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) recently released a final regulation setting forth the requirements
for Stage 2 of Meaningful Use under the Medicare and Medicaid Electronic Health
Record Incentive Program (the “Final Rule”).
In the Final Rule, CMS adopted a number of provisions that require
eligible professionals and hospitals to increase their efforts to share data
electronically with patients. As a
result, the Final Rule is likely to encourage greater patient engagement in
health care, something the Robert Wood Johnson Foundation advocated in comments
it submitted on the proposed rule. Here
is a relevant excerpt from RWJF’s comments::
We
are encouraged by efforts in the proposed rule regarding patient and consumer
engagement, especially regarding secure messaging; direct, downloadable access
to patient data; patient reminders; inclusion of family health history; and
provision of patient education. Nevertheless, we would like to see the required
percentages higher than proposed in some cases. In addition, as our Project
HealthDesign makes clear, patients now expect to engage with their personal
health data in apps and on mobile devices of their choosing. We expect this
trend to increase significantly. Further, patients will almost certainly expect
that the flow of information be in two directions. In other words, patients
will reasonably expect they will have both access to personal health data but
also the ability to provide personal data to their health professionals.
RWJF’s full
comments are available here.
The chart below
lists the “patient engagement” requirements in the Final Rule:
|
Stage 2 Objectives
|
|
Stage 2 Measures
|
|
Eligible
Professionals (EPs)
|
Eligible
Hospitals (EHs) and Critical Access Hospitals (CAHs)
|
|
|
Provide patients the ability to view online,
download and transmit their health information within 4 business days of the
information being available to the EP.
|
|
1. More than 50% of all
unique patients seen by the EP during the EHR reporting period are provided
timely (within 4 business days after the information is available to the EP)
online access to their health information, subject to the EP’s discretion to
withhold certain information.
2.
More than 5% of all unique patients seen by the EP during the EHR reporting
period (or their authorized representatives) view, download, or transmit to a
third party their health information
|
|
|
Provide patients the ability to view online,
download and transmit information about a hospital admission.
|
1. More
than 50% of all patients who are discharged from the inpatient or emergency
department (POS 21 or 23) of an EH or CAH have their information available
online within 36 hours of discharge
2. More than 5% of all patients (or their
authorized representatives) who are discharged from the inpatient or
emergency department (POS 21 or 23) of an EH or CAH view, download or
transmit to a third party their information during the reporting period.
|
|
Provide clinical summaries for patients for
each office visit
|
|
Clinical summaries provided to patients or
patient-authorized representatives within 1 business day for more than 50% of
office visits
|
|
Use certified EHR technology to identify
patient-specific education resources and provide those resources to the
patient
|
Use certified EHR technology to identify
patient-specific education resources and provide those resources to the
patient
|
Patient-specific education resources
identified by the certified EHR technology are provided to patients for more
than 10% of all unique patients with office visits seen by the EP during the
EHR reporting period.
More
than 10% of all unique patients admitted to the EH’s or CAH’s inpatient or
emergency department (POS 21 or 23) are provided patient-specific education
resources identified by the certified EHR technology.
|
|
Use secure electronic messaging to
communicate with patients on relevant health information
|
|
A secure message was sent using the
electronic messaging function of certified EHR technology by more than 5% of
unique patients (or their authorized representatives) seen by the EP during
the EHR reporting period.
|
Also of note to
Project HealthDesign: the Final Rule
includes a new “menu set” requirement that eligible professionals and hospitals
record a patient’s family history.
Stage 2 begins in 2014. In the Stage 1 meaningful use regulations,
CMS established an original timeline that would have required Medicare
providers who first demonstrated meaningful use in 2011 to meet the Stage 2
criteria in 2013. The Stage 2 Final Rule gives providers more time to meet the
Stage 2 requirements. A provider that attested to Stage 1 of meaningful use in
2011 would attest to Stage 2 in 2014, instead of in 2013. Therefore, providers are not required to meet
Stage 2 meaningful use before 2014.
Since the Medicare and Medicaid EHR Incentive
Programs began in January 2011, more than 120,000 eligible healthcare
professionals and more than 3,300 hospitals have qualified to participate
–23,000 more than the federal government had hoped to enroll by now, according
to the U.S. Department of Health and Human Services, which oversees the
programs.
The Final Rule – along with a fact sheet describing
it - are available at http://www.hhs.gov/news/press/2012pres/08/20120823b.html
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