Billing data, PHRs, and pay for performance

As reported in the Boston Globe, Beth Israel Deaconess Medical Center (BIDMC) in Boston has decided to stop sharing  administrative billing data with personal health record sites such as Google Health and Microsoft HealthVault. This came about after e-Patient Dave noticed that the data in his Google Health account –which came from BIDMC– was a mess, and suggested that Dave was in dire health, indeed. I suggest looking here, here, and here for more information on the story. This isn’t an anomalous case: pretty much anyone with a complex medical history would have a similar result.

I may well have missed it in the various articles and comments, but I haven’t seen anyone explicitly draw the link between this case and the use of the same kind of claims data for pay for performance purposes. There are analogous examples of administrative data being tied improperly to specific physicians (rather than patients). This is the basis for the Massachusetts Medical Society’s lawsuit against the Group Insurance Commission, for example.

It’s not a surprise that various organizations use billing data rather than clinical data. Providers always produce billing data, because they want to get paid. And billing data is highly structured. The problem is that the information is often inaccurate and coding for billing is not the same as coding for clinical use. The shift to electronic health records won’t solve the problem that fast, however. EHR data has plenty of problems of its own: it’s often unstructured (lots of free text), and data can be entered inaccurately even when it is structured and uses standardized terminology.

The solution is not just to throw up our hands, however. Health care is too expensive and important for that. There’s good work being done by a number of local organizations including Massachusetts Health Quality Partners,  the Massachusetts Medical Society and the Massachusetts eHealth Collaborative to improve the accuracy and usefulness of administrative and clinical data, and to find ways to use them together effectively. In an ideal world, patients, physicians, payers and technologists will combine forces for the best result.

April 21, 2009

One thought on “Billing data, PHRs, and pay for performance”

  1. The e-patient phenomenon is fascinating, and one I think doctors, billing agents, and lawmakers cannot afford to be ignorant about. Patients are going to be more and more informed of what is in their medical records, and we as billing professionals are going to have to be more accountable. Let’s hope the new committees established by the HITECH Act will provide some oversight on these issues, as well as some much needed funding for improvements.

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