Many providers will want to demonstrate that they are using their electronic health records in a meaningful way under Stage 2 of the EHR incentive program. But it becomes much harder to meet the thresholds when some of the criteria are beyond the provider's direct control, according to attorney Elizabeth Litten, of Princeton, N.J.-based firm Fox Rothschild.
Litten, writing on a recent blog post, specifically points out the two proposed Stage 2 rules that contain new provisions that hinge on, not the physicians' use of EHRs, but rather their patients' use of the technology. One requires physicians to provide to more than 50 percent of their patients secure online access to their records, but at least 10 percent of patients (or their authorized representatives) will need to have actually viewed, downloaded or transmitted this information.
Physicians also will need to communicate with patients using secure electronic messaging and verify that a secure message was sent for more than 10 percent of patients using the EHR.
"The Stage 2 Proposal will incentivize providers to continue this trend toward meaningful use of EHRs, but [it] is also likely to result in providers' efforts to induce to their patients to become EHR users," Litten points out.
CMS acknowledges that these provisions put some of the burden on patients, but doesn't seem fazed. The agency specifically invites comment on whether the 10 percent threshold is the correct percentage, but not whether requiring patients to shoulder this responsibility or have this power is appropriate. Of course, commenters certainly can raise the issue.
Litten doesn't suggest how providers should try to entice patients to help them meet the thresholds. She observes that retired patients are embracing electronic media at an "unprecedented rate", which she believes to be encouraging. On the other hand, evidence also exists that are not all that interested in using and accessing medical records online.