Patient Engagement and Meaningful Use

We are now in the home stretch of demonstrating Meaningful Use of certified Electronic Health Record (EHR) technology for 2011. For the Medicare pathway to Meaningful Use incentive money – $18,000 per doctor in the first year of payouts – a certified EHR system needs to be used “meaningfully” for 90 consecutive days in 2011. The way in which Meaningful Use is demonstrated is by attesting to 20 of 25 criteria that have been specified by the Centers for Medicare and Medicaid Services (CMS).

In looking at the 25 Meaningful Use criteria, are there any that stand out as particularly challenging for doctors to implement? Anything that represents a significant workflow change in the typical ambulatory office? Several criteria are likely new for most doctors, but one in particular is probably the biggest challenge – giving patients a clinical summary that is updated after each and every visit (core criterion #13).

For Meaningful Use, this must be done for at least 50% of the visits. In a busy medical practice, where 20-30 visits a day for each doctor is commonplace, this can be an overwhelming task, involving many personnel within the practice in order to achieve.

The Clinical Summary criterion is one of several that are part of increasing patient engagement in their health care – one of the 5 healthcare priorities that underlie the 25 Meaningful Use criteria. Electronic Access to a patient’s healthcare information when patients ask for it (core criterion #12), and Timely Access to health information (menu criterion #7) are other items in the “patient engagement” domain.

Patient involvement in their care is an irreversible trend
Active patient involvement in their own health care is a national priority that went into the creation of these Meaningful Use measures in the first place. Numerous studies have confirmed what seems like common sense – engaged, participatory patients have better health outcomes (and cost the system less money, in the long run) than those with a more traditional, passive relationship.

Outside the tradition of doctors delivering care to their patients, “consumer health” has been a trend fueling a whole market segment over the past many years – from consumer health Internet searches, to web tools that allow consumers to track or understand their own health conditions, to social media tools that put consumers with similar conditions in touch with each other – all of this has arisen outside the domain of traditional health care.

Freestanding Personal Health Records (PHRs) have also seen a rise (and subsequent decline) in the market, guided by the hope that patients will create their own health record that can follow them across different healthcare-system settings. The main problem with this approach, which led to the failure of most such ventures, is their very disconnectedness – consumers were not interested in filling their own PHRs with data they gleaned from their doctors; they want that information automatically populated, from connected EHRs that their doctors are using.

Impact on physician workflow
One small step in routinely engaging patients in their own health care is embodied by the “patient engagement” Meaningful Use criteria. Many clinical practices will print out problem lists and medications lists to give to patients (or their caretaking surrogates) – especially for elderly patients on multiple medications. This is done selectively, and not as part of an obligatory routine. Similarly, printing out lab results and giving a copy to patients is frequently done on-demand, during the course of a patient visit.

But the Clinical Summary criterion obligates a clinician to give patients a summary – an updated list of problems (diagnoses), current medications, drug allergies, and lab results – every single time, for every single patient (not just for those who ask for it). This can be onerous.

Is there an alternative to printing out (what will amount to) reams of paper during the course of the work day, giving every one of the 20-30 visits each day a newly updated Clinical Summary? Fortunately, there is.

Using the connected PHR
The Practice Fusion system has a built-in PHR that (currently) is a one-way view of elements of patient data automatically populated by the doctor’s EHR. It is updated real-time when changes are made to the Problem List (the Diagnosis Summary), the Medication List, the Allergy List and Laboratory Results (for structured lab data – currently including LabCorp, BioReference, and several regional laboratories).

Enrolling a patient in the Practice Fusion PHR accomplishes the Clinical Summary Meaningful Use measure item. It also satisfies the Electronic Access and Timely Access measures. In fact, enrolling a patient once in the PHR satisfies the Clinical Summary requirement for all visits, since the PHR is automatically updated with any new information that results from each encounter.

What does this mean? It means that practices that enroll at least 50% of the patients they see during the 90-day measurement period in 2011 will qualify for Meaningful Use. It means that reams of paper and serious clogging of in-office workflow can be avoided (which would be the alternative scenario needed for the Clinical Summaries measure).

A massive increase in PHR enrollment will be the result of such efforts. Kaiser, which has an EHR-connected PHR, has experienced somewhere between 30-40% enrollment in their PHR. Is a 50% PHR enrollment target achievable? Meaningful Use will provide a powerful incentive to reach that. It is up to each practice – every solo and small-group practice that has adopted the Practice Fusion web-based EHR in their offices – to enroll their patients as they are seen during the 90-day period.

Hitting a 50% threshold is a challenge, but is quite achievable. It involves re-working a routine workflow in the office, and getting into the habit of enrolling patients in the PHR as part of the day-to-day routine.

With this kind of PHR enrollment as a starting point, future plans to build more features and functions into the PHR become more valuable. Things like two-way secure communication between patients and practices, or integration of patient-collected (or device-collected) data with the PHR and therefore with the EHR that their doctors see, are all part of the roadmap.

With large-scale adoption, the impact this will have on the overall health-policy goal of increasing patient engagement with their health care will be dramatically moved forward. There will be a time in the near future where everyone will expect to see their data via a PHR portal. This will become the standard of care.