Health Information Management

There has been major emphasis over the last decade in the WC industry, and indeed in healthcare in general, on hospitalizations, pharmaceutical spend, and diagnostic testing. Naturally, this has taken shape because of the amount of dollars spent in each of these areas. The old aphorism of “follow the money” definitely applies in this case.

Medical management has been sadly lacking in some if not many cases due to the paucity of electronic health records (EHR) that are available to each treating and consulting physician involved in the claims. Without being able to review past medical records from a secure data warehouse, current diagnosing and treating physicians are often in an inferior position when attempting to formulate a proper regimen of treatment. Of course, we have all heard of instances when different treating physicians on the same claim prescribe pharmaceuticals that have an adverse drug-to-drug interaction, due to not knowing what other prescriptions the injured person is already ingesting. This is another by-product of a lack of EHR.  

Clearly, a modicum of medical record information management must be considered somewhat of a basic requirement for an efficient healthcare delivery system. Yet it is sadly lacking not only in WC, but in general in this country. It's not that a clarion call hasn't been sounded, but the infrastructure hasn't been built as yet to allow the objective to be attained. On top of that there are issues over system security, data integrity, access and retrieval ease, etc. 

The cognizance of the importance of having and managing digital medical records as part of critical information management to improve treatment patterns is filtering through the healthcare industry. Information management tools can assist in determining outcomes of treatment and financial consequences of medical decisions at certain points in the treatment pattern of each claim.  With the Supreme Court largely upholding the Affordable Care Act, electronic data storage of medical records that are available to treating physicians is even more a of national concern.

Ideally, access to EHR for each patient will result in improvements in the quality of care through more timely and accurate diagnoses, with an overall anticipated consequence of improved financial performance. I do not think anyone will argue with the goal of improved medical outcomes that should result from formulating efficient health information management. 

WC cannot be an “outlier” in this arena. Although comprising approximately 3% of the national healthcare spend, it is a costly area to employers that must be subject to modernization in the way medical records are stored and available for review. It would be nice to witness WC leading the charge here, instead of being dragged along. But I'm certainly not expecting that to occur. Innovation and WC seem to go together like fish and bicycles.

About the Author:

John D'Alusio has over 30 years experience in P/C insurance with executive management positions in administration, field operations, and claim technical areas. Mr. D'Alusio has had many articles published in industry periodicals, and is also a contributing author to the LexisNexis published, “Complete Guide to Medicare Secondary Payer Compliance.”  He writes a monthly column for Risk & Insurance Magazine and is a quarterly columnist for AMComp Magazine.

His Risk & Insurance column is located at:
http://www.riskandinsurance.com/workerscomp.jsp

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