It's Not Only Medical Records - Add Prescription Records to the Mix

Washington Post reporter Ellen Nakashima recently wrote an article on healthcare databases being used to develop a "health credit report". It appears that insurance companies to help improve health care and reduce costs can use prescription drug databases containing over 200 million records. 

Instead of using physician medical records, drug profiles are considered more accurate, less expensive, and quicker to obtain. This practice demonstrates the use of electronic data obtained for one purpose, then used and marketed for quite another. Is such a practice protected by the federal health privacy rules? Does it border on accepted – non-accepted practice? 

Here's what is occurring: companies Ingenix and Milliman construct patient profiles using prescription drug databases to retrieve prescription drug histories. Insurance companies may then make an on-line query on a patient. The database is searched and returns aggregated data going back as far as t years and includes information such as dosages, dates filled, therapeutic class and prescribing physician. This data is massaged to produce a "pharmacy risk score." High scores suggest higher medical costs. 

According to report Nakashima, such profiles cost about $15/search. One company gets approximately 1 million queries from insurers each year. Sounds like a very lucrative business! 

Questions for MSPs to consider: How will this affect a hospital's pharmacy? How does this affect the confidentiality of patient health information? 

Carole La Pine, MSA, CPMSM, CPCS