Joseph Kvedar: Why federal efforts to spur patient engagement miss the mark

The Centers for Medicare & Medicaid Services' attempt to spur patient engagement by provider organizations via the proposed rule for Stage 3 of Meaningful Use is "admirable" but "misguided," according to Joseph Kvedar, vice president for connected health at Boston-based Partners HealthCare.

The rule essentially forces providers to send mounds of information to patients without proper context, Kvedar, who also serves on FierceHealthIT's Editorial Advisory Board, writes in a recent post to The cHealth Blog. It calls on doctors to report about their efforts on the following measures, and to successfully meet the requirements of two:

  1. Increase the percentage of patients viewing, downloading and transmitting their personal health informant from 5 percent to 25 percent
  2. Ensure that more than 35 percent of patients are sent a secure message via the provider's electronic health record
  3. Ensure that more than 15 percent of patients contribute patient-generated (or information from a nonclinical setting) to the EHR

"It is not surprising that many providers have had challenges meeting the Stage 2 requirement that 5 percent of patients download their medical records," says Kvedar, who calls the rule's execution flawed. "It seems akin to saying that this week's book club selection is the text for advanced graduate study of quantum mechanics--and then wondering why no one shows up for the meeting."

Roger Neal, vice president and CIO at Duncan (Oklahoma) Regional Hospital, calls the 25 percent view-download-transmit threshold "far-fetched" and "ridiculous," echoing Kvedar's statements about provider struggles with the Stage 2 requirement.

What's more, Beth Israel Deaconess Medical Center CIO John Halamka calls the patient-engagement requirements "stretch goals," adding that they would be more appropriate were Meaningful Use converted from a stimulus/penalty program to a pay-for-performance program.

Rather than defining engagement as how many times a patient interacts with information posted to an online portal, Kvedar says, the bar should be to truly get patients to interact with their health data. To that end, Partners is working on development of a tool to better enable engagement by helping patients overcome barriers to using personal wearable health devices, he says.

"This engagement engine will leverage machine learning and other big data analytic tools to convert insights from users into targeted feedback," Kvedar says. "We'll develop and test an algorithm, and then test it in a clinical study."

To learn more:
- read Kvedar's post