Next month, the Hartford, Conn.-based insurer will begin offering the Aetna Care Engine Powered Personal Health Record (PHR) to 1 million of its clients. The remaining 14 million members will be able to access the PHR during the second quarter of the year.
In addition to allowing patients online access to health care information obtained from Aetna's claims, the PHR also will allow users to update records with their own submissions, such as blood pressure readings taken at home.
An analytic engine developed by Aetna subsidiary ActiveHealth Management Inc. will analyze daily the information in the PHR and notify a patient if anything in the data falls out of line with commonly accepted best practices, said Robert Heyl, architect manager of Aetna's E-Health business unit. For example, he said, if a physician prescribes a medication that would have an adverse reaction with medicine prescribed by another doctor, a patient would be called and e-mailed about the potential problem.
Electronic health records are increasingly being adopted by insurers and large employers as a way to reduce duplicate testing, medical errors and other problems that can lead to higher health care costs. The records allow consumers to share their data with health care providers rather than depend on fragmented health history data maintained by multiple physicians and hospitals. Aetna was among thousands of insurance companies with a total of 200 million customers that support for a common set of standards for creating and managing electronic health records.
Aetna will feed claims data to ActiveHealth through Web services messages, Heyl said. ActiveHealth will use its Care Engine analytic software to compare that data to a large set of rules developed by physicians for 30 different medical conditions, he added. ActiveHealth also adds data from laboratories and pharmacies to the PHR.
'[The Care Engine] will look at individual records for evidence across multiple data points to allow it to create a statistically valid conclusion,' Heyl said. 'Whatever conclusions are made, whatever your health status is, [it] gets summarized into a PHR.'
The online component that allows members access to the PHR is a Microsoft .Net-based application that uses Web services to transmit information between the online interface and ActiveHealth's databases, Heyl said. While the PHR data will be stored on a Microsoft SQL Server database, ActiveHealth is moving the CareEngine from SQL to run on an Oracle database to add advanced analytics, he said.
Although the PHR application is built in .Net, Aetna wanted to incorporate some of the patient data from the PHR into various internal Java applications -- such as call center and disease management applications -- that use IBM's WebSphere middleware. 'We've placed an intermediary between the Java and .Net interactions that works on XML to make sure ... we remove any kind of .Net-skewed XML data types or Java-skewed data types,' Heyl said.
While Aetna considered using an enterprise service bus (ESB) as the intermediary to do the transformation needed for the applications to interoperate, it opted to write its own custom code for that job because of concerns that an ESB might not provide the scalability needed for the PHR, he said.
The biggest challenge that Aetna has encountered in building the PHR is managing individual patient identities and the credentials used to authenticate identity, Heyl said. The insurer is using industry standards related to federated identity management along with IBM's Tivoli software and Microsoft's Active Directory for identity management.
However, Heyl noted that as patients change jobs and doctors, 'making sure that you maintain a line of sight of that individual ... across all those changes and making sure you can tie it to one record presents an ongoing challenge. This is highly sensitive data, and we want to be very crisp on our identity management.'