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Why This Health Insurer Wants Instant Alerts From The ER

Why one health insurer wants to make sure doctors are instantly notified when a patient is in the emergency room.

Why This Health Insurer Wants Instant Alerts From The ER
[Photo: Flickr user Camilo Rueda López]

When one of the more than 8,000 clients signed up with Brooklyn Health Home–an organization that connects consenting Medicaid patients with HIV, diabetes, serious mental illness, and other conditions to medical care–goes to the emergency room, something unusual happens: A dashboard ping is instantly sent to the patient’s primary physician, letting the doctor know their patient has been hospitalized. Now an insurance company called Oscar has begun receiving the alerts as well; it’s one of the first systems in the United States that lets an insurer instantly know when a patient has been hospitalized. Oscar and another insurer, Emblem Health, both receive information from Healthix.

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The technology, provided by an organization called Healthix that maintains clinical records for more than 7.5 million patients in and around New York city, is designed to get patient information from primary care professionals and caregivers into the hands of emergency room doctors more quickly. It also sends notification if patients have been jailed (Rikers Island, it seems, also keeps electronic medical records and is part of the network that participates in this alert system).

Mario Schlosser, Oscar’s co-CEO, told Fast Company that patients are asked to consent to Healthix alerts during signups. Pings are then sent via an internal dashboard to the insurer and, specifically, to their in-house medical staff. Schlosser gave the example of nurses being able to relay information to the emergency room about patients who are pregnant or have diabetes.

Schlosser also claims that the alerts will reduce the likelihood of unnecessary out-of-network surgeries. “In some cases, this changes things substantially,” Schlosser added. “When one of our members broke his ankle and was sent to the emergency room, the ER scheduled him for an out-of-network surgery because of a paperwork mixup. This would have caused a more than $10,000 cost for the member for out-of-network surgery, but Healthix’s notification helped us to negotiate the surgery in real time, and the connectivity led to treatment in-network.”

While Healthix is one of a number of organizations called health information exchanges that offer similar real-time alerts, the Healthix notifications appear to be one of the most robust systems operational in the United States. According to industry academic journals, Healthix’s notifications are among the only ones that push SMS text messages and emails to care providers when patients are hospitalized or jailed.

But one of the big challenges for these alerts are the technical and legal limits of what they can provide. A series of regulations called HIPAA sharply control which pieces of patient information can and can’t be placed in a normal, unsecure text message or email. This means that while doctors and nurses can receive emails telling them they have a new alert on their dashboard, they can’t actually see what the alert contains without logging in.

More importantly, there’s no standard electronic health record format used in the United States. Depending on the hospital or doctor’s office, the vendor they use, and the other health systems they interact with, one of hundreds of data formats could be used. These formats don’t play well with each other, and often cause serious compatibility issues. For instance, recipients of the Healthix alerts only find out if a patient has been hospitalized in New York City (with the exception of the Bronx) or in Long Island. Hospitals in the Bronx and nearby New Jersey use a different format; if a patient is hospitalized just a PATH train stop away in Hoboken, Healthix can’t do anything about it.

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Nonetheless, the alerts are an example of what we can expect in coming years. While the primary use for systems like Healthix is to help relay urgent information about patients with serious, long-term conditions, they also have wide ramifications for the public at large. Oscar might be one of the first, but expect other health insurers to follow suit in the future.

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