The hotel chain is using a Web-based personal health record system from ActiveHealth Management, which is owned by insurance company Aetna. Members fill out a medical history plus a health-risk assessment that includes questions such as, "Do you smoke?" ActiveHealth uses its rules engine to compare that patient data, plus medical and pharmacy claims data and lab results, with clinical rules and metrics.
The company has 20 full-time physicians tracking medical literature to keep the databases behind the rules engine up to date, says ActiveHealth CEO Lonny Reisman, a cardiologist. So, if a patient says he's taking the herbal supplement St. John's Wort and claims data shows that he's taking prescription medications in preparation for a kidney transplant, the system should alert his doctor that the combination increases the chances of organ rejection. Alerts to doctors come by phone, fax, or letter, depending on the urgency, and members usually are notified after the doctor.
BEWARE OF DOCTOR OVERLOAD
For such systems to work, they need to reach the right conclusions and gain the trust of employees--and the doctors who get the alerts.
Doctors worry about being overrun with alerts, says Dr. James King, president of the American Academy of Family Physicians. Without parameters around the number and types of alerts sent, urgent ones could be missed. King already receives alerts from some patients' insurers, often about changing a prescription drug from a name brand to a less-expensive generic.
King says he's received alerts from insurers about patients he hasn't even met or treated, which he warns "opens a Pandora's box" about liability. Still, King supports such efforts, believing more information will help him do his job. However, he'd like to see patients get alerts even before their doctors. "Patients need to be responsible for their health," he says.
Marriott tested the system a few months ago with a small group of the toughest critics of e-records systems--nurses, which the company has on staff at its largest hotels. Having won them over, says Jill Berger, Marriott's VP of health and wellness, now the company's developing incentives to encourage employees to complete online risk assessments and input information into their personal health records. Then the system will link to information about chronic illnesses, plus give access to live health coaches to help people manage their chronic conditions. "Our goal is to get our associates to take a more active role in their health," says Berger.
One employee concern is patient privacy. As a Web-based service, health data resides with ActiveHealth, not the employer. Employers get access to aggregate data showing, for instance, high blood-sugar levels. Launched in 1998, ActiveHealth was acquired by Aetna in 2005 and is run as a standalone company, with 18 million members from more than 100 companies, about half of which are Aetna insurance customers.
Companies and their IT teams are struggling with the right way to get involved in employee health. Wal-Mart is part of coalition of employers adapting an online health record system that will be run as an independent entity, but it's been a stop-and-start effort that's still in the pilot stage. Others offer employees online records through independent services such as WebMD. It's hard going, but the lesson from more and more companies is that it's time to try something.