Busting 5 Electronic Health Record (EHR) Myths for Life Insurance
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Even though electronic health record (EHR) adoption has skyrocketed in the past several years, there’s still a lot of noise in the life insurance industry surrounding EHRs. So I sat down with a seasoned underwriting expert who has worked on numerous consulting projects with leading carriers to bust some myths related to using EHRs.
Nichole Myers works at Swiss Re, a leading reinsurer in the industry, and was the founding member of the underwriting innovation team tasked with being the voice of the market for the organization and pulling organizational capabilities together to enable success for carrier partners. Nichole’s focus is around strategic consulting around underwriting innovation, and is often centered around custom consulting engagements that help carriers solve specific problems, whether that be "process" or "new distribution" or bringing in a new data source. As a result, she has accumulated a lot of knowledge and real world experience working with EHR data and helping carriers implement and scale EHRs across the organization.
Our conversation revolved around busting 5 popular EHR myths in the industry, to help companies realize the promise of innovation faster. Here are the key takeaways from our discussion where we got real about the state of EHRs to clear up the noise.
How have you seen EHRs evolve over the last few years to today? A where do you see it going tomorrow?
“Electronic health record (EHR) use in the insurance space is still relatively new. In the span of insurance, if you measure it against the total timeline of how long underwriting has been around, it’s really new. It's run up in the last couple of years. I remember a lot of these initial contracts being signed and products being launched in the space, and I remember hearing about "Human API" for the very first time then, and realizing that we were kind of really on the cusp of bringing in access to a new digital clinical data source like EHRs. It can make it really hard if you're a leader out there in life insurance or a key stakeholder on the business side or the distribution side to know what's real, and what's not real.
If you go back to 2008, the use of EHRs by our physician and our medical community at large was very small - around 8% of hospitals even have coverage. And now, we have more than 90% in terms of coverage. Remembering that this data source wasn't originally created for life insurance underwriting is an extremely important thing to continue to center back to. But in the last few years we've gone from essentially zero to a thousand in terms of coverage. And companies are rapidly bringing this EHR data source in and starting to think really critically about the way that we underwrite the requirements that we order. It's considered the gold standard to use attending physician statements (APS), which is that kind of hand curated physicians records in underwriting. Unfortunately underwriting with the APS is a process that is just not conducive to a great customer experience. It’s still a necessity, it won't go away entirely. But EHRs have really allowed us to do things better and faster through digitization.”
Myth #1 - “EHRs just simply aren’t there yet.”
“The first myth we come across a lot is that EHR just simply isn't there yet. That the connection rate isn't there and that the quality of the data that's coming through isn't there. I remember when the first Epic contract was signed and the dirty secret was that there actually was a 0% error rate, right? There was no one in the box yet, nobody had signed up for it, and that work had to be done. Well, the work has been done.
EHRs have progressed so dramatically and so quickly, that this myth just needs to be busted. We need to pack it up and move on. The connection rates are great. The data is flowing through, and we know that it's quality data. It's a matter of us getting usability but we can affect that by mining it for what we need. The usability is already there, and whether that's an HIE (health information exchange), patient portals, or EHR networks.”
When EHRs first were being adopted a few years ago, and no one had truly bought in yet, perhaps this made sense. There was a lot of uncertainty around the data source. But now adoption is higher than ever and the data flowing through is of high quality. The industry has come far in just a few short years. EHRs are here, and fully ready for use.
Myth #2 - “We have to have a retro study or we have to perform some sort of pilot in order to go forward with EHRs.”
“I want to be super clear about this one. I'm not disparaging the power of retro study, and I am not being insensitive to the fact that we all have processes internally, in terms of proving out business cases. I'm not saying either of those things. I'm just saying that if you're going to do a "retro" specifically, what you're going to get is a snapshot in time. And because EHRs on the whole are evolving so quickly in terms of coverage, you're immediately going to have results that are not accurate, so coverage tomorrow actually isn't what coverage looks like today because it's literally growing day by day. The piece around piloting and these retros, they become a roadblock along the way. It’s easy to end up in analysis-paralysis mode and be stuck. Maybe we don't get that high bar that we set for ourselves in the pilot, or we feel a little uncomfortable with what we saw, and so we stay in the status quo.
It’s time to bust this myth to get into production, to start clicking into "learning mode". We have to get past this. I think once the connection rate question was really answered for us (and it has been answered for quite some time), this myth needed to go along with it. The early mindset that we have to be "retro" and we have to pilot is based on that fear that there was nothing in the EHR box. Because of restraints around capacity and with our IT teams in our business and all these things, we have to put this to the top of our list in terms of priority, and we have to go into production. And we have got to start figuring out how to use it. So just stop, move, iterate, innovate, and keep going.”
