Access to medical records is controversial but achievable

  • 5 September 2018

Should insurers be given access to digital medical records? The question has more ethical angles to it than you might first think. The danger is that advocates and opponents focus on those angles that favour their position and downplay the rest. That would just drag on the whole access question for even more years. 

What I want to do here is outline the key ethical points that I think need to be taken into account in the search for an inclusive and lasting solution.

There’s no question that giving insurers greater access to digital medical records will have benefits for both consumers and insurers. There would be more certainty for consumers earlier on in the new business process, with fewer and less onerous hoops to be jumped through.

Consumers would then feel more confident that the policy they’ve bought will respond in the way they hope it will. And should they need to make a claim, fewer complications are likely to arise in deciding eligibility and payment.

For insurers, such access would remove a lot of the friction that can arise in the new business process. Underwriting and claims can become more streamlined and orientated around supporting the needs of the customer.

It sounds so obviously like a good idea all round. Yet it’s not that simple. There are important ethical issues that need to be addressed. So while accessing the information may in many ways be a relatively straightforward technological step, being confident that it will be used in the best interests of consumers is a more nuanced situation. Yet both have to be addressed in parallel for lasting success and acceptance to be achieved.  

Competency Counts

Let’s look at this from the perspective of competency. Consumers would want to be reassured that their medical records are being handled with a similar level of skill and competence as the medical professional who wrote them. Medical records are not being written with insurance cover in mind, so how will insurers bring the expertise to bear on their interpretation? Sorry insurers, but I’ve yet to be convinced that the training and experience of medical underwriters matches that of medical practitioners. If I’m wrong on that, let's see the evidence. 

It may of course be coded into underwriting algorithms. That however feels like one step forward and one step back. The forward step comes from having medical experts design, train and test those algorithms. The backwards step comes from the evidence of how some algorithms can produce quite 'iniquitous outcomes' (the regulator’s words). Again, evidence to show how well those training and testing regimes have eliminated those iniquitous outcomes helps built confidence in algorithmic competency.

Reliability Matters

Now let’s turn to the perspective of reliability. Consumers will want to feel confident that in providing insurers with access to their digital medical records, the insurer can in turn be relied upon to use the information with fairness and honesty. Hardly a problem, many insurance firms will think. After all, we’re all good people.

And that’s fine, apart from the reality that good people don’t always make good decisions. I’ve seen questionable decisions made for extraordinary reasons, such as ‘everyone else is doing it’ and ‘the company needs me to do this’. So of course the insurer intends to be fair and honesty, but the real question is how that is delivered with the certainty that will reassure consumers. Let’s pick three angles from which to approach this.  

The form of consent found in most new business documentation is often broad and generic, to the extent that it would give medical underwriters pretty close to carte blanche to do what they want with easily accessed digital medical records. This is an issue that needs addressing, for insurance is changing and some of that restructuring will change the decisions points at which medical underwriting takes place.

Another angle is inclusivity. Can insurers be relied upon to use access to digital medical records to embrace even more people than ever before? Reports earlier in the year in relation to proposers with any sort of history of mental health issues make this a very present question. And a pertinent one too: one in four of us will experience some form of mental health issue at some point in our lives. So insurers need to show that their approach to ‘access to insurance’ is rising to the occasion, and will keep on rising as our health service’s understanding of, and responsiveness to, various forms of illness develops.

Another angle is that of fraud. Recent data from the insurer trade body pointed to 80% of insurance fraud being at the application stage. If that’s also the case for protection covers, then medical professionals, in going along with any access initiative, will want to know that their records are being properly interpreted. If ‘walking away from an insurance application’ causes that proposer to be labelled as fraudulent (a current practice), how will a patient that doesn’t complete treatment or follow their doctor’s recommendations, be treated? On the surface, access to digital medical records will reduce the volume of fraudulent applications, yet that upside sits right alongside the largely black box process by which insurers make judgements about fraud. It is an iceberg of an issue.

The Honesty Perspective

Let’s move on and turn to the perspective of honesty. Remember that consumers see honesty in a market like financial services very much along the lines of ‘doing what they said they would do’. And in seeking access to digital medical records, insurers need to both make the promise of greater certainty in underwriting and the promise of greater certainty in the settling of claims. The latter should of course be a natural outcome of the former, and insurers can of course be expected to make that case very strongly, but it is not enough.

Instead of just ‘telling’ consumers that that will be the case, insurers need to be ‘proving’ to consumers that that will be the case. That means transforming the market’s engagement with the public on how, and why, claims are settled, or not. Why are more claims settled in one line of business than in other lines of business? How are different conditions assessed, and how does that compare with medical practice? How are complex medical conditions weighed up?

Present information of this kind is underwhelming and sometimes questionable. Being more open and more engaging with the public on issues like this could go a long way to building the public’s confidence in the market. Doing this well may not be easy, but it is important for the new relationship between insurer and customer that access to digital medical records may come to represent.

The Goodwill Glue

Let’s take a quick look at the last of the four perspectives I want to cover, which is goodwill. What goodwill brings in is the attitude of both insurer and consumer. Both not only have to want to make this happen, but both must also want to make this happen for the mutual benefit of both parties. And this needs to be viewed from the perspective of both individuals and groups – not just one insurer but the overall market; not just my cover, but everyone’s cover. Intentions matter.

I chose those four perspectives – competency, reliability, honesty and goodwill – for a very good reason. Those four things are the ingredients of trustworthiness. And if your firm and its peers work together on all four of them, then the result will be great trust by consumers. Access of digital medical records will only succeed in the long run if consumers really do trust insurers.

It’s a big call by the protection sector to be given access to digital medical records. It now needs to be backed up with some concrete evidence that it is a justifiable call.