Stage 2 of meaningful use requires at least 5 percent of a given provider's patients to be engaged in their own care either through an online portal or an electronic personal health record. The threshold seems low, but it is the first time that achieving meaningful use is dependent on patient behavior.

The Medicare policy in place since 2011 that penalizes hospitals for certain preventable readmissions is spurring patient engagement as well, since there is a significant financial incentive to keep people with serious cardiovascular and respiratory problems from needing further inpatient care.

In fact, the Robert Wood Johnson Foundation has reported that patients not engaged in their own care can cost 21 percent more than "highly engaged" patients. Obviously, payers have long been motivated to rein in costs, but now, with the growth of accountable care and risk-sharing contracts, so are many healthcare providers.

[See also: Smart data key to patient engagement.]

Some healthcare providers are worried about the patient engagement piece of Stage 2, and perhaps there is reason to be.

According to a survey from consulting firm Technology Advice, published this month, 40 percent of people who had seen a primary care physician within the last year did not even know whether that doctor offered a portal. Only 9 percent said their physicians followed up with them after the visit via a portal, and 48 percent indicated there was no follow-up.

Clearly, there is much work to be done to engage patients, but examples of successful engagement are showing up.

A six-month trial of engagement of recently discharged Medicare patients by health coaches armed with a mobile app to assess readmission risk saved $109 per patient per month and cut 30-day readmissions by 39.6 percent among high-risk patients at Elder Services of Merrimack Valley in Lawrence, Mass.

"During each encounter, the coach uses a tablet-based application that provides suggested questions written in lay language based on the patient's diagnoses, treatment, and risk profile," according to the study, released in July by the federal Agency for Healthcare Research and Quality. "If the answers indicate a decline in health status, the system sends a real-time alert to a nurse care coordinator who uses a different part of the system to help the patient and coach address the issue within 24 hours."

[See also: Patient engagement gains momentum.]

On July 1, Greenwich Hospital, which is part of Yale-New Haven Health System in Connecticut, turned on a secure messaging system at its ambulatory surgery center to keep family members updated during surgical procedures.

"The single most important thing to our patients in that venue is information," says Christine Beechner, the hospital's vice president of patient and guest relations.

Most ambulatory surgery patients have a preoperative telephone call to prepare them for the procedure, according to Beechner. At that point, the hospital offers them the option of using FamilyTouch, an app from Avation Health in Concord, Mass. The app is free to patients and available in English or Spanish. It provides designated family members with a series of timely messages.