Last week we began a series of blogs dedicated to Meaningful Use Stage 2. In today’s blog we begin to review the new measures. We also provide a new Meaningful Use Stage 2 page on our website displaying a table that was included in the proposed rule by the Department of Health and Human Services (HHS). The table lists the new proposed measures sorted by the Core and Menu set.

The Stage 2 Meaningful Use (MU) Measures are structured as Core and Menu sets, just as they were in Stage 1. In Stage 2 of Meaningful Use, there are a total of 17 Core objectives that are required for ambulatory Eligible Professionals (EPs) and 5 Menu measures. EPs must report on 3 of 5 Menu set objectives. In addition, EPs must report 12 ambulatory clinical quality measures. Many of the Menu measures that were optional in Stage 1 of Meaningful Use are now incorporated into the Core objectives of Stage 2.

EHR Meaningful Use Stage 2As we review the 22 new measures and the clinical quality requirements, we will try to explain, in detail, the goals of each measure and their applicability and impact to physicians that are “in the trenches” providing care.

Definition: Social engineering is a discipline in political science that refers to efforts to influence popular attitudes and social behaviors on a large scale, whether by governments or private groups.

(If you’re wondering why we provide this definition, read on)

The 2 Core measures that we will review today are titled:

  1. Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the EP.
  2. Use secure electronic messaging to communicate with patients on relevant health information.

We believe that these two Meaningful Use measures are the most egregious of the 22 new measures, because they are the best example of the government overextending their authority. The Meaningful Use program should be about the propagation of EHRs and not an exercise in social engineering.

On face value these measures seem reasonable, but the “devil is in the detail”.

Let’s review the first measure captioned above: Providing patients with the ability to view, download, and transmit their personal health record (PHR) within 4 business days. The government explains that, “The goal of this objective is to allow patients easy access to their health information as soon as possible so that they can make informed decisions regarding their care or share their most recent clinical information with other health care providers and personal caregivers as they see fit.”

This objective replaces the Stage 1 Core objective for EPs of, “Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies) upon request”, and the Stage 1 Menu objective for EPs of, “Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP.”

Specifically the government proposes that:

  1. More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP’s discretion to withhold certain information.
  2. More than 10 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download or transmit to a third party their health information.

The first part of this measure seems logical; it is solely within the power of the healthcare provider and their EHR vendor to actualize that part of the measure through a patient portal. In our system that means that a provider needs to sign their encounter within 4 business days and make sure that their patient has login credentials to the MediTouch – YourHealthFile® patient portal, and the MediTouch system takes care of the rest.

The second part of the measure is the part where we find a glaring overreach by the government. It requires that the patient use the online data by viewing, downloading, or transmitting it. In other words, if your patients don’t go online and use this feature of your patient portal, then you can’t meet Meaningful Use. This is the first situation that we know of where a healthcare payer is tying physician incentives (monetary rewards and penalties) to the social behavior of their patients. If a provider’s patients simply do not have the need to log in and review their health records, then the provider is penalized. If the provider spends time with each patient, such that less than 10% of their patients feel the need to view their record online, the provider is penalized.

Example: If you are a pediatrician and you provide your patients with excellent care:

  • You explain the details of each encounter to the patient’s parents
  • You provide an up-to-date paper version of the child’s immunization record
  • You communicate abnormal test results to the patient in a timely fashion
  • Most of your care is routine

If the above is true, then what type of demand is there for the parent to view the record online 10% of the time? You provided great care and less than 10% of your patients (or their parents) have the urge or the need to look at the health record online. Sorry, you can’t meet Meaningful Use.

The government explains their approach: “While this is a departure from most meaningful use measures, which are dependent solely on actions taken by the EP, we believe that requiring a measurement of patient use ensures that the EP will promote the availability and active use of electronic health information by the patient or their authorized representatives.”

EHR Meaningful Use Stage 2 Online Access

The second measure to review today is titled: Use secure electronic messaging to communicate with patients on relevant health information. The government explains why this measure is an important Core measure that assists in engaging patients and families in their health care:

“The inability to communicate through electronic messaging may hinder the provider-patient relationship. … The use of common email services … may not be appropriate for the exchange of protected health information. Therefore, the exchange of health information through electronic messaging requires additional security measures while maintaining its ease of use for communication.” (Secure Messaging)

The government provides the following detail on why secure messaging is good for patients. They report that research supports that:

  1. Secure messaging has been shown to improve patient adherence to treatment plans, which reduces readmission rates.
  2. Secure messaging has also been shown to increase patient satisfaction with their care.
  3. Secure messaging has been named as one of the top ranked features according to patients.
  4. Providers have seen a reduction in time responding to inquires and less time spent on the phone.

Specifically, the government proposes that a provider can’t meet Meaningful Use unless:

“A secure message was sent using the electronic messaging function of Certified EHR Technology by more than 10 percent of unique patients seen by the EP during the EHR reporting period.”

We agree that providing technology to patients that facilitates secure physician messaging is appropriate, in fact, our YourHealthFile patient portal already offers this capability. The government’s intrusion in the practice of medicine and in the very special physician-patient relationship is exemplified by the 10% of all patient mandate section of the proposed Meaningful Use Stage 2 rule. There are benefits to secure messaging, but there is no proof that a federal mandate that applies to all physicians and practice types would advance the care of all patients. This type of extrapolation is reckless and, in addition, the government should not link financial incentives to the manner in which providers and patients communicate.

In today’s blog post we grouped together two measures that propose to change the way physicians and patients relate to each other. The government is proposing to reward or punish medical practices not based on physician performance, but instead on the behavior of their patients. This infringement on the traditional physician-patient relationship is an overreach and could have a detrimental effect with regard to that special bond. One of my physician friends sarcastically commented that he might be incentivized to have less people answering his phone and force patients to communicate electronically with his office in order to meet one of these measures. Over-regulation has unpredictable consequences, and forcing doctors to monitor the online activities of their patients may backfire. One thing for sure, it is the worst kind of social engineering. We hope that when the Stage 2 proposed rule becomes law that the provisions that mandate that physicians are responsible for their patient’s online activities are removed. Now is the comment period for the Stage 2 rule and we plan on submitting this blog post to CMS.