Proposed patient access change sparks MU debate

Abolishing v/d/t threshold could help providers, but patient engagement proponents cry foul
By Mike Miliard
10:28 AM
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One of the more troublesome measures of Stage 2 meaningful use has been the requirement that providers get at least five percent of their patients to view, download or transmit their digitized health information.

The biggest knock against it has been that, like similar outward-facing measures of Stage 2, it left too much out of health organizations' hands. As Robert Wachter, MD, puts it in his new book, The Digital Doctor: Hype, Hype and Harm at the Dawn of Medicine's Computer Age, some of the early challenges related to the rule had to do with the fact that, to work, it "depended on a clinical ecosystem and healthcare culture that did not yet exist.

"To comply with (view/download/transmit), not only did the vendors need to reengineer their patient portals and the hospitals and clinics revamp their workflows, but providers now became responsible for ensuring that their patients were doing something with their newly downloaded data," Wachter wrote.

But many patients either weren't aware of, weren't interested in, or didn't have the means to access their portals.

"Stuck in this electronic Catch-22, some hospitals are going to fantastic (in both senses of the word) lengths to meet the meaningful use requirements." Indeed, we've reported on some of them here.

Late in the afternoon on Friday, April 10, as many in the healthcare IT industry were packing their bags to head to Chicago for the 2015 HIMSS Annual Conference & Exhibition, the Centers for Medicare & Medicaid Services published a proposed rule that, among other changes, would relax that 5 percent v/d/t requirement in a big way – instead requiring only that a single patient access his or her data, to merely show that the capacity for digital engagement exists.

If some Stage 2-struggling providers are welcoming that news, there's been an immediate backlash from some high-profile patient access proponents, and the move was hotly debated this past week at HIMSS15.

The suggested modification "is a startling and unwelcome departure," said National Partnership for Women & Families President Debra L. Ness, in a statement. "All of us who care about achieving the 'Triple Aim' – better care, better health and lower costs – know that success depends on patients being equal and engaged partners, true co-creators, of their health and their care. This rule signals a turn in precisely the wrong direction."

Ness said NPWF was "stunned and dismayed" by the change – a feeling that might also be ascribed to Farzad Mostashari, MD, the former national coordinator who was largely responsible for drafting the Stage 2 rules.

Mostashari, who is now CEO of Aledade, a firm that offers consulting and IT services aimed at ACOs, was vocal about his disapproval of the new proposal; it's a rare thing for such a high-profile figure to expressly take issue with federal health IT policy rules, so the strength of his feelings on the issue seemed clear.

"I support patients rights to get their own health records - electronic, affordable, NOW," he tweeted.

At HIMSS15, he and other advocates put forth the call for a "day of action" –  #DataIndependenceDay and #GimmeMyDamnData were among the hashtags on Twitter – during which one million patients would simultaneously assert their health record access rights.

Current National Coordinator Karen DeSalvo, MD, was measured in her response to the debate. At a HIMSS15 press conference, she expressed the need for "shared solutions," and called for policymakers, providers, patients and vendors to "come to the table" and find the right balance for encouraging patient access without overburdening physicians and hospitals.

Speaking at a HIMSS15 education session on Tuesday, titled "What Do Consumers Really Want from Personal Health IT?" patient engagement guru Jan Oldenburg said she recognized that the 5 percent threshold has been a big challenge for some providers.

"There's been a lot of distress about how hard that seems to get to," she said. "But there's a lot of work going on, of systems trying to make that work. Trying to figure out how to make everybody in the system participate in bringing patients in."

Oldenburg pointed to the example of some large integrated delivery systems that are "achieving engagement rates with their digital tools of more than 50 percent, (with) an average in the 20 to 30 percent range."

When care providers "work together, when they view patient engagement as a team sport," she said, "it actually has impacts on what people do and how they engage."

The new proposed rule is a step back, said Oldenburg.

"One patient isn't enough. One patient doesn't require you to make it an organizational priority. One patient isn't sufficient to demonstrate that you really have embraced this, and are doing the behavior and culture change necessary to make it a real thing."