I attended a HIMSS Virtual Briefing on Stage 2 of meaningful use last week. Kenneth Ong, M.D., chief medical informatics officer of New York Hospital Queens, gave a valuable presentation summarizing what is new about Stage 2 and the areas in which CMS has specifically asked for public comment. But it didn’t take long for the audience to zero in on the new proposal that isn’t sitting well with providers: the patient engagement measure that requires that not only do more than 50 percent of patients have the ability to view, download, or transmit their data, but that 10 percent of patients actually have to look at their data, download it, or transmit it to others.

One HIMSS briefing participant wrote in the online discussion: “I think that the requirement to enforce a threshold involving 10 percent of patients in the access, downloading, or viewing of their health record is completely unrealistic. The hospital/EP requirement should end with the availability of the data via an online portal. Also, an EH/EP has absolutely no control over the transfer facility EHR vendor! How can we be held accountable for the choices made by other facilities? Also, this will need to be accomplished via a Health Information Exchange Network. How can the hospital possibly track the EHR vendor of the recipient? The requirement should end with the actual submission of patient summaries of care to the HIE.”

When Dr. Ong was asked how providers could be held accountable for making sure patients use a portal, he said, “I don’t have a good answer. I have that same question myself.”

He added that the question has come up many times in listservs and other forums where people are talking about meaningful use.

He added that there is good evidence from integrated health systems such as Kaiser Permanente to suggest that patients with chronic diseases make good use of portals to ask for appointments and get medications refilled. But the evidence is less clear so far about whether you get the same sort of benefit to patient care and efficiency in a stand-alone hospital.

There are also questions, Ong added, about whether the 10 percent threshold should apply to all specialties, or whether there should be different values for ambulatory care surgery vs. a pediatrician. “These are really important questions,” he added.

Others have noted the challenge this threshold presents. Asish Jha, M.D., an associate professor of health policy and management at Harvard University, wrote on the Health Affairs blog that “federal policymakers are trying to move the provider community from the ‘ability’ to do things electronically to actually demonstrating that they are doing it.  While this is a laudable move, I suspect that many providers are going to push back.  It is not clear that 10 percent of patients will want to view, download or transmit their data to others.  It is hard to imagine that we are going to punish providers when their patients choose not to look at their own data.  Whether this part of the preliminary rule will make it into the final one is unclear.”

Louis Wenzlow of the Rural Wisconsin Health Cooperative wrote on cooperative’s Rural Health IT blog that the requirement introduces a new wrinkle that is likely to disproportionately negatively impact rural providers. He notes that there are exclusions available to rural providers in areas where broadband Internet access is limited. But Wenzlow suggests that, “even with the 4-Mbps broadband availability exclusion provision, it’s likely that rural providers (who disproportionately serve older patients) will have significant challenges meeting a core requirement that is not reasonably within their control. My experience of the ‘provide patient with an electronic copy of health information’ Stage 1 objective is that many rural providers had zero patients make the request. In this context, a 10 percent access core requirement seems unjustified.”

Based on these and other comments, my nominee for “Measure Most Likely to be Scaled Back After the 60-Day Comment Period” goes to the 10 percent rule.

Anyone in the Healthcare Informatics community disagree? Or do you have any other measures you would nominate for Most Likely to Be Scaled Back?