CMS May Revisit Patient Engagement Rules – Meaningful Use Monday

Health Data Management has a fascinating quote from Travis Broome, specialist at CMS, during a presentation on meaningful use Stage 2 at MGMA 2012.

Stage 2 electronic health record meaningful use requirements that at least five percent of patients conduct secure messaging with physicians, and view, download, or transmit their ambulatory and inpatient data came at the insistence of HHS Secretary Kathleen Sebelius. And those requirements might not be set in stone.

The patient engagement requirement has long been one of the most talked about challenges with meaningful use stage 2. The problem is easily seen. Doctors EHR incentive is being held hostage by something they don’t control. If patients don’t want to access their health information, are doctors suppose to coerce them into doing so?

An article in Fierce Health IT also has a money quote on what’s wrong with this MU stage 2 provision:

As Jeremy Tucker, medical director of MedStar St. Mary’s Hospital in Leonardtown, Md., told FieceHealthcare, better patient experience comes from cultural change across all levels of the organization. “If the reason for doing patient experience is simply to get a better score on a test, you will fail,” he said. “It only takes one cold meal tray or a roll of the eyes by a staff member to derail the patient experience.”

While I love the intent of patient engagement, I don’t love it as a requirement for EHR incentive money.

Another great comment from Broome from the Health Data Management article above is in regards to meaningful use audits:

Answering a question about meaningful use payment audits, Broome acknowledged that the audits have begun. He declined to give many specifics other than saying that providers falling into certain “risk profiles” might be asked to justify their attestations. One practice, for example, attested to meaningful use and supplied identical statistics across multiple criteria, all but inviting suspicion. When challenged, that practice returned the money, Broome said.

UPDATE: Travis Broome sent me this clarifying tweet:

Of course we know he can’t do anything without the secretary approval. Hopefully the bar is a little more than everyone failing. How about almost everyone failing or most people failing?

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John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

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  • So Doctors can’t control patient use of patient portals. Hmm. I’d say they can – by not even telling patients that the portal is available. By making sure that office staff won’t sign up users, and by making sure that it’s not setup properly, doesn’t have the right info. Right, that’s all negative, but it sure works to prevent portal use. Or, a doctor can ask patients if they use the web, and would like access to their records, would like to be able to message their doctors if something comes up, etc. My mother would probably say no – at 80 plus she has minimal interest in computer use. But so many other people I know, once they understand this, could get very interested with a bit of help.

  • They can certainly inhibit adoption of the portal. They can even as you say sign up users. However, what the user does once they’re signed up is out of their control. The regulation says that 5% of patients have to download their record (not the exact language, but the gist of it). That’s why many think it went to far.

  • I don’t remember the exact text, but on the one portal that someone in my family has access to, we’ve looked up meds, past visit info, tried to see lab results (internal lab test results don’t show on their portal even though there is a place for it). And we’ve communicated with the doctor via the portal.

    Does this count towards MU Stage 2? I sure hope so.

  • I think there are actually 2 requirements for this. I’d need to dig in to find the exact language. One requires that I believe 10% send a secure message with a provider. The other requires that records be available to patients and that at least 5% of them print, share or download their records. In your example, it sounds like you haven’t downloaded the record.

  • I did do the secure message. I viewed records, but had no need to print them, and had no particular need to download anything (like to a PHR that doesn’t exist)! Lovely.

  • I think if you viewed them that’s considered a download. In order to view them, they had to be downloaded to your computer even if it was in your cache. That would likely count. Although, we’ll see how their interpretation goes.

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