Meaningful Use Stage 3: A battle for appropriate patient engagement requirements

Battle lines are being drawn between Meaningful Use Stage 3 supporters and those not so keen on some or all of the newly proposed rules.

On one side, the Centers for Medicare & Medicaid Services is receiving praise for its "streamlined" focus and its push toward interoperability. For instance, Health IT Now applauded the agency for its move to eight core objectives. And Duke University Director of Mobile Technology and Strategy Ricky Bloomfield, who also serves as an assistant professor in internal medicine and pediatrics at the school, called the proposed rule a step into the 21st Century thanks to the "coordination of care through patient engagement" objective.

"While patient-generated data can come in many forms, including manual entry by patients, this measure will only be achievable if we employ technologies that reduce or remove such barriers," Bloomfield said. "[I]t's great to see APIs [application program interfaces] and patient-generated data being emphasized in the latest NPRM [notice of proposed rulemaking]."

Meanwhile, providers questioning Stage 3 haven't been shy, either. For instance, shortly after the rule was unveiled, John Halamka, CIO at Boston-based Beth Israel Deaconess Medical Center, called CMS' patient engagement requirements "stretch goals" that would be more appropriate if the program were to convert to a pay-for-performance model from a stimulus/penalty model. He also criticized the Office of the National Coordinator for Health IT for its accompanying certification criteria, which he said could cause massive market confusion for developers and impede provider progress.

Roger Neal, vice president and CIO at Duncan (Oklahoma) Regional Hospital, also panned the Stage 3 proposed rules, calling the patient engagement requirements "far-fetched."

"Twenty-five percent of patients using a portal is almost ridiculous," Neal told FierceHealthIT. "Most providers are struggling to get the 5 percent they need now to qualify for Stage 2."

Instead, he said, patients will engage in healthcare when they need to at the rate they feel comfortable.

"It won't be quick," Neal said. "'Smoking kills' campaigns took decades to take hold and are still around. This won't move any faster just because it's a requirement for the industry."

Neal also expressed concerns with the proposed transitions of care areas, such as the requirement that 40 percent of summary of care documents get ingested into a provider's electronic health record. "I already hear some push back on those because the providers are overloaded with data," Neal said.

Halamka and Neal raise some good points. After all, what good will it do to penalize providers who can't get their patients to actively engage their EHRs?

However, Health IT Now and Bloomfield make some good points, as well. In particular, API use in healthcare is an overdue concept, one which Halamka has also said he agrees with (even if he doesn't agree with the patient-engagement levels proposed).

Providers, where do you stand? Does Stage 3 need a makeover, or are you satisfied with what CMS is laying down? Share your thoughts in the comments section or on social media via Twitter, LinkedIn or Facebook. - Dan (@Dan_Bowman and @FierceHealthIT)