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GAO Report: HHS Needs to Step Up Efforts to Encourage Patient Access, Use of EHRs

March 17, 2017
by Heather Landi
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Health care providers that participated in the U.S. Department of Health and Human Service’s (HHS) Medicare Electronic Health Record Incentive Program offered nearly 9 out of 10 patients the ability to access their health information online. However, a recent Government Accountability Office (GAO) report found that relatively few of these patients accessed their records online, and patients typically did so in response to a medical visit.

Since 2009, HHS has invested over $35 billion in health information technology, including efforts to enhance patient access to and use of electronic health information. One of the largest programs is the Centers for Medicare & Medicaid Services’ (CMS) Medicare Electronic Health Record Incentive Program (Medicare EHR Program), which, among other things, encourages providers to make electronic health information available to patients.

According to the GAO report, program data for 2015 show that health care providers that participated in the program (3,218 hospitals and 194,200 health care professionals such as physicians) offered most of their patients the ability to electronically access health information, the GAO report found. The full report can be accessed here.

While a median of 88 percent of hospitals participating in the 2015 Medicare EHR Program offered patients the ability to electronically access their health information, only 15 percent of patients accessed their health data electronically when given the opportunity, according to the GAO report. And, only 30 percent of patients of physician practices electronically accessed their available health information, despite the fact that a median 87 percent of providers participating in the 2015 Medicare EHR program offered patients the ability to access their electronic health record.

Patients GAO interviewed described primarily accessing health information before or after a health care encounter, such as reviewing the results of a laboratory test or sharing information with another provider. Additionally, patients generally described this access as beneficial, but noted limitations such as the inability to aggregate their longitudinal health information from multiple sources into a single record, the GAO report authors wrote.

The goal of the study was for GAO to review the state of patients' electronic access to their health information and evaluate HHS's efforts to advance patients' ability to electronically access their health information. GAO analyzed data from HHS and other sources; reviewed applicable strategic planning documents; surveyed a generalizable sample of providers that participated in the Medicare EHR program; and interviewed HHS officials and a sample of patients, providers, and health information technology product developers.

The GAO analysis found that age could be a factor in how likely a patient is to assess their electronic health information. By examining access rates by age, the GAO analysis of data from the 2015 Medicare EHR Program and data from HRSA’s Area Health Resources File indicates that the level of electronic access to health information reported by both hospitals and health care professionals was lower among those located in areas with a higher percentage of the population over age 65.

“The findings from our analysis of access rates by patient age are consistent with other evidence suggesting that older patients may be less likely to access their health information electronically compared with younger patients. Providers we interviewed and who responded to our survey, as well as health IT developers we interviewed, said that a patient’s age affected the extent to which she electronically accesses her health information. Multiple providers who responded to our survey and that we interviewed conveyed that, in their experience, older patients are less likely to electronically access their information. Providers and health IT developers noted that younger patients and those with chronic conditions are most likely to want electronic access to their health information.

The GAO found that while HHS has multiple efforts to enhance patients' ability to access their electronic health information, it lacks information, specifically outcomes measures, to determine the effectiveness of these efforts. “The Office of the National Coordinator for Health Information Technology (ONC) within HHS collaborates with CMS to assess CMS's Medicare EHR Program as well as its own efforts to enhance patient access to and use of electronic health information. However, ONC has not developed outcome measures for these efforts consistent with leading principles for measuring performance,” the report authors wrote. Without such measures, according to the GAO, HHS lacks critical information necessary to determine whether each of its efforts are contributing to the department's overall goals, or if these efforts need to be modified in any way.

GAO advises that HHS needs to evaluate the effectiveness of its efforts, to date, to enhance patient access to and use of electronic health information.

Moving forward, GAO recommends that the Secretary of HHS should direct ONC to develop performance measures to assess outcomes of key efforts related to patients' electronic access to longitudinal health information. “Such actions may include, for example, determining whether the number of providers that participate in these initiatives have higher rates of patient access to electronic health information,” the report authors wrote.

Secondly, to help ensure that the agency’s efforts to increase patients' electronic access to health information are successful, the Secretary of HHS should direct ONC to use the information these performance measures provide to make program adjustments, as appropriate. GAO advises that such actions may include assessing the status of program operations or identifying areas that need improvement in order to help achieve program goals related to increasing patients' ability to access their health information electronically.

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