Editor's letter: Record, record on the wall

Many large health care organizations have adopted electronic recordkeeping to maintain information coherence. But are these truly health records?

The ingenuity – and boldness – of the health information technology industry is amazing. In this issue of Government Health IT, we look at so-called claims-based health records. These are essentially virtual health records, derived by sophisticated databases from insurance claims, prescription orders, lab test results and other health care documentation that normally flow between payers and providers and patients.

Many large health care organizations, such as regional health information organizations, health information exchanges and government organizations, have begun to adopt this form of electronic recordkeeping as a way to maintain some information coherence across their large, increasingly segmented, business domains.

But are these truly health records? What are they best used for? Would you want to rely on one if you were on a gurney rolling toward surgery?

There is a lively debate going on about these questions, as our cover story this month by senior writer Nancy Ferris points out.

For one thing, a claims-based record is a piecemeal report, filtered by the financial customs and requirements of payer organizations, insurance companies, government agencies and the like. Although it might reflect the clinical experience, a claims-based record would normally lack the nuanced observational data residing behind treatment codes and other payer-based metadata.

To be fair, most user organizations and providers of claims-based record systems say they are not intended to substitute clinical records. Instead, they say, claims-based records are a type of decision-support tool, which we explore in our technology briefing. They can come in handy, for instance, to remind physicians that a patient is due for a test or is not supposed to take a medication.

We touch on yet another model for the electronic health record in this issue. America Online founder Steve Case is putting his blood, sweat and bankroll behind Revolution Health, an interactive personal health Web portal. Revolution Health is set up to encourage consumers to create their own personal or family health record, a repository where health-related reference materials, queries, and messages for the whole family can be kept.

Is this a revolutionary health record? Not in a clinical sense, but the American Academy of Family Physicians has endorsed the general approach.

What these examples show is that the health IT industry will generate an endless number of innovative ways to render health records. And the market will ultimately decide the value of these approaches to the health consumer. In the meantime, it will be important for companies and entrepreneurs looking for opportunities in health care to be as clear as possible in all their claims about claims-based records.

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