Claims data in PHRs

Today the Boston Globe has published an article about Dave deBronkart’s problem with claim data in his Google Health PHR. I think it is awesome that the main stream press is picking up on the problem of using billing data for clinical work!

A little digging reveals that there is an much better post over at that details exactly what his experience is.

I have been aware of this problem for some time. For me it all started when CVS Minuteclinic imported a ‘condition’ of ‘Blood Pressure Screening’ as  ‘Active’ condition onto my record.

Why did they do this? Because their system must have an ICD code for the purposes of billing for my procedure, even though I payed in cash.

One of the best things about being deeply involved in both FOSS Health IT and a blogger, is that when something hits the main stream press, I get to prove that ‘I told you so’ with reference to posts that are months or even years old. Heck, I bet that ‘I told you so’ feelings are a full 25% of my motivation to blog! That puts it way ahead of ‘joy of shameless self promotion’ and ‘muuust raaannt’ as motivation components!

The problem here is that the current diagnosis onotology system in the United States is based on billing data. With the migration to ICD 10, this problem will only get worse. Most doctors do not really understand how to use ICD 9, and ICD 10 is muuuch bigger.

I got wind of this article from the Modern Healthcare Health IT Strategist.


Two standards approved for pharmacy billing

          For those who do not follow ancient history (more than 2 years on the Internet) of the Free and Open Source health software movement, I got my start with FreeB, which was the first GPL medical billing engine. It was designed to help address the medical bill formatting problem. If you are not sure what that means then you should read the interview I gave to LinuxMedNews called Fred Trotter on Medical Billing, much of it is still relevant.

So I got started with medical billing and I am still interested in it.

Joseph Conn (a reporter to follow if you are interested in Health IT) has just written an article detailing how HHS (who sets the billing standards in the U.S.) will allow two different standards for certain pharmacy billing systems.  This is the kind of thing that give me headaches, even though it is unlikely that I will need to support the new standards.

Part of the problem is that X12 is an old-school EDI transfer standard. It is hardly human readable, and it is pretty intimidating for the end-user. Much better would be an xml-based system.