title: On feasibility and benefits of patient care summaries based on claims data.
abstract: BACKGROUND
  Electronic availability of health care claims data maintained by health insurance companies today is higher than the availability of clinical patient record data.
  
  
  OBJECTIVE
  To explore feasibility of automatically generated patient care summaries based on claims data and its benefit for health care professionals (HCP), when no shared electronic health record is available.
  
  
  METHODS
  Based on an existing claims data model for German health insurance companies, a transformation and presentation algorithm was developed. To determine the utility of the resulting summaries, a focus group session comprising HCP and insurance representatives was arranged. Properties of an information system architecture capable of providing summaries to HCP were specified.
  
  
  RESULTS
  A set of valuable healthcare information, in particular clinical pathways, medication, and anamnesis, can be derived from claims data that fits into the ASTM specification of a Continuity of Care Record. The focus group assessed the potential benefit of the summaries as high. Major issues are partial incompleteness and a lack of timeliness due to delayed reimbursement procedures as well as privacy-preserving and practicable access methods. The specified system architecture uses web services and a web interface to provide the summaries in HL7 CDA format. An important insight was that only a timely electronic reimbursement process will lead to precise, current, and reliable claims-based summaries.
  
  
  CONCLUSIONS
  Generating patient care summaries based on claims data is feasible and produces valuable information for HCP, provided that the reimbursement process is conducted timely. Integration into a national health telematics platform will facilitate access to the summaries. Evaluation of algorithm and prototype system is underway to prove the benefit in clinical practice.
authors.affiliation: Institute for Medical Informatics, Technical University of Braunschweig, Germany. t.brennecke@tu-bs.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Brennecke
authors.forename: Lars
authors.initials: L
authors.lastname: Michalowski
authors.forename: Joachim
authors.initials: J
authors.lastname: Bergmann
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Bott
authors.forename: Axel
authors.initials: A
authors.lastname: Elwert
authors.forename: Reinhold
authors.initials: R
authors.lastname: Haux
authors.forename: Ralf
authors.initials: R
authors.lastname: Schlicht
mesh_terms: D000465:Algorithms; D005240:Feasibility Studies; D017144:Focus Groups; D005858:Germany; D006801:Humans; D007344:Insurance Claim Reporting; D016347:Medical Records Systems, Computerized; D005791:Patient Care