Robert Belfort, Project HealthDesign Regulatory and Assurance Advisory Group, Manatt, Phelps & Phillips, LLP
The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) released the proposed rule governing Meaningful Use Stage 2 under the Medicare and Medicaid Electronic Health Record Incentive Program last week. In a move that is likely to promote patient engagement, the agencies took the advice of the Health IT Policy Committee and beefed up the requirements on eligible professionals and hospitals for sharing data electronically with patients.
The patient engagement requirements in Meaningful Use Stage 1 are important but limited. For example, in Meaningful Use Stage 1:
- Eligible professionals and hospitals must provide patients electronic copies of their health information upon request and within three business days
- Hospitals must provide electronic copies of discharge instructions to patients upon request.
- Eligible professionals must provide clinical summaries of each office visit to patients upon request, but these do not have to be in electronic format.
- Eligible professionals have the option of providing at least 10 percent of their patients electronic access to their health information within four days of the information becoming available to the eligible professional.
In the proposed rule for Stage 2, CMS and ONC are proposing to require eligible professionals and hospitals to provide patients with direct electronic access to their information. Patients will no longer have to request an electronic copy of their health information; instead they will have to be provided with a mechanism to electronically view — and securely download on demand — relevant portions of their health information.
Specifically, CMS and ONC are proposing the following patient-engagement-related objectives for Stage 2 of Meaningful Use:
For eligible professionals:
- Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the eligible professional.
- Provide clinical summaries for patients for each office visit.
- Use secure electronic messaging to communicate with patients on relevant health information.
For hospitals:
- Provide patients the ability to view online, download, and transmit information about a hospital admission.
For both:
- Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient.
Although these new objectives and their attendant measures do not hew exactly to those proposed by the Health IT Policy Committee, they are very close and represent CMS and ONC’s commitment to ensuring that health care providers use EHRs to improve not only their own access to health information but their patients’ access as well.
Further, beginning in 2014, CMS and ONC are proposing to replace the Stage 1 objectives requiring eligible professionals and hospitals to provide patients with an electronic copy of their health information/discharge instructions and with timely electronic access to their health information with the new view, download and transmit objectives proposed for Stage 2.
We think the patient engagement provisions in the proposed rule are good news for patients and that they could increase the demand for personal health records and applications that help individuals securely store, share and make use of their personal health information. We’d also like to give kudos to the Project HealthDesign team for providing the Health IT Policy Committee with valuable comments about extending the effect of meaningful use of EHRs beyond clinicians and to patients and their family members.
Of course, there is more work to be done. CMS and ONC will take public comments on the proposed rule before finalizing it. The comment period will last 60 days and we can expect a final rule sometime this summer. At that point, we’ll set our sights on Stage 3, which is scheduled to begin in 2015 and where we might see requirements that deal with accepting electronic data from patients.
The proposed rule will be published in the Federal Register on March 7, 2012. In the meantime, it is available for display or as a fact sheet.
Let us know your reaction to the new patient engagement requirements in Meaningful Use Stage 2 below.
