When it comes to meeting meaningful use (MU) requirements, it’s no secret that providers across the country have struggled with the patient engagement aspect of the mandate—specifically, getting the required 5 percent of patients to view, download, or transmit (VDT) their electronic health information.
That being said, the longer hospitals have been meaningful users, the better their performance on this measure. At a Health IT Policy Committee meeting earlier this month, it was revealed that of hospitals that have attested to Stage 2 of meaningful use, on average, 15 percent of their patients viewed, downloaded, or transmitted their electronic health information at least once.
Hospitals that have been meaningful users since 2011 have the highest average rates (18 percent). Even during 2014, there was movement on this measure: an average of 17 percent of hospitals that attested in November had the highest rates of patients viewing, downloading, or transmitting their electronic health information at least once. Those attesting in April and May had much lower rates of patients VDT compared to November, said Dawn Heisey-Grove, an analyst with the Office of the National Coordinator for Health IT (ONC).
Despite this uptick, this measure has been a pain point for physicians, who have routinely expressed dissatisfaction with the idea that they can lose incentive dollars for a requirement that’s dependant on other people. Jenna Barsky, manager at the New York City-based accounting firm WeiserMazars, works in the organization’s healthcare consulting group and has noticed that her clients—ranging from small physician groups to large health systems and everything in between—have received worse-than-expected numbers on their Stage 2 reports when it came to this patient engagement measure. “Stage 2 takes a lot of preparation, and it was a lot more than what organizations were ready for,” Barsky says. “With the patient engagement pieces, getting your patients to do things and relying on them is a key area of Stage 2, and a lot of times its difficult for providers to incentivize their patients to even log into the portal,” she says.
There are several strategies that Barsky says she recommends to her clients to increase patient engagement. For one, establishing governance around the project is key, she says. “A lot of times when I go to an organization, that’s the first thing I need to do, because from Stage 1, people they have had working on it have dropped off. You need to concentrate on the project and specifically have a patient engagement workgroup, so people are focused on that aspect,” she says.
What’s more, getting your physicians and staff to understand what a patient portal actually does and how it’s beneficial for the patient is another strategy that seems simple, but is often not done, Barsky notes. “Patients are more likely to log into the portal if the physician is recommending it to them—that goes a long way. Then patients will see the benefit of using it and the types of things they can access through it.”
As such, it requires effort from both the provider and the patient, Barsky adds. “With a project such as MU, you have a group working in IT or administration who are aware of requirements, and while physicians understand it, they don’t know exactly of what’s being asked of them, such as the details of each requirement, and the number of patients they need to log into the portal,” she says. “If physicians were more aware within their practices of what’s being asked of them, that would help the process.”
On the patient side, they’re often being asked at the front desk if they want to be part of portal, and along with that, to give an email address. Usually they’ll say no at first as they don’t want to be given more things to do, Barsky says. “That’s why it’s up to the offices and hospital staff to educate patients, and give them a quick summary on what the portal can help them do,” she says. “You can get appointments through it, send a message to your doctor, it’s another way to communicate. All of your healthcare information will be in this portal. I think if patients were aware of the benefits, they would be much more likely to say yes when asked if they want to be part of the portal,” Barsky says.
She adds that organizations tell her that one of their biggest challenges with this measure is getting around asking patients for their email addresses. “I hear that patients don’t want to be enrolled in the first place, they don’t want to give them their email addresses, they think they’ll be spammed,” Barsky says. “What a lot of vendors have done—and they’re learning what works too just like physicians—is they have changed their workflow so patients don’t have to provide email address to be part of the portal. That’s a big first step. Getting past that first hurdle, discussions became easier, as that barrier is no longer there. You can give them a username and password, and patients seem better with that option than with email addresses.”
Tougher Times Ahead?
Even though the 5 percent requirement appears to give providers enough trouble as is, in the Centers for Medicare and Medicaid Services’ (CMS) proposed rule for Stage 3 of meaningful use, the feds have increased the threshold to 25 percent. This jump has certainly caught the attention of various health IT experts, as noted in a recent Stage 3 proposed rule reaction piece from HCI.
Barsky thinks that the 25 percent threshold is a starting point by CMS, which could eventually be lowered. She advises organizations to make use of the rule’s public comment period, thinking that this specific measure will garner a lot of feedback. CMS has been clear about the goals of the program so it’s possible it sticks to that number, but Barsky is “hopeful” they could adjust after the comment period.
Barsky does admit that organizations will have to deploy more strategies to meet the new threshold if it does indeed stay put. “Clients are doing follow-up phone calls with patients, community outreach, having all the patients that want to come in on a day to teach them the functionality of patient portals. The first step is awareness, so you see marketing campaigns and t-shirts with patient portal information on it. There are lots of different ways to do it, and they will need to be utilized to hit that 25 percent number,” Barsky says.
Also related to patient engagement in the MU program is the requirement which asks providers to send an electronic message to 35 percent of their patents, up from 5 percent in Stage 2. Barsky points out that while the percentage went up, the Stage 3 rule has changed requirements so it’s more in the hands of physicians rather than patients. “Now, provider-initiated messages will count, rather than relying on patients sending you messages as you have now. If a patient sends you one and you respond, that also counts. It’s back in the control of providers, so I expect that to be well-received,” she says.
Barsky was additionally pleased to see Stage 3 objectives split up into electronic patient access and coordination of care through patient engagement. “Through that, they allow you to select two out of three requirements to meet. You have to report on all of them, but only meet two of the thresholds. That will be helpful as it gives providers more options,” she says.
“Providers will probably be very concerned at first, but the more they read though it, I think they will see the flexibility inside the rule when it comes to patient engagement,” Barsky notes. “It’s important to also remember that while some of these jumps are high, it’s still a few years away. There is time.”