Aetna electronically alerts physicians about care needs

Real-time alerts will show when it's time for a test or if patient is allergic to prescribed drug

Consumers have long been signing up to be electronically alerted when their airline flights are delayed or their bank accounts dip too low. So it may seem perplexing that a major health insurance company is just now announcing plans to start alerting doctors when claims data shows that it is time to conduct a certain test or that a patient is allergic to a prescribed drug.

But because the health care industry has lagged behind other industries in using IT technologies, most patient records are not yet fully automated.

Today, Aetna Inc. announced a new initiative that will send electronic alerts -- called Care Considerations -- to 320,000 of its member physicians. Aetna said that information on some 14 million patients can be sent to their physicians through a portal used by the insurer to distribute eligibility information.

For example, if a diabetic patient hasn't had a required eye or foot exam, an alert will be sent through the portal. Or an alert will be automatically generated if claims data shows that a patient has been prescribed a drug that he or she is allergic to.

The new effort, which uses portal and alerting technology called NaviNet from NaviMedix Inc., analyzes claims data using an analytic engine Aetna developed and put into place last year as part of a program to let its members access their health records. That analytic engine compares actual claims data with clinical guidelines that suggest certain care routes (like routine tests) for patients with specific conditions.

When a discrepancy is discovered, an alert is sent to physicians via fax, e-mail or telephone, noted Chere Parton, head of provider e-solutions at Aetna. By alerting physicians through Aetna's portal -- which many doctors routinely use to verify patient coverage -- they may learn more quickly about care considerations, she added.

Aetna began alerting physicians in the portal several weeks ago.

"We wanted to introduce this important clinical information while they were already doing something that was important to their practice and get it to them in a faster, more efficient way," Parton said. "Physicians make the best decisions they can based on the information available to them. It is hard to keep up with every evidence-based clinical guideline available. This is a way of giving them critical information in a very fast and efficient way that will help them eventually reduce medical errors and potentially improve patient safety."

For patients, it is often difficult to remember and provide all pieces of medical history to doctors, Parton said. "[Now] they don't have to worry about bringing their full medical histories to different physicians they have seen. Aetna is going to package that up for them and make it available for their physicians."

The ongoing quest to make patient health records electronic has often been hampered by the unwillingness of physicians and hospitals to undertake the cost and effort needed to automate their own patient records.

Health care providers often say that insurers are better suited to maintain and mine electronic patient records because claims data is often the best way to compile the most comprehensive patient history. The insurers' data includes information from multiple physicians who have seen a patient. In addition, some providers argue that insurers will reap more financial gains from electronic health records by cutting down on duplicate tests and proactively treating chronic diseases.

Even with the new alerting system in place, Aetna will still also send the information via telephone, fax and e-mail -- especially for extremely urgent issues, Parton added. But the new method will likely be quicker and won't include a paper file that could be lost, Aetna added. In addition, the secure Web site will help ensure that personal data isn't stolen.

The portal will also allow physicians to provide instant feedback to alerts.

Copyright © 2008 IDG Communications, Inc.

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