Literature Review and Environmental Scan: Evaluation of Personal Health Records Pilots for Fee-for-Service Medicare Enrollees. Standards for Claims-Based PHRs


Donald Mon, Ph.D. indicates there is not a specific set of standards currently available for claims-based PHRs. There are, however, two overlapping standards for claims-based PHRs: X12 and IHE-XDR. Claims-based PHRs use a HIPAA X12 275 transaction standard for transmitting PHR data, and the HIPAA X12 275 uses XML to encode the data elements. Specifically, the X12 275 transaction is the outer ‘envelope’ that will contain the CDA/CCD data elements supported by health plan claims and administrative data entered by consumers into the PHR.[237] Claims-based PHRs also use the IHE-XDR; this standard enables the exchange of patient-related medical documents between health care entities using a point-to-point network.

HL7 is striving to produce standards at the functional requirement level, which will then be applicable to all PHR models, rather than developing standards for different types of PHR models (e.g., claims-based, provider-based, stand-alone, or web-based),

According to an expert from the HL7 work group, which developed the PHR-S, the goal is for all PHR models to be derived from the same functional model – regardless of whether the PHR is populated by claims data or via some other mechanism. From a standards perspective, it would be beneficial for all PHR systems to conform to a functional model.

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