Electronic medical records (EMR), which would enable health care providers to have a coded integrated health care system, could be a reality in 2016-17. According to insurers, once the framework is implemented, medical coding will be in place. This initiative would benefit insurers because they will have easier access to medical data of policy-holders and settlement of claims would be faster.
EMR would store a patient’s detailed medical history, hospital charges, health insurance details, etc. The EMR concept, mooted two years ago, aims at making available medical records of patients in an electronic format. Once these records are in place, the data would be shared with insurance companies. According to a senior insurance executive, the draft of the regulation is being finalised by the health and family welfare ministry and that the final draft would be issued soon.
According to experts, the move will help insurance companies do more effective underwriting. Currently, the customer has to declare her medical condition and most of the time the customer is not able to articulate her pre-existing diseases or conditions, which could lead to investigation at the time of claim.
General insurance firms face a lot of fraudulent claims, the most common being inflated hospital bills. In such cases, EMR would help proper authentication of medical records. While there is no clarity if all insurers will be given access to these records, the regulation is expected to mandate a written consent from the patient for accessing his or her EMR.
According to the April 2013 recommendations of the EMR Standards Committee, patients would have the privilege to restrict access to and disclosure of individually identifiable health information. According to a health insurer, EMR might have the provision to show pricing for each ailment. Given the privacy issues involved in sharing a patient’s medical data, insurers are unlikely to be given seamless access to EMR. However, the data would be made available for standard surgeries etc.