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Exploring Patient Engagement, and What it Means to You

This post originally appeared on Dr. Sisselman’s Blog

I spent the last few days learning about patient engagement and I stumbled upon some interesting developments in the healthcare world.  I learned about #hashtags and #HIMSS15 and how passionate some patients and doctors are about data.  And medical records.  And access to both.  And much of this happened by complete accident.

Wanting to increase our office’s web presence, we have been very active in soliciting patient reviews and making us more visible on Google.  I have a twitter account for the practice @sissmedgroup and wanted to make it more active.  I noticed a lot of tweets on my timeline had the #HIMSS15 hashtag.  This refers to the Healthcare Information and Management Systems Society, a not-for-profit organization dedicated to improving healthcare quality, safety, cost-effectiveness, and access, through the best use of information technology and management systems.  They were apparently having their annual conference in Chicago and a lot of tweets were coming from there.  Many people at the conference seemed to be outraged that CMS, the group that oversees Medicare, had decided to modify some of the requirements doctors needed to fulfill to meet meaningful use.

First a little background.  Our practice has been involved in meaningful use since the beginning, meeting criteria in 2011, 2012 and 2013 with Stage 1.  In 2014, CMS began Stage 2, which featured more complicated measures and required additional technology such as DIRECT address communication between doctors and hospitals and required that 5% of patients view download or transmit their clinical summary and use secure electronic messaging with their provider.  It was found that so few hospitals and providers could attest to Stage 2, that it was delayed 1 year, and in 2014 providers could use stage 1 or a hybrid of stage 1 and 2 measures and attest for a 90-day period rather than a full year.  Well again in 2015 CMS decided that many EMR vendors had not upgraded systems and become certified with regard to stage 2 and again it has been suggested by CMS that the attestation period be just 90 days and reduce the number of objectives.  It’s that last part which sparked a(nother) fire in Chicago.  CMS did away with the 5% of patients needed to view download or transmit their clinical summary and send a secure message and replaced it with ONE patient needed to do so.  Some of the people at the conference were suggesting that patients all over the country should declare a Data Independence Day – and that a million patients should request electronic copies of their medical record – all on the same day.  July 4th no less, when 99% of all doctors offices are closed.  I thought that would clearly overload the system and patients who really needed their records would have trouble getting them.  Many others thought that Meaningful Use is about patient engagement and that with no patient engagement, needing just one patient per doctor to engage, is not Meaningful Use at all.

So I started thinking.  What exactly is meaningful use?  Before this week I thought Meaningful Use was something doctors had to meet in order to avoid being penalized by Medicare.  If Meaningful Use is not met, docs are subject to a 2% and more payment reduction from CMS.  Docs are paid money by CMS as part of the meaningful use program.  Each year, bonus money is paid to those who meet MU. What is the money for?  CMS says on their website, “ … provide incentive payments … as they adopt, implement, upgrade or demonstrate meaningful use of certified HER technology.” defines meaningful use as “ … using certified electronic health record technology to: Improve quality, safety, efficiency, and reduce health disparities.  Engage patients and family.  Improve care coordination, and population and public health.   Ah. There it is.  Engage patients.  My initial issue with the angry mob in Chicago was – we couldn’t control patient engagement as doctors.  We can’t make a patient download clinical summary and send me a message.  In fact, I recently emailed 2200 patients an invite to our patient portal and gave instructions on how to do so and asked they download their clinical summary and send a message.  Of those, 5% did download their clinical summary but only 1% sent a message.  I told some of the Chicago people that.  They had no answers but told me I had to try harder and engage them.  So I told each patient in my office that I wanted them to log on and gave instructions – handed to them – and told them this was important to me – so we could communicate securely and they could see their lab data and also – send me a message that they connected.  Any message.  Over a test period of 5 days, less than 5% logged on and 1% sent a message.  So if this kept up I’d lose money from Medicare.  I had no control over that.  I asked one well-known patient advocate who wanted to rally patients to request their records “if you failed to rally a certain percentage of patients, should your salary from your COO position be lowered?”  She never responded.    I asked some of these people in Chicago why should my money be tied to patients not sending me a message?  HIMSS  – the very organization holding the conference in Chicago released a quote by its vice president after MU stage 2 was changed to remove the patient engagement essentials “ … HIMSS is encouraged that CMS has listened to its members and other stakeholder concerns and included more realistic parameters for providers and hospitals, so they can meet the meaningful use requirements in 2015 and beyond”.  Is that what meaningful use is about?  Is it about demonstrating that an EMR can do what it says it can do and my ability to implement that?  Or is it also about engaging patients and their families.  So I’m left with this question – who or what does meaningful use have to be meaningful for?