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When the feds finalized the Stage 2 rules for Meaningful Use of electronic health records last summer, Dr. Farzad Mostashari, the national health IT coordinator, said Stage 1 was about "beginning the journey" to a nationwide network of interoperable EHRs that promote safety, quality, efficiency and care coordination. Stage 2 builds on that momentum and begins to emphasize data sharing. "The big message here is the push on standards-based interoperability of information," Mostashari said.
Indeed, Stage 2 ramps up requirements for health information exchanges, interoperability and, importantly, engaging patients in their own care in the name of care coordination. For the first time, achieving Meaningful Use and earning federal EHR incentive payments are no longer completely in the hands of providers, and that fact worries more than a few clinicians.
Stage 2, which begins two years after a hospital or individual provider first gets to Stage 1 -- but not before federal fiscal year 2014 -- requires participants to send electronic summary care records to other providers for 50% of patient transitions and referrals they handle. This must include 10% of transitions outside their organizations to providers using an EHR system from a different vendor.
Additionally, hospitals and practices alike must give 50% of their patients the ability to view and download their own medical records through online portals or other means, such as personal health records, up from 10% in Stage 1. And perhaps most significantly, 5% of patients actually have to log in to those portals for doctors and healthcare organizations to achieve Meaningful Use.
The 5% threshold may not sound like much -- an earlier proposal suggested 10% -- but for the first time, providers will have to engage patients in their own care or risk losing out on the bonus money.
"Even though it's just 5%, providers are now accountable. It's indicative of a larger industry shift," says Dan Prevost of Arcadia Solutions, a healthcare consulting firm focused on ambulatory care improvement. Prevost notes that few organizations have incorporated patient engagement into their workflows yet, so they face a daunting challenge. "This wasn't a formal requirement in Stage 1, so many will have to start from scratch," he says, requiring a lot of education.
"We need to bring in the consumer as part of the team," says Petra Knowles, CIO of PeaceHealth Southwest Medical Center in Vancouver, Wash. Knowles says organizations may choose to teach the importance of patient engagement as part of a patient-centered medical home, in which a primary care physician or practice coordinates all care for a given patient. "I think we have a lot of components already in place. What we've not done yet is tie them all together," Knowles says.
Success with engaging patients may hinge in part on an individual's level of comfort with the Internet, Prevost says. This is particularly true among Medicare and Medicaid patients -- seniors and low-income Americans.