Marriott E-Health Record System Spots Medical MishapsMarriott E-Health Record System Spots Medical Mishaps

As health care costs have soared annually in recent years, more employers are providing electronic tools to encourage workers to keep better tabs on their health issues in hopes of reining in costs.

This month, Marriott joined a growing legion of companies providing electronic personal health records to their employees.

But unlike some of the personal health records offerings being rolled out by other employers, the system deployed at Marriott also taps into a sophisticated clinical rules engine that looks to avert potential medical mistakes or gaps in care that could lead to serious complications and costs.

When those gaps or potential mistakes are identified by the system, doctors are alerted by phone, fax, or letter with a "care consideration" notification that might recommend the doctor prescribe a different treatment, order additional tests, or make another change to the patient's care. The member employee -- or patient -- is also alerted.

Marriott rolled out to 50,000 workers nationwide access to a Web-based personal health record system from ActiveHealth Management after piloting the system with a smaller group of users a few months ago. Those pilot users were nurses who work at Marriott's largest hotels. "They loved it," says Jill Berger, Marriott VP of health and wellness.

ActiveHealth members go online and fill out a health risk assessment, answering questions such as whether they smoke, as well as other information about their medical history. This data becomes part of the person's personal health record and is combined with data ActiveHealth collects from other sources.

Launched in 1998, ActiveHealth was acquired by Aetna in 2005 and is run as a standalone company, says ActiveHealth CEO Lonny Reisman.

ActiveHealth's CareEngine system analyzes patients' data -- including medical and pharmacy claims data and lab results -- and compares it with thousands of evidence-based clinical rules, metrics, and algorithms. ActiveHealth has a staff of 20 full-time physicians "who comb through medical literature and journals" to keep the CareEngine databases up to date with new findings and guidelines, says Reisman, a cardiologist and architect of the ActiveHealth CareEngine system.

All new patient data is analyzed against the clinical rules and responded to instantaneously, as it is collected, says Reisman.

So, for instance, if the system spots a patient who indicates in his PHR that he's taking St. John's Wort -- a nonprescription herbal supplement -- and also finds claims data that the patient is being treated for kidney disease and is taking other prescription medications in preparation for a kidney transplant, the system would kick off an alert to the doctor. The physician -- and then the patient -- would be notified that the combination of drugs and St. John's Wort could increase the chances of a new kidney being rejected, he says.

It's these types of potential medical mistakes that the system is trying to alert physicians and patient about, as well as helping guide patients about staying healthier as they deal with other chronic diseases such as diabetes or high blood pressure, Reisman says.

For Marriott employees, the system will provide members with links such as information about chronic illnesses, says Berger. Members also have access to live health coaches to help manage their chronic conditions.

Marriott also is developing an incentive plan to encourage employees to complete a risk assessment online and input information into their personal health record, says Berger. "Our goal," Berger says, "is to get our associates to take a more active role in their health." Aetna offers the ActiveHealth service to members of its health insurance plans. However, the service also is offered through other non-Aetna health plans. More than half of the 18 million members using ActiveHealth are covered by other health insurance companies, Reisman says. Those 18 million members are employees of more than 100 different companies, including Marriott, he says.

Employers don't get an individual's information, just aggregate data showing, for instance, a high percentage of workers have high BMIs or blood sugar levels. This information could help propel the employer to make it easier for workers to drop bad habits in favor of good ones, says Reisman, including "shutting down the fast food" sold in company cafeterias and "buying some treadmills" for workers to use on lunch break, he says.

The problem ActiveHealth was created to address and solve is that there are tens of thousands of people in the United States who die each year due to medical errors. Evidence-based medicine can help, but the health care system is fragmented -- there are so many different kinds of health care data, doctors, pharmacies, hospitals, and so forth.

"The access we have to medical information is broader than most doctors have," says Reisman. ActiveHealth has "codifed" thousands of clinical standards and evidence-based best practices.

If it's an urgent issue that's identified by the CareEngine, ActiveHealth personnel will call the doctor directly. Less urgent situations involve certified letter. Also, electronic messages can be sent to the electronic medical record. Members or patients also receive a letter or an e-mail instructing them to check their PHRs for an alert, usually after the doctor has been notified.

Dr. James King, who was recently named president of the American Academy of Family Physicians, an organization that represents nearly 94,000 family physicians, residents, and medical students, says he welcomes information that helps him provide better care for his patients.

Right now, he says, he currently receives alerts from some of his patient's insurers, especially when those companies are interested in changing a patient's prescription drug from a name brand to less expensive generic, he says.

"I'm a firm believer that all the information I get on my patients, I'm better off and so are my patients," he says. However, insurance companies and other third parties also need to be careful in "setting parameters" about the type of alerts they send and how often they're sent, so that they don't run the risk of being ignored. "We don't want to be overwhelmed," he says.

Also, King suggests that patients receive the alerts even before the doctor is notified. "Patients need to be responsible for their health," he says.

Occasionally, King has received alerts from insurers about patients he hasn't even met or treated, he says. When incidents like that happen, "it opens a Pandora's box," about liability he says, another reason why patients should be the first alerted to suggestions about alternative treatments, additional tests, or other concerns.