APS to EHR – Supporting the Underwriter in the digital process

For years underwriters have relied on an attending physician statement (APS) to make decisions. However, data from electronic health records (EHR) and health information exchanges (HIE) is becoming more reliable and user-friendly, making it the preferred readout of an applicant’s consolidated health history. Insurers are now challenged to get their underwriters to embrace the data, while giving them the support they need. Here’s how we can help.

The way it was

Life insurance underwriting has evolved over time, but medical records have been part of the equation for as long as most of us can remember. The attending physician statement (APS) gives the underwriter a curated snapshot of the medical services the applicant has received over time. The APS captures things like ailments, treatments, family health history and often free form notes memorializing the physician’s knowledge of the patient’s medical history. In short, the attending physician statement has been considered the gold standard in North American life insurance underwriting for decades.

The APS has not been without its idiosyncracies, however. Its heavy dependence on human intervention and curation means it often takes weeks or even months to produce the requested documentation. An underwriter could thus receive a fractured or limited view of the patient’s history.

So why do underwriters laud the APS but not the more comprehensive and immediate electronic record? It comes down to familiarity, which can often produce blind spots.

Underwriters have grown comfortable using the APS to assess overall risk and too readily accept its shortcomings.

The way it is: electronic health records

Electronic health records systems (EHR) have been around since the 1970s, yet their rapid and widespread adoption by industries that require health information is a more recent phenomenon.

As late as 2008, there was still very little adoption across the United States. As the financial crisis swept the country, the federal government looked for projects to put people to work and improve our health care infrastructure. Around this time the HITECH (Health Information Technology for Electronic and Clinical Health) act signed as part of ARRA (American Recovery and Reinvestment Act), whereas 70% of providers have adopted EHR by 2014 and EHR will become a requirement for reimbursement from the US government. EHR adoption by life insurance carriers has grown from 9% in 2008 to 84% in 2015. In 2018, Epic Systems, a developer of medical records software, was engaged to provide those records to the insurance industry.

Access to digital medical records did not improve underwriting overnight; in fact, it was evident that the underwriting community wasn’t ready for the arrival of this new data.

The dream of digitizing the patient record was alive and thriving, but the reality was the information was inoperable because it couldn’t be easily and freely exchanged. With the steady adoption of EHR by carriers in North America and throughout the world, an incredible opportunity has presented itself.

It’s important to note that EHR for insurance use has historically been driven by the healthcare industry. The time has come for the insurance industry to embrace electronic health records data by customizing and adapting it. With this adaptation comes legal concerns and it is always important for that carrier to make sure they are working within their regulatory and legal means, including with HIPPA, data security and data privacy.

Want to learn more? Download the white paper.

The Opportunity: Marrying team and technology

Contact For more information, reach out to our North American Underwriting Propositions Team:

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Life & Health Underwriting Americas