Electronic health records (EHRs)
"EHRs have the potential to make a profound impact on insurance – from how policies are underwritten and claims assessed, to how insurers engage with customers over time."
In this interview, Dr. Monique Esterhuizen, Chief Medical Officer and Head of Medical & Health Services at Hannover Life Re of Australasia, discusses the impact of EHRs on the life insurance industry. She reflects on insights gained from three pilot projects and outlines a practical path forward. From underwriting to claims, she explains how EHR integration can enhance efficiency, improve customer outcomes and open the door to more inclusive insurance solutions.
Our industry is undergoing a rapid digital transformation. What role do EHRs play in this evolution?
EHRs are transforming insurance by providing timely, accurate health data that enhances both underwriting and claims processes.
Traditional underwriting relies on thorough but slow medical reports, while automated direct-to-consumer (D2C) approaches are faster but depend on less reliable self-reported data. EHRs bridge this gap, delivering objective information that supports efficient, personalised, data-driven decisions through underwriting rules engines. Because EHRs are comprehensive and reliable, they help insurers assess risk fairly and accurately, building customer trust and reducing the need for lengthy questionnaires. Verified EHR data allows insurers to more precisely evaluate risk, which can lead to more substandard risks being offered terms, and at potentially lower premiums compared to relying solely on customer disclosures.
For claims management, EHRs enable Smart Claim Forms to auto-populate with relevant data and let general practitioners (GPs) add structured details, streamlining information collection and reducing follow-ups. This results in more efficient claim triage and improved customer experiences.
What are other key benefits of EHR integration for underwriting and claims management?
There are some really compelling benefits worth mentioning.
In underwriting, medical tests done for insurance purposes can potentially be waived if EHRs show recent results, reducing acquisition costs and improving the customer experience considerably. In addition, innovative product solutions can be developed without necessarily compromising respective risk rates, and improved underwriting efficiencies could lead to better use of human resources.
EHR data can also streamline the claims assessment process, triage claims and result in automated decisions. In the future, claims could even be initiated on an individual’s behalf, with support being provided when it is needed most.
How does the availability and usage of EHRs vary globally?
Two decades ago, the majority of doctors relied on handwritten medical records. Since then, there has been a significant shift towards the adoption of electronic Practice Management Systems (PMSs) for storing medical notes. In developed nations, most medical records are now in digital format. However, in many developing countries, handwritten records are still common, which limits the ability to access medical information effectively and efficiently for life insurance purposes.
Certain countries permit patients to enrol in a centralised health record system, which utilises data to inform health economic decisions and ensures that resource allocation is based on epidemiological information. However, utilising these health records for life insurance purposes is prohibited due to stringent privacy regulations. Additionally, these records may be incomplete and not offer a comprehensive view of an individual's health status.
It is also worth pointing out that life insurance carriers in some countries, for example the United States and South Africa, already integrate directly with various health data sources such as ‘labs’ to obtain blood test results.
Monique joined Hannover Re in 2012 and transferred to our Sydney-based office in 2016, where she is currently the Chief Medical Officer and Head of the Medical & Health Services team.
A medical doctor by background with diplomas in Primary Emergency Care and Anaesthesiology, Monique is passionate about problem solving and innovation – from developing evidence-based medical risk assessment models to enhancing health and wellness for customers through digital solutions.
"Because EHRs are comprehensive and reliable, they help insurers assess risk fairly and accurately, building customer trust and reducing the need for lengthy questionnaires."
What are the main challenges in accessing and using EHR data?
The challenges differ between various stakeholders.
Firstly, customers. Life insurance providers need to secure signed consent to access their EHRs. This can be challenging due to customers needing technology capabilities, such as e-signing devices. Any delay risks losing their interest.
Secondly, GPs. They must be able to trust both EHR vendors and insurers to keep patient data safe. In Australia, EHRs are only released after GP authorisation, which can cause delays. Although nudges and reminders help, some GPs continue to use familiar, established processes rather than digital alternatives. The absence of a standard billing code for this service can lead to varying billing practices, which may introduce cost uncertainties. Furthermore, the quality of EHR data can vary significantly due to unregulated record-keeping practices and differing approaches to clinical examinations or test ordering.
Finally, EHR vendors. They act as intermediaries between life insurers and GPs. However, privacy laws prevent them from verifying the EHRs or e-forms for accuracy. As a result, incorrect information from GPs can cause additional costs and delays.
How can Artificial Intelligence and Machine Learning contribute to the utilisation of EHRs in underwriting and claims management?
Artificial Intelligence (AI) can enhance information from EHRs by summarising and restructuring it for underwriters or claims assessors. It can present health data in timelines, trend graphs, or tables, and even enable interaction through a chatbot. AI can also detect inconsistencies between customer disclosures and EHRs, helping to identify fraud and unsupported claims. Another interesting area is the potential for AI to analyse health trends and improve predictive modelling.
From a reinsurer’s perspective, how can we support our clients in making the most of EHR opportunities?
Bringing thought leadership and expertise is key in supporting our clients with EHR opportunities. As our industry moves through the early stages of digital transformation, providing guidance on best practice and sharing our knowledge will lift our clients’ capabilities and encourage their participation in this revolutionary space. This includes informing them of global trends and practices. Insurers need systems that can acquire, analyse, measure, and use EHR data effectively.
