunately the federal health privacy rule does not cover many of them. . . . The lack of transparency with how all of this works is disturbing."
(Note: I do not know if Valtrex specifically would increase one's "health credit score". I am simply hypothesizing.)


  1. Guess I might be in toruble. I have been prescribed a ton of meds lately. They sit in my cabinet unused (lol).

  2. The question looms: how do we fight this?

  3. Insurance seems only available really to the employed and the married (with a spouse that works)...thank goodness I've got ONE out of the two.

    Linda D. in Seattle