CMS should rethink patient engagement requirement for Meaningful Use

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One of the most controversial provisions of the proposed rule implementing Stage 2 of Meaningful Use is the requirement that more than 50 percent of an eligible professional's (EP) patients have the ability to view, download and transmit data, and more than 10 percent of those patients actually have to do so. Not surprisingly, this has been met with fear and anger in the provider world, with some noting that providers can't control what their patients do, and can't force them to access their electronic records.

The agency acknowledges in the rule that the new measure, meant to encourage patient engagement, is a departure from the other requirements by obligating action by patients or their representatives in order for an EP to meet Meaningful Use.

"We believe that requiring a measurement of patient use ensures that the EP will promote the availability and active use of electronic health information by the patient or their authorized representatives," the Centers for Medicare & Medicaid Services says.

But CMS didn't offer any guidance for EPs to engage their patients. In fact, the proposed rule imposes additional restrictions, such as prohibiting use of flash drives or CDs to meet the requirement, while at the same time pointing out that disabled patients that can't access their information electronically still must have equal access to their records.

CMS also failed to allow for differences among various specialties, patient types or situations. A patient with a chronic condition may be more apt to check his records than a healthy person who only sees his physician sporadically. A pediatrician may see more electronic interaction with a nervous new parent than, say a radiologist.

"You'll get younger, most interested, educated patients to do it initially," David Lee Scher, Adjunct Clinical Associate Professor of Medicine at Penn State University's School of Medicine and owner of DLS Healthcare Consulting, tells FierceEMR.

But what about physicians who treat mostly older, poorer patients?

"Patient engagement is so hot now. But [it's] the clinicians who are stuck with the mandates," Scher says.

It's hard enough to get patients to access their records without having to how worry it will affect physicians' incentive payments. So what on earth could EPs do to boost such compliance? Put signs up in the waiting room? Beg the patients? Give them chocolate?

One blogger suggested incentivizing patients to access their records by offering to waive their copayments. I'm sure that will go over well with the Department of Health & Human Services' Office of Inspector General.

Even the Office of the National Coordinator for Health IT is having second thoughts about this detail. The ONC HIT Policy Committee's Meaningful Use working group has questioned the extent a provider should be accountable for patient engagement in its discussions on the proposed rule, and is suggesting another proposed provision: that the threshold that at least 10 percent of patients use secure messaging with their providers, be lowered to 5 percent.

Scher suggests that if the government is going to mandate these obligations, then it also should be tasked with providing the tools to engage the patients and educating them about their ability to access their records electronically. "The government should put out public service announcements, teach this in schools" he says. "Doctors don't have time to teach patients about patient portals."

Agreed. - Marla