Automation of a patient medical profile from insurance claims data: a possible first step in automating ambulatory medical records on a national scale.

This report describes how a detailed patient medical profile can be produced by the systematic collection and linkage of claims data in a state-wide Medicaid program. Extension of this system nationally could provide automated medical profiles for more than 20,000,000 people at a small increment in cost. The possibility that this cost could be offset by reduction of duplicated services currently provided deserves serious consideration by health care planners and administrators. The ability of the profile to portray a patient's clinical status accurately hinges on both the determination of health care administrators to adopt sensitive and precise diagnostic codes and on the adoption of improved data acquisition techniques. The deficiencies of the database are described, and methods of overcoming these problems are suggested.