Stage 2 patient engagement should be voluntary during MU sorting-out process

The Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT don't seem to get a break these days, do they?  

This year so far has been pretty hectic for the agencies, which have had to contend with interoperability issues and the development of the rule implementing Stage 3 of the Meaningful Use program.

So the backlash on what may have been seen as an easier task--issuing the promised rule softening the requirements of Stage 2--seems a bit surprising.   

The rule proposes to lower the 2015 reporting requirement from 365 days to 90. It reduces the patient access obligation so that just one patient has to view, download and transmit records, not 5 percent of them. The rule simplifies some of the measures and objectives, and drops a few that have been topped out. It aligns some obligations so that they mesh better with proposed Stage 3 of the program.

Official comments aren't expected until June, but already people are weighing in--and views vary significantly.

There appears to be universal support for the shortened reporting requirement for 2015, which the College of Healthcare Information Management Executives and the Association of Medical Directors of Information Systems call a "welcome adjustment" and the American Hospital Association (AHA) says is "much needed relief."

But some of the other provisions, or lack thereof, have already been criticized. For instance, CHIME and AMDIS call the rule a missed opportunity to address the pass/fail aspect of the program, which still penalizes providers who are trying to meet Meaningful Use in good faith, rather than focusing only on those that "clearly" don't try to meet Meaningful Use. The AHA worries that the many other changes so late into the process are burdensome and confusing.

Then you have former ONC head Farzad Mostashari and patient rights advocates decrying the reduced patient access requirement. The National Partnership for Women and Families was "dismayed" by this "startling and unwelcome departure from the administration's commitment to health care transformation."


But as a consumer, I've always been a bit uncomfortable being partially responsible for whether a provider meets or fails to meet the patient engagement requirement of the Meaningful Use program. Why are we patients holding the keys to the kingdom? I want a normal patient/provider relationship, not one where providers are beholden to me and these other people in the waiting room for viewing, downloading and transmitting our records. I don't want to be part of the Meaningful Use program's incentives and penalties.

And since access is all traceable, the providers know which patients helped them earn the incentive--or not.

The truth is that HIPAA has granted patients rights to their records for years, and very few patients bother to obtain them. That's probably for the same reasons patients don't access them much now. Some don't know that they can. It's also a bit of a chore to access each provider's EHR. Personally, I'd rather be able to access Surescripts' new national locator service and retrieve my records all at once. Now that would be convenient.

And now that the Medicare Access and CHIP Reauthorization Act has passed the Senate, sending the physician side of the Meaningful Use program in a brand new direction, it's hard to predict just what will be expected in terms of patient engagement.  

I understand the rationale behind the patient access requirement. But patient engagement should be up to the patient without strings attached. And it's only one piece of the puzzle here. Perhaps it should be kept more voluntary until all of the pieces are put together. - Marla (@MarlaHirsch and @FierceHealthIT)