The idea that a pilot needs to be performed before moving forward was a by-product of the early fears that there might not be useful data in the EHR. We know that the data is there now, and we need it’s time to get moving!
Myth #3 - “EHRs are a silver bullet for everything.”
“The third myth I hear quite a bit is this "silver bullet" feeling. That you're going to sign the contract and you're going to start ordering and that this is going to solve all your woes. I don't believe in werewolves and I don't believe in "silver bullets". For the record, if I did believe in werewolves, I'd go with a different mechanism rather than trying to aim for the heart with just one "silver bullet". It's just not an attitude that we should have with anything. Nothing is ever going to be perfect. We need to be okay with this.
There's tremendous power in this EHR data and what we can do and what the future looks like, but we shouldn't be looking to any single source of anything. The world just moves too fast. We move too fast, and we need to be nimble. And the attitude around single points of failure, when I think of what a "silver bullet" actually is, sets us up to not actually be able to pivot and be nimble and to use things in creative ways. It appears very self- limiting to what we're able to do in terms of innovation.”
There seems to be unrealistic expectations floating around the industry, with a belief that EHRs can solve all the problems. This sentiment seems to be polarized against the first myth that EHRs simply aren’t there, but it’s also a misconception within the industry. The truth lies somewhere between the extremes - EHRs are not a cure all, but it’s also fully ready to be used.
Myth #4 - “Patient portals cause too much friction.”
“This next myth is around patient portal friction causing consumers. In the early days, we were very uncomfortable, or very used to ordering our requirements behind the scenes. It’s this process where a consumer signs an authorization and then we just go do our things in the dark cover of night, order whatever it is we're going to order, and we don't expose any of that to the customer. The mindset shift it takes to ask a person to share their username and credentials, is understandably perceived by some as a layer of friction.
The truth here is that there are ways to get past this. There are innovative companies working to reduce the friction by creating better consumer experiences so more people are willing to opt into this type of experience. With the right "choice architecture", the right design around the experience, people are comfortable providing this information because they’re already doing it in other settings of their lives.I'm not saying it’s always frictionless, but certainly with the right design and the right engagement strategy, this isn't a barrier. We also need to live in a multi-solution universe where if "step one" doesn't work, we have step two, step three, etc. And patient portals are a fantastic first step.”
Patient portals have emerged as a trusted source of information and engagement channel for consumers within the last 18 months, due to how we are virtually interacting with our healthcare providers and receiving care. Designing the experience around this puts an additional option into the hands of patients as part of a broader solution, and will only feel more natural to consumers over time as patience portal usage continues increasing in our virtual-first world.
Myth #5 - “Hit rates are super low.”
“The last myth that keeps coming up, which is the bane of my existence, is that the hit rates are super low. I tried really hard to actually stop the use of the term "hit rate" in the industry and started going for saturation like "geographic saturation" or saturation among your distribution or your applicant pool. The hit rates aren't low, and they’re climbing. Certainly, if we are to look at an area of the country that might be a desert in terms of connectivity, there's going to be some period of time while we still try to cover that area, but we have other methods to get data there, so this is not a doomsday scenario. Many areas of the country have also come up considerably fast in terms of coverage and interconnectivity for health information exchanges (HIEs). These are the types of data sources where the hit rate is good now, and will only get better in the next year, next 18 months. We really need to move beyond this worry that we won’t be able to anything from EHRs, when we’re now riding into the sunset of being well connected.
And getting the data is just a start. Being able to do something useful with that data, have it normalized, have it aggregated, be able to provide it in a searchable way, these are a lot of the things that we don't often talk about. We stay high level, talking about hit rates and this and that. But when we start thinking about the quality of the data, we should be asking whether we’re getting the same type of information that we would be getting from the traditional APS. Is it allowing me as an underwriter to process more applications, search for data faster within information, maybe find something that I would have missed because now in applying machine learning and AI to it? That's where we should get excited. This isn't just a faster horse, this is something completely different.”
Hit rates are not low anymore, and they are climbing steadily each day. This myth may have been true a few years ago, but it no longer represents our reality today. It’s about time we moved past hit rates as a limitation to EHR adoption, and begin thinking about how to best use the data we receive programmatically, in an automated fashion, to create additional value.
So there you have it. 5 popular EHR myths busted. Do you have another in mind? Email it to me at richard@humanapi.co.
