- Patient engagement is seen as one of the most important pieces of the Triple Aim: the lynchpin for reducing costs, ensuring high care quality, and making population health management an effective proposition. The proposed rule for Stage 3 meaningful use takes patient engagement to heart by drastically increasing the proportion of patients who must view, download, or share their personal health information through a patient portal in order for their providers to successfully attest for the EHR Incentive Programs.
But with so many eligible organizations struggling to meet the conservative 5 percent patient engagement threshold for Stage 2, is the jump to 25 percent of patients in Stage 3 an encouraging goal or a sheer impossibility?
“We think this 25 percent threshold is a showstopper that has to be changed,” stated Robert Tennant, Senior Policy Advisor at the Medical Group Management Association (MGMA). “And we’ll be pushing for that and working with our other colleagues in the provider community on that message.”
“The 25 percent threshold does seem pretty aggressive,” agrees Katherine Downing, MA, RHIA, CHPS, PMP, Director of HIM Practice Excellence at AHIMA. “But it really is such an important step to patient engagement. We want our patients to catch errors. We want them to help ensure that providers who might not have access to health information exchange data aren’t repeating tests. We need them to engage. It will require a different way of thinking for us as providers, because we’ve always been so focused on how the data presents to our physicians and nurses. Now we have to think about how the data looks to our patients.”
Patient portals have not seen the rapid uptake that rule makers had hoped for when devising the Stage 2 criteria, and patient engagement hasn’t significantly increased in the run up to Stage 3. Surveys continually show that patients are interested in engagement, and think that viewing and sharing their data will help them make better decisions about their care. Yet one poll found that more than a third remain unaware of the fact that patient portals might be available to them. Another states that only a quarter of hospital patients can access their personal health records or lab results. And providers aren’t doing much to help themselves by failing to have the conversation.
Perhaps that is one reason why “the view download transmit requirement of Stage 2 has been the most difficult of any of the requirements, even though the threshold was just five percent,” Tennant said. “There have always been some problems with it. When a patient goes to see her primary care provider, she has an ongoing relationship with that person. So sure, it makes sense to log on to her patient portal, because she has a reason to have a conversation with that PCP. She might want to bring something up at the next visit, or she might want to message back and forth in the meantime.”
“That’s a very primary care-centric approach, whether it’s for an OB/GYN, a pediatrician, a gerontologist – even an oncologist in some cases, who essentially acts as a primary care for those folks going through cancer,” he added. “But there are so many other types of practices and specialties.”
“For example, that patient might get a blotch on her skin, and her primary care provider sends her to a dermatologist. The dermatologist takes one look at her and says she’s fine. She’s good to go, right? The appointment took ten minutes, and at the end of that, the doctor gives her a clinical summary. What is the likelihood that she would go onto that dermatologist’s patient portal website, create a username and password, and log in to download what is essentially a ten-minute record that she already has printed in her hand?”
“So while this patient engagement structure makes sense for primary care, there are many specialists who play more of a consultative role, and patient engagement doesn’t mean the same thing for them,” Tennant explains.
While Stage 2 does allow specialists who are participating in some health information exchanges to count patient portal visits to the HIE towards their own goal, many providers have had to turn to creative methods, like enticing patients to sign up for portals with the offer of a free gift card, in order to meet the relatively low threshold. And even when providers do all they can, those organizations operating in communities with low computer literacy rates, spotty home internet access, or language barriers may find it difficult, through no fault of either party, to coax patients into engagement at all.
“I’ve got a good friend who works at a big medical institution where a high percentage of their patients are on Medicaid,” Tennant said. “They don’t have Internet access in the home. They don’t have an iPad that they’re using. To reach these types of thresholds with a patient population like that, frankly, is impossible.”
And then there is the obstacle of poorly designed portals with lackluster usability, Downing points out. “I think a lot of it has to do with the technology and its interface. You can’t have somebody sitting there for 20 minutes trying to log into it. You have to have a patient education program and materials that are easy to use and easy to understand,” she says. “And now, instead of worrying about a nurse on the floor who can’t get logged in, you have to have to a help desk for people at home who are trying to log into their patient portal.”
“For someone who isn’t too computer savvy, they might mess with it for a few minutes, but if they can’t get in, they’re not going to bother,” Downing continued. “So it really has to be supported on the technical side. You can’t just buy a patient portal, set it up, and let it go. You have to have a help desk for that. Usability is a very important thing to remember, and I think it will change healthcare for the better once we get there.”
“The patient engagement part of meaningful use needs to be changed so that it’s more geared towards actually helping patients and helping physicians treat their patients,” added Tennant. “I think that’s going to be the focus of our comments to the government on the Stage 3 rule. And we hope they take them to heart, because nobody wants this program to fail.”
“With Stage 3, there’s really no incentive money left. Now we’re looking at penalties. We don’t want a practice to say, ‘Well, we can’t afford to meet Stage 3, so we’ll cut down the number of Medicare patients we see to lessen our penalties.’ We clearly don’t want that to be an outcome of this program, and there are certainly some opportunities to improve it,” Tennant said. “We’ll be more than happy to help show CMS how we think they can do that.”