Getting Patients Engaged in Care and in Meeting Meaningful Use

In the Stage 1 rules to meaningful use of their EHRs, physicians and their practices had to step up the way they collected and shared patient data. Now in Stage 2,  they will have to continue those efforts, but also be prepared to get patients more involved with their own health information, beginning in 2014.

"If Stage 1 was the introduction [to sharing patient data] … then Stage 2 takes the engagement bar even higher," said David Rowe, director of product marketing for health IT firm Caradigm. "[The federal government] is using Stage 2 as the springboard for patient engagement."

Rowe moderated a panel at this year's HIMSS13 Conference in New Orleans about making patients partners with physicians to increase engagement and in turn, assist in meeting the Stage 2 requirements.

From the use of secure messaging to providing patient education, physicians will have to prove to CMS that they are meeting certain thresholds of patient engagement to achieve meaningful use in Stage 2 and receive an incentive check.

But meeting those goals is not too cumbersome when you consider the payoff in getting patients involved in their own care, according to Eric Manley, eHealth system manager for the Mayo Clinic.

"When we looked at meaningful use and what it was doing to engage patients and utilize health IT ... Mayo was already moving toward that to prevent visits and follow-up visits," he said. "Meaningful use was 'nice' in that it was pushing us forward."

Manley said that the clinic's network-wide patient portal was a key tool for Mayo in meeting core requirements of Stage 2; providing patients with their own health information; using secure messaging with patients; and increasing the sharing of patient information between providers.

In terms of providing patient health information, Manley said it is "the way we provide this access." Mayo has moved past the passive approach of simply introducing the technology to patients and essentially forcing them to use it as the source of information, he said.

"Just having it is no longer enough," he said. "Now we have to get you [the patient] to use it."

And that's the key, Manley noted, for the link between patient engagement and meeting the Stage 2 rules for meaningful use. Nothing is automatic or happens simply by bringing new technology onboard.

"Simply making services available doesn't cut it," he said. "Unless you are engaging patients, you won't meet meaningful use requirements. [Messaging and other mechanisms] need to be a part of your practice."

And even if you explain the portal 10 times and a patient refuses 10 times, Manley added, if you listen to what exactly the patient wants, more times than not it is what you are currently offering in the portal. Often these descriptions of technology happen outside the context of the patient  visit, so there is greater hesitation to adopt.

That sentiment was echoed by Simeon Schwartz, MD, CEO of New York-based WestMed Medical Group, which is shifting to the accountable care organization model. WestMed's approach goes beyond tech as well, Schwartz noted, as the real key is timely access to information.

"It is no longer sufficient to be visit-centric," he said. "You have to pull from a variety of educational resources to get patients [involved in their care]."

Schwartz added, "Electronic is important, but phones and snail mail are as important [for patient engagement]," referring to his facility's use of patient mailings and reminders, including utilizing the top of a bill for friendly preventative care reminders.

WestMed isn't even the sole source of patient information, partnering with a third party to provide educational videos and other materials to their patients. WestMed physicians actually "order" the patient education materials following the patient's visit and the vendor provides it online or through a device in the practice. Schwartz said that 30 percent to 40 percent of all patients are using the materials and the health system is actually incentivizing physicians for patient utilization of the educational materials.

Patient engagement opportunities like this, he said, "won't be used" unless they are integrated into a facility's physician and staff work flow.