Stage 2 of meaningful use has been a challenge thus far for many providers. The Health Information Technology Policy Committee reported in July that only 10 hospitals have met the requirements.
One of the main challenges hospitals are reporting facing Stage 2 deals with something that is, in essence, out of their hands: the requirement that 5% of patients be engaged in their care through an online portal or electronic medical record. Hospitals that don't achieve 90 consecutive days of meaningful use at Stage 2 during the 2014 fiscal year will be penalized financially. They must do this to continue receiving their incentive payments and avoid losing 1% of future Medicare reimbursements.
Importance of engagement
It is generally accepted that hospitals have a vested interest in improving patient engagement beyond the federal requirement. Engagement plays a crucial role in when providing quality care to patients and reducing costs. A Robert Wood Johnson Foundation report showed that patients who were not engaged in their healthcare were 21% more costly to the system than those who were.
A pilot with high-risk Medicare patients recently discharged from a hospital found that 30-day readmission rates were cut by nearly 40% and patient costs were reduced by $109 per patient per month. During the six-month trial, a health coach used a mobile app that offered questions for patients to consider based on the their diagnoses, treatment plans and risk profiles.
Cost-reduction benefits to hospitals aside, patients want to be engaged in their own care. A 2013 study from Accenture found that 40% of patients surveyed would be willing to switch providers if it enabled them to gain access to their health records online.
Barriers to progress
Still, increasing engagement has been a challenge. Hospitals have reported that vendors are not prepared for the more stringent requirements of meaningful use.
The American Hospital Association surveyed members between November 2013 and February 2014 and found that nearly 75% of hospitals had electronic medical records that could carry out most of the requirements for Stage 2. A much smaller number—only about 10%—had systems where patients could view, download or transmit their health information. Not even half of the systems could create a care summary.
And while patients are eager to take part in their care, they find it challenging for a number of reasons including limited access to EMRs, low health literacy and a lack of information given to them by providers.
Another barrier to increased use of EMRs may be the providers themselves. A study by TeleVox and Kelton Research found that half of providers surveyed said they don't communicate with patients between office visits—they felt their job ended when a patient left their building.
Dominick Frosch, a Robert Wood Johnson Foundation scholar, had similar findings in a study he performed between 2010 and 2012. He worked to educate physicians on using patient decision aides and create incentives for them to provide the materials to patients with various health conditions. In spite of this, only one in every 10 eligible patients received an aid and only 27% of physicians distributed them to patients.
Physicians said they didn't have time to hand out the materials, but also that they also felt that patient input wasn't needed and that physicians should be the ones making decisions. Finally, the physicians reported a lack of familiarity with the materials (even though the researchers had spent time educating providers on the content of the aides).
A February 2014 report by the American Health Information Management Association offered ways providers can increase electronic patient engagement. These include updating organizational policies addressing patient EMR access (particularly looking at gaps in the system); continuously educating patients and providers of their roles related to the engagement; making sure information is robust, including more than just appointment dates and lab results; staying current with standard development that supports consumer engagement; and eliminating patient fees for electronic health information.
At the Health Information Technology Policy Committee meeting, Tom Johnson, CIO of DuBois Regional Medical Center in Pennsylvania, said the organization hired a full-time licensed nurse practitioner to talk with and encourage all hospitalized patients to log into the system post-discharge to find their lab results.
These efforts only got 7% of patients who were enrolled to use the system. But that surpassed the 5% requirement and the hospital was the first in the nation to attest to Stage 2.