While MU proposed rule is daunting to some, they agree it’s critical for patient engagement

Most hospital CIOs would agree that achieving meaningful use of electronic health record systems is not for the faint-hearted. It’s a rigorous, complex program that demands difficult and bold action from even the most seasoned IT experts. Most seem ready to tackle the work, both to improve patient care – and to collect the attendant incentive money.

Still, it seems no other aspect of meaningful use has sparked as much comment, angst and controversy as the patient portal. (Quality reporting might run a close second). The patient portal is the gateway through which hospitals can meet the meaningful use objective of engaging patients. Under the rule as proposed (the final rule is expected this summer), hospitals would be required to make sure patients can view online, download and transmit information about a hospital stay within 36 hours of discharge.

Can’t do that, says the American Hospital Association, which represents 5,000 hospitals and healthcare networks across the country. First of all, asserts its executive vice president, Rick Pollack, in a letter last month to the Centers for Medicaid & Medicaid, it flies in the face of HIPAA rules, and CMS has no authority over patients’ access to their health records. Second, the objective is just “not feasible.”

Consumer advocates blasted Pollack for attempting to block patient engagement. Christine Bechtel, vice president of the National Partnership for Women & Families, and a member of the federal Health IT Policy Committee called the arguments “spurious,” and one of her colleagues on the health IT policy panel, Deven McGraw, characterized the AHA’s comments as “a Hail Mary pass.”

Individual hospitals, though, have been more measured than the AHA, with their responses to the Stage 2 proposed requirement, and many are already gearing up for it.

“I suspect this requirement will not be the "one" Stage 2 criteria that prevents hospitals from achieving overall compliance, but it will likely create a fair amount of challenge for many,” said Rick Schooler, vice president and CIO of Orlando Health, a seven-hospital health system in Orlando, Fla.

Schooler said Orlando Health intended to meet this particular Stage 2 requirement through its existing portal technology.

“However, we do have concern about the requirement for 10 percent of our patients to view, download or transmit the required information to a third party,” he added. “We believe measurement of this activity can be accomplished, but influencing patient behavior will be more of a challenge.”

That aspect of the patient portal requirement is a sticking point for the AHA, too, and for many individual hospitals.

At Shriners Hospitals for Children, with 22 hospitals across North America, CIO William Bria, MD, said he and his team had not begun to discuss MU Stage 2 as they are planning to attest for Stage 1 this summer.

“We’re of course, aware of the ‘patient portal’ concept,” he said, adding that, although it will be challenging, “we’ll need to address it.”

“As president of AMDIS and advocate for patient involvement in their care, personal and professional,” Bria said, “I believe the more information engagement between healthcare systems and professionals and the patient – the level playing field, so to speak – the better off we’ll all be in achieving our goal of excellent healthcare.”

In Indiana, Charles Christian, CIO of Good Samaritan Hospital, said meeting the requirement was on the hospital’s roadmap.

“We think that giving patient access to their information is part of engaging patients in their care,” he said. “We’ll be able to do that later on this year.”

Christian said what is more worrisome is whether 10 percent of patients will use the portal, as required by the proposed Stage 2 rule.

At Citizens Memorial Hospital, a Davies Award winner in Missouri, CIO Denni McColm said the hospital encourages patients to use the hospital’s patient portal already in place, or a PHR. Yet, fewer than 5 percent of patients use the portal or PHR options, she noted. While CMH is in a rural area, she added, broadband service is widely available. “Many patients have simply declined to utilize online access for their health information,” she said.

Protima Advani, a research director with the IT Strategy Council at the Advisory Board Company, a research, technology and consulting firm headquartered in Washington, D.C., said she recognizes the prospect of launching portals and getting patients to use them can be daunting. “Hospitals have not been in the business of engaging their patients,” she said.

However, she added, “if we truly believe the only way to manage the cost and quality of healthcare is to bring the patient to the table, to engage them in their own care so they’re more responsible consumers of healthcare, we’re not giving them the tools to manage by. So I am thrilled to see this requirement come through. I’m not saying it will be easy, but I think that’s the only way we engage patients. People are leveraging technology in every aspect of their lives. Why not in healthcare?”