The Meaningful Use program was introduced in 2009 and was intended to push the U.S. healthcare system into the future by encouraging the use of electronic health records (EHRs) at all levels, creating a system of interoperability, and establishing quality reporting systems. The program is being implemented in three stages. Stage 3 expected to be rolled out in 2017-18.

Problems with Stage 2

The patient engagement requirements of Stage 2 are challenging, particularly considering that many health-care providers are still struggling to meet the Stage 1 criteria. Stage 2 was supposed to have been fully implemented by most medical practitioners by 2014, but so few practices met the criteria that the Center for Medicare and Medicaid Services (CMS) postponed the deadline until late in 2015, giving providers extra time to meet the criteria without facing financial penalties.

Patient Portals

The major stumbling block for Stage 2 has been the patient engagement requirement. A certain percentage of patients were required to engage in their health care by logging into the patient portal of the EHR provided by the practice. Only 32% of physician practices and 11% of hospitals managed to meet the 5% patient portal use requirements of Stage 2. The Stage 3 requirements are even more difficult to meet- the 5% number is being bumped up to 25% of discharged patients viewing their medical records online through a patient portal. At least 35% of patients will also need to be sent electronic messages via the patient portals.

Reluctant Patients

During Stage 2, the original goal of 10% of patients using a patient portal was reduced to 5% after so many health-care providers struggled to get even a few patients to use the patient portals. This aspect of the draft Stage 3 requirements may be under attack by the health-care industry, which argues that it cannot force reluctant patients to use patient portals.

Meeting Patient Engagement Criteria

Advisers strongly suggest that health-care practices seek dedicated administrative staff or engage outside experts to manage their patient engagement requirements. Busy physicians often do not know how to use the patient portals themselves, and are unwilling and/or unable to explain to patients how to use the portals and the many benefits of using the portals. Specialized support staff may also be necessary to maintain and use the practice's EHRs, manage the data and reporting requirements, and send out all of the messages to patients required under Stages 1 and 2.

Successful Practices

Practices that have successfully integrated EHRs and met patient engagement rules indicate that changes in workflow and staffing are necessary. A greater amount of time and dedicated, specially trained staff are necessary to work with each patient both upon entry into the practice and after meeting with the clinicians. The time spent at entry involves updating the EHR.

The time spent after meeting with the clinician involves introducing the patient to the patient portal and encouraging its use. Most successful practices also engage outside experts to assist in maintaining and using the EHRs, and in meeting the data and reporting requirements. The Stage 1 and 2 rules are a challenge and as such, it may be much more difficult to meet Stage 3 requirements going forward, and practices that are already struggling to meet the Stage 1 and 2 requirements will clearly have to re-think their approach.