We can also help our clients by identifying small-scale opportunities for testing. For example, they could pilot an area of risk with EHRs and get guidance on data requirements. In parallel, we can support by conducting actuarial and medical research to extract relevant insights from EHRs, enabling data-driven decisions.
Hannover Life Re of Australasia has been exploring EHR integration into underwriting and claims. Can you describe the three pilot projects you have conducted to date?
Our first pilot tested whether patient summaries from GP PMSs could be mapped to our underwriting rules. We analysed 60,000 records across three age bands. All summaries could be mapped; over 60% lacked long-term conditions or medications. Of those with conditions, 78% were mapped accurately. Fewer than 10% of the data was irrelevant. The pilot also revealed gaps in family and social history, as well as specialist visits. Importantly, the top 10 medical risk categories made up 80% of EHR health data – a crucial insight for rules development.
The second pilot validated these findings using 660 weighted records across 24 subcategories. We assessed whether patients could be automatically underwritten using health summaries alone, and tiered health data by criticality. Completeness was 68% for Level 1 – most critical – and 30% for Level 2. This suggested that simplifying data requirements or applying assumptions could improve straight-through processing (STP), estimated at 71–84%.
The third pilot tested feasibility in a live D2C setting. With EHR consent, nearly one third of previously uninsurable applicants could proceed, with over half offered terms. While confirming feasibility, the pilot also underscored the importance of supporting GPs with onboarding to these novel processes and improved invoicing practices.
Monique has always been committed to helping people. Combined with her interest in actuarial science, she enjoys embracing technological advances to improve how digital health data is acquired, analysed, and used within life insurance to benefit customers.
In her free time, Monique enjoys being outdoors, whether exercising, walking her dogs or spending time with her family. She has run three half marathons and recently did her first open water 1km swim at sea.
"Real-time access to verified health data could enable fully automated underwriting and claims processes, meeting demand for seamless services while improving risk assessment."
From your experience with EHR integration, what were the key learnings and success factors?
A key lesson is the importance of minimising disruption to existing processes and ensuring that there is minimal risk to customers and to the company's reputation. Demonstrating that EHR integration can be smooth, secure and valuable is the first step in building trust. EHRs can speed up underwriting while improving accuracy, enabling more customers to access life insurance via the D2C channel. Where recent results are available, medical tests can potentially be waived.
Testing involved collaboration across stakeholders, with clear roles, effective communication and accurate documentation. We prioritised customer-centricity, despite challenges such as unrealistic GP billing. Going forward, a key focus is fostering close relationships with GPs ensuring shared interest in their patients’ insurance needs. In addition, direct integration with GP practices will remove the need for GP review and authorised release – requiring vendor-GP contracts and a regulatory framework.
Finally, agility is essential. In a live setting governed by regulation, including the Life Insurance Code of Practice, we must always deal with customers efficiently, honestly, and fairly.
What advice would you give to insurers exploring EHRs for the first time or looking to expand their use?
I have two main pieces of advice for insurers. Firstly, ensure your EHR solution benefits customers with a smooth, reliable, and trustworthy process. Work with trusted partners to facilitate seamless GP engagement. Invest in data governance and compliance to securely transfer and manage personal data.
Secondly, the value of EHRs is contingent upon the quality of the data they provide. If EHRs are unreliable, incomplete, or unreadable, their utility is significantly diminished and may lead to unnecessary additional requirements. Starting with a targeted use case that ensures high-quality data will yield the greatest benefit and can be expanded progressively.
Looking ahead, what’s the long-term potential of EHRs to shape the future of insurance?
EHRs have the potential to make a profound impact on insurance – from how policies are underwritten and claims assessed, to how insurers engage with customers over time. Real-time access to verified health data could enable fully automated underwriting and claims processes, meeting demand for seamless services while improving risk assessment. In the claims process, it could even trigger automatic initiation, ensuring timely support and greater efficiency.
In the longer term, authorised access to EHRs during the policy period could support prevention-focused models, promoting healthier lifestyles, early detection, and targeted interventions without compromising risk rates. Insurers could expand D2C underwriting, waive medical tests when data is available, and simplify products. Enhanced risk precision could also improve competitive pricing and customer access.
Together, these developments are creating a digital, data-driven ecosystem for sustainable underwriting, improved customer outcomes and high-quality automated decision-making.
Thank you for this insightful interview. That truly sounds like an exciting space…
It's an exciting and meaningful field to work in. What makes it so compelling is the potential of EHRs to drive our industry forward in the digital age. At the same time, they open the door to improving health outcomes and financial security for consumers – ultimately, that's what life insurance is all about. It’s inspiring to be part of an industry that delivers such tangible value to society.
The collaborative nature of the work also makes this area so rewarding. Reinsurers, insurers, healthcare providers and technology partners all play a part. Together, we’re shaping a future that puts customers at the centre and delivers lasting benefits across the entire ecosystem.
Dr. Monique Esterhuizen Chief Medical Officer, Head of Medical & Health Services Hannover Life Re of Australasia Ltd Tel.: +61 2 9251-6911 Mail: monique.esterhuizen@hlra.com.au
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