Patient engagement is key to incentive payment


Your patients’ actions may hold the key to whether you can achieve meaningful use of electronic health records and receive an incentive payment under Stage 2 rules released last August.

For both Stage 1 and Stage 2, physicians will need to offer patients the ability to view online, download and transmit their health information.

But at least 5 percent of them must actually view, download or transmit the information for the objectives to be achieved in Stage 2. Critics say the measure holds physicians hostage to circumstances over which they have no control.

doctor talking to patient

Access to electronic health information

new core objective for Stage 1 becomes effective in 2014. It will replace the core and menu objectives of providing patients with electronic copies of their health information upon request and timely electronic access to their health information.

For both stages, more than 50 percent of unique patients seen during the electronic health record (EHR) reporting period must have access to the health information within four business days after it is available to the physician. Health information includes lab results, problem list, medication lists and allergies.

“Access” as defined by the Centers for Medicare & Medicaid Services (CMS) can include providing patients with instructions on how to access their health information, the required website address, a unique and registered username or password, and instructions on how to create a login, for example.

There is an exclusion for physicians who do not order or create the health information included in the list (e.g., lab results, problem list, medication lists and allergies, etc.).

Another Stage 2 core objective and measure requires secure electronic messaging between more than 5 percent of patients and the provider.

Patients’ decisions not to access the information may be only one of several barriers. Demographics may be another.

Physicians practicing in areas with large low-income or elderly population s may be at a disadvantage, as well as those practicing in areas with a high non-English-speaking population.

A Pew Internet study published in April 2012 found that one in five American adults does not use the Internet.

“Senior citizens, those who prefer to take our interviews in Spanish rather than English, adults with less than a high school education, and those living in households earning less than $30,000 per year are the least likely adults to have Internet access,” the study reported.

In addition, only 54 percent of adults living with disabilities in the United States go online.

Limited Internet access can be a potential problem in rural areas. In acknowledging the problem, CMS has excluded the 5 percent measure for physicians if at least half of patient encounters are in counties where 50 percent or more of housing units do not have 3Mbps broadband available on the first day of the reporting period.

Information on broadband width is available at

Patient acceptance

Proponents of increasing electronic engagement with patients claim the 5 percent threshold is actually quite low, given society’s penchant for electronic devices. About 9 percent of Americans already exchange emails with their doctors, according to a Harris Interactive poll.

Kaiser Permanente reports that more than 63 percent of eligible members use their online health management tools. What’s more, access to the information builds loyalty.

Patients with online access to key components of the Kaiser Permanente electronic health record’s patient portal, My Health Manager, are 2.6 times more likely than nonusers to remain members, according to a study published in The American Journal of Managed Care last July.

The University of Texas MD Anderson Cancer Center also has reported enthusiastic acceptance of their secured, Web-based portal for personal health information, which was launched in May 2009. In the first year, 57 percent of patients – more than 28,000 patients – accessed their personal medical information, test results and records.

Need for 2014 edition of certified technology

Both of the Stage 2 measures must be met using certified EHR technology (CEHRT). Capabilities provided by a patient portal, online personal health records (PHR) or any other means of online access would have to be certified in accordance with the Office of the National Coordinator for Health Information Technology requirements.

Many CEHRT vendors already make patient portals available that meet Stage 1 criteria and standards. However, the Stage 2 measure requires some additional capabilities.

These capabilities will be included in the 2014 Edition of CEHRTs. Among other things, the new edition will comply with Web Content Accessibility Guidelines (WCAG) 2.0 Level A.

The guidelines provide the minimum technical standards needed to make content accessible primarily for the disabled.

All participating physicians must upgrade to the 2014 edition come next year – whether they are in Stage 1 or Stage 2 of the incentive program. To allow physicians time to adopt the 2014 edition, CMS reduced the reporting period to three months in 2014.