The proposed rules for Stage 2 Meaningful Use are now available for public comment. In looking through the CMS Proposed Rule on defining what Eligible Professionals must do to satisfy Meaningful Use beginning in 2014, and the corresponding ONC Proposed Rule that defines specification criteria for EHR vendors in order to become certified as Stage 2 products, there are some emerging themes.
As described by ONC head, Farzad Mostashari, in the ONC’s blog, “Stage 2 meaningful use includes standards such as online access for patients to their health information, and electronic health information exchange between providers.”
Patient engagement is a big part of where health IT is heading, and is encouraged by the shifting emphasis seen in the Stage 2 proposed rules. Creating online portals where patients can review their health information – in other words, a connected PHR-EHR – is becoming more central. The expectation is that, at the very least, patients should be able to see their problem lists, medications, allergies, immunizations, and lab test results online, on-demand.
Further, the notion of routine two-way secure messaging between a patient’s portal and their physician is coming to be an expected standard-of-care. This is a proposed capability in the Stage 2 EHR certification specifications. Many practices have achieved this themselves already, though it may have been done piecemeal by aggregating elements of multiple technologies together – integrating such capability into the EHR will be a positive thing. The messages can become more centralized, so that this is not “yet one more place” to go looking for patient messages.
Personal Health Records become increasingly important
The emerging role of connected PHRs will likely need to evolve beyond what the ONC is proposing in Stage 2. Most patients are seen by multiple physicians, and often those physicians are in distinct clinical practices using systems that (at least on the surface) are disconnected from each other. A PHR should be a focal point that is able to tie all those locations of care together, so that a patient can review all the information from all the different caretaking professionals in one centralized place. We are a ways from achieving that goal, but that is the general direction. The closest examples of such capabilities are in multi-specialty closed systems (such as Kaiser) where there is a single PHR window to the whole system. But outside the walls of such systems, online access is as fragmented as healthcare delivery is in the first place.
If we can build PHRs that can connect different doctor’s practices together, and do so in an easy, seamless fashion, then the PHR can be the focus of permission-granting for sending records to where they are needed. They could, potentially, be the hub of Health Information Exchange – the other emergent theme of Stage 2 Meaningful Use.
More and more, patient engagement is becoming central to health IT, and to health care in general. Patient experience (formally called “patient satisfaction”) is something that has been measured for quite some time, mainly by health plans. Now, with more coordinated care organizations emerging to take responsibility for managing the health of defined populations (e.g. ACOs, PCMHs), such patient experience feedback is taking place at the organization level (not just from the payers). Emerging EHR technology will also likely include the capability of measuring and assessing patient experience at the practice level – and utilizing a connected PHR as the place for doing this is something that makes sense.
There will likely be many experiments in the marketplace, as different vendors try different approaches to improving patient experience and enhancing engagement. Only through such experience, honing “what works best” from results “in the field,” will best-practices emerge showing how to most effectively maximize patient experience and engagement. This is a very promising area where health IT can truly help re-define the relationships in health care, and result in a more engaged, more effective, and more participatory delivery system.