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Disappointing Proposed Change to Stage 2 Looms Over Patient Engagement Symposium

April 12, 2015
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The air was let out of the room towards the end of a great panel at the patient engagement symposium, part of the pre-HIMSS education at the 2015 Healthcare Information and Management Systems Society (HIMSS) conference in Chicago. 
The panel, Provider Perspectives on Patient Adoption of Portals, Secure Messaging, included Judy Derman, Director of Member Engagement at Kaiser Permanente and David Willis, M.D. CMIO of the CommunityHealth IT, a community-driven health information exchange (HIE) in a rural area of Florida. They were sharing stories of success in engaging patients from two different sides of the spectrum.
It was a thrill to hear about the all-hands-on-deck approach that epitomizes Kaiser’s drive towards patient engagement success. Make no mistake about it either, having 4.8 million patients registered to your patient portal is a resounding success. Derman spoke of one Kaiser facility that advertised the drive to get patients to register. 
“When one of the medical centers went live [with the portal], they put a huge banner in the parking garage so when patients parked, it was the first thing they saw,” Derman said. She also talked about the many capabilities that Kaiser has in its portal, including prescription refill, online test results, the ability to pay a bill, image sharing and secure messaging with providers, contextual health education, and much more.
Dr. Willis’ talked about how many in his HIE are one-to-three doc practices and blind to the world of meaningful use. He spoke of engaging these providers as well as their patients, and the inherent difficulties that make it hard for them to do so. Despite these challenges, he said, they’ve established an online platform which allows providers and patients to access their medical record. 
“They’re empowered to do many of the other things you’ve heard that other portals can do. Even in the rural community, they have the same needs. They’re looking patient refill, lab results, secure communication. The patient is the patient, whether they’re in a urban or rural environment,” Dr. Willis said. 
It was uplifting to hear these stories of progress, especially when those of us in attendance got a cold, hard slap of reality towards the end. During the Q&A, someone asked about the proposed rule change to Stage 2 of meaningful use. Much of this proposed change—released at a nicely convenient 4:45 pm on the Friday before the biggest conference in the industry— has focused on the streamlining of reporting timelines. This has gotten it a lot of favor with industry stakeholders like the College of Healthcare Information Management Executives (CHIME). 
That’s fine however, the proposed change includes an overlooked provision that would take the requirement that asks providers to get 5 percent of their patients to view, download, and transmit their health information and shrinks it to one person. That’s right, the Centers for Medicare and Medicaid Services (CMS) is asking providers and hospitals to get ONE patient to view, download, and transmit their information to attest to Stage 2. 
It’s unclear why this change was proposed. We know that many providers disliked the 5 percent. They disliked having a lack of control over a requirement. I’m guessing—not unlike the changes to the ICD-10 timeline—the “right” people got in the government’s ear. 
When this requirement first came out in 2012, I remember talking with John Halamka, M.D., CIO at the 631-bed Beth Israel Deaconess Hospital (Boston, Mass.), who explained how the threshold accomplished one thing. 
“I think what this does, it’s a nice forcing function that ensures every hospital and ambulatory care site implements a fully functional patient portal,” Halamka said at the time. “It allows gradual adoption for those that haven’t implemented the technology, recognizing in some ways the transmission of data is a novel concept.”
What I said at the time, as expressed in this blog, is that the threshold could have been 10 percent, 5 percent, or 1 percent. It accomplished the same thing, getting them to go on the path towards patient engagement. 
Despite what I wrote then, I can’t help now but feel as if dropping it to one person is ridiculous. They couldn’t give providers a little bit of a goal to work towards? It’s quite frankly, an insulting blow to patient engagement efforts everywhere, and all that it represents in the shift towards the new healthcare. I also am curious how providers will go from 1 person to 25 percent, as proposed in the Stage 3 rule? 
Patient engagement is challenging, of course, but it’s necessary. It’s also been successful in the largest and smallest of environments, as we saw today. This proposal would all but take the patient out of the picture when it comes to their own healthcare. What incentive would providers have to show patients their data? 
Luckily, there has been a good amount of pushback already. Naturally, at the patient engagement symposium, attendees didn’t seem enthused. Like I said, it felt like the air was let out of the room when that question was asked. All those on the panel spoke out against the change. Derman called it a “very unfortunate change.” 
In a later session, Farzad Mostashari, M.D.