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Should Eligible Professionals Be Held Accountable for Patient Use of Health IT?

The Health Information Technology Policy Committee Meaningful Use Work Group’s objectives include two measures for which I invite comments from the AmericanEHR community.

Under the category of “Engage Patients and Families in Their Care” are these draft objectives for Eligible Professionals (EPs):

1. 10% of patients/families view & download their longitudinal health information; information available to all patients within 24 hours of an encounter

2. Patients are offered secure messaging online and > 25 patients have sent secure messages online

I expect that many (if not most/all) members of the AmericanEHR community support the idea of engaging patients and families because it is good clinical care and helps people understand and manage their health conditions. However, if the objectives above are put into the Core Set of Stage 2 Meaningful Use objectives, then EPs would have to demonstrate — among all of the other Core Measures — that: a) at least 10% of an EP’s patients accessed and downloaded their clinical information, and b) at least 26 patients used a secure messaging feature to communicate with the practice.

Advocates of these objectives make the case that simply offering the opportunity for patients to download clinical information or communicate through secure online messaging is not sufficient to get patients/families engaged. They maintain that creating a threshold will motivate offices to encourage their patients to use the technology. Others believe that if the capabilities for information download and secure messaging are designed appropriately, fit into the office workflow, and are simple for patients/families to use, that such thresholds will be unnecessary. Those who hold this belief maintain that EPs and patients/families will avail themselves of these features and functionality because they will create value and provide useful (perhaps “meaningful”) information.

So… what do you think? Is it reasonable to set these thresholds (or any threshold) for EP performance based on patient/family utilization of available health IT? If your answer is “yes”, then would you be comfortable if the threshold for Stage 3 was set much higher — let’s say 30% or 40% for download and >100 for secure messaging?

If you are against the notion of setting thresholds but support the concept of engaging patients in their own care, then how would you respond to advocates of these metrics who are concerned that engagement of patients/families will be slow if the only expectation of EPs is to offer these functions without holding them responsible in some way for the use by patients/families?

Disclosure alert: I sit on the HITPC Meaningful Use Work Group.

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.

Comments:

4 responses to "Should Eligible Professionals Be Held Accountable for Patient Use of Health IT?"
  • May 24, 2011
    Sherry Reynolds aka @cascadia
    said:

    Although we often hear that we manage what we measure and metrics like this might encourage closer collaboration between patients and their care team what really needs to shift is towards a culture of patient centered care. Otherwise you just have an electric pencil.

    At Group Health with over 600K members (is it a co-op)we designed the EHR around the patients needs and in fact gave the patients the ability to read and write (via email) to their records even before the doctors and other health care professionals did (they had read but not CPOE).

    The result? The highest rates of adoption in the country (over 50%) by patients. Over 30% of all visits done remotely (via email or telephone encounters) and higher patient and provider satisfaction scores..

    Health IT is a powerful way to expand the almost sacred relationship between provider and patient to fit into the patient (and their family members) workflow by providing a new way to communicate and connect. This way of communicating allowed all of the family practice providers to shift to the medical home model with visits up to 30 minutes and a focus on chronic conditions.

    In my opinion, the real goal are outcomes that matter and measuring patient use is just a simple surrogate to help identify those practices that really grasp the power of health IT these metrics are the bare minimum.

    • May 24, 2011
      Michael S. Barr, MD, MBA, FACP
      said:

      Sherry – thank you for your comment. Does Group Health hold clinicians accountable for the use of the new health IT options by their patients? Is there any financial incentive (or penalty) for clinicians based on patient/family use (or lack of use)? The impression I get from your comment is that Group Health focused on building a system that worked for patients and the clinical team – and that is what drives its utilization.

  • May 25, 2011
    Arvind Cavale
    said:

    All this just goes to show how disconnected CMS and the powers-that-be in the government are with real clinical practice. Meaningful use should be defined by each physician practice and its patients, not the government. Once you start on this path, there is no stopping it, because you afford legitimacy to such an illegitimate mandate.

  • June 2, 2011
    Anita Samarth
    said:

    Hi Michael – we’ve been watching this dialog intently and pondering the same questions. We’re eager to watch the discussion here. As our eHealthDC team thinks about patients seen by PCPs and CHCs in DC, there’s certainly lots to consider regarding patient access to computers and the Internet.

    I hope to see other applications and tools that support patient-provider communication and access to health information such as mobile devices. While the current thresholds are admittedly low, the longer term plan needs to address acccess to PHRs/portals or alternative tools and platforms for all patients.

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