The Limitations of Administrative Data

The data issue described in the Boston Globe this morning is really unrelated to Google, Microsoft, or any Personal Health Record (PHR) provider. In the US, there are two kinds of healthcare data - clinical data in Electronic Health Records (EHRs) and administrative billing data that is used by payers, researchers, and the government. Billing data is imprecise, but it is a starting point to describe the care given by a doctor or hospital. The only thing that's new in 2009 is that PHRs now enable patients to see the kind of billing data that's been used for 20 years for reimbursement, quality measurement, and population health. Blue Cross of Massachusetts and Medicare (in a few pilot states) share billing data with patients via Google Health, so this is not just a BIDMC implementation.

As a society we're likely to see increased data transparency between patients and providers, which will lead to several improvements:

1. Doctors will likely begin using more structured problem lists based on SNOMED-CT, a standardized clinical vocabulary of symptoms and conditions. This will enable their EHRs to better share data with PHRs as well as to more accurately measure quality. The Healthcare Information Technology Standards Panel (HITSP) has harmonized the national standards needed to reduce the dependency on billing data for PHRs, quality measurement, and population health.

2. Eventually, billing data will become more detailed as ICD-10 replaces ICD-9 billing codes in 2013. It will take several years for ICD-10 to be widely adopted and improve data granularity.

3. In the future, patients and doctors will work together to ensure records are up to date and accurate. It's a shared responsibility. Now that the Stimulus Bill requires doctors to make records available electronically to patients, the limitations of billing data will become more widely understood.

In the meantime, BIDMC will take the following actions to accelerate this work:

1. I'm working with the National Library of Medicine to map the most common Problem List terms used at BIDMC to SNOMED-CT, enabling BIDMC to use a clinical vocabulary and not just a billing vocabulary.

2. I'm working with Google to evaluate the impact of sending our existing free text problem lists instead of billing codes. It will reduce the number of features available to patients, since Google's educational materials are based on billing codes, but it may be more informative to patients to see the text their clinician wrote, not the diagnosis on the bill. Showing problem lists is what we've done in Patientsite for 10 years.

3. We'll hold a conference call with e-Patient Dave, his doctor, Google, and me to review Dave's clinical and administrative data (with his permission), to capture a real world example of the differences between these data sources.