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Patient Engagement Challenges in Meaningful Use

What is Meaningful Use?

Meaningful Use is a program initiated by the Office of the National Coordinator for Health Information Technology (ONC) to incentivize physicians, hospitals, and other eligible healthcare providers to implement the potential innovative benefits of electronic health record (EHR) systems. Meaningful Use has three stages currently with two already in play and the third intended to build upon the mandatory and optional requirements of Stages 1 and 2.

It was originally hoped that previous stages of MU would solve the problems related to the exchange, sharing, and interpretation of data, also known as interoperability. Objectives and measures in that stage did address most of those issues, and they were a step forward. However they are still incomplete. More attention appeared to be given to a thorough definition of "meaningful use" in Stage 2 than to actual steps to foster more meaningful use of EHRs. Nevertheless, the purpose of that clarification was to make it easier for providers to demonstrate compliance with EHR and related technologies before moving to dig deeper into more detailed issues.

Among the various crucial areas of importance addressed in MU, there is established a number of significant patient engagement benchmarks.

How is Patient Engagement Evolving in MU?

Patient engagement is primarily implemented through the active use of patient portals. In fact, this is still one of the most problematic aspects of implementing Stages 1 and 2. In comparison, it is also anticipated that Stage 3 requirements may be even more challenging still.

For instance, initially, Stage 2 established that a minimum of 10% of patients verifiably use the patient portal to access their medical records. But hospital executives argued that they should not be held financially responsible for compliance since they could not force patients to use the system. In the face of these concerns, regulators lowered the benchmark down to 5%.

Oxymoronically, it is anticipated that Stage 3 requirements of patient engagement will dramatically raise the benchmark to 25%. The challenge now for hospitals and providers is to persuade one-quarter of their patients to use the patient portal. Raising participation to 25% is a significant challenge, especially given that most providers are still struggling to meet the current 5% participation required to qualify for Stage 2 incentives.

Potential Solutions

One possible solution is for the program to be redesigned from an incentive/penalty program to pay-for-performance. This would attempt to alleviate the financial consequences associated with patient non-compliance. But this would be a significant overhaul of the program, and therefore unlikely.

The focus returns to administrative solutions. With any kind of structural change, workflow is integral. Computer system changes, implementation, training, coordination, documentation, new data entry and management requirements, internal and external reporting, and detailed specific knowledge of the evolving Meaningful Use program and EHR in general are ongoing challenges for providers and their staffs.

It may be advisable to have a team of experienced subject matter experts dedicated to managing these many challenges. The number and complexity of potential distractions pulling healthcare staff away from direct patient medical care is increasing and will continue to do so. Systematic support team development is therefore necessary now and in the future.

However, how can medical professionals and their staff leadership be expected to build and manage such teams? No doubt these ongoing challenges are creating market solutions. Solution providers of various types will see the problems faced by healthcare organizations and attempt to develop viable paths to successful outcomes. The decision whether to engage such an organization is, in a way, another possible distraction.

In any case, the new challenges brought about through the patient engagement requirements in MU, and the modernization of healthcare through EHR are for each healthcare organization to face and, in the end, embrace. 

 

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