Meaningful Use and Patient Access to Records: Understanding the Fine Print

For better or for worse, meaningful use has been top of mind for most healthcare executives and physicians since 2010. Reports suggest that many have reaped the financial benefits of stage one MU. For example, Hospital Corporation of America predicts a HITECH income of $190 million to $220 million in 2011 alone! While providers are beginning to receive incentive payments, it is questionable whether or not patients have directly benefited from HITECH's meaningful use incentive program.

There is long-standing public demand for less paperwork and more automation in healthcare, particularly in physician offices. Eliminating clipboards is a common goal and documented benefit of stage one MU. Another area where patients benefit is through greater access to information and medical records. This article explores the five stage-one MU criteria focused on patient access to information.

Balancing MU access with HIPAA privacy: Get HIM involved
Also called the release of information process, achievement of these five MU criteria must be carefully balanced with the need to protect privacy and confidentiality under HIPAA. There is increased risk of breach and monetary penalties associated with releasing information to the wrong party. This balancing act brings health information management departments much more visibility in the executive suites of healthcare institutions. Therefore, we recommend that HIM professionals be part of any MU criteria planning, discussions and reporting for these five critical areas.

Stages two and three of MU are assumed to involve more and more electronic release of information. This means the risk of breach is only going to increase, so dealing with risk now and empowering HIM to control the process is a best practice that can mitigate the downside potential.

Five stage-one criteria for executives to understand
The five stage-one MU criteria of concern are listed below. The remainder of this article provides an executive primer on these specific criteria.

•    Summary at transition/referral
•    Electronic copy of discharge instruction upon request
•    Clinical summaries each visit
•    Electronic copy of health record upon request
•    Timely electronic patient access to their information

Summary at transition/referral

This criterion refers to patients whose records are kept in a certified EHR. Fifty percent of all patients who transition must have this measure fulfilled within three days. It can be fulfilled either by electronic means or by paper means. The issue with this criteria is the three-day window. The record must be closed out and delivered within a timeline that often involves a workflow change in HIM.

If you move records in a paper format the risk manifests itself in the physical nature of the record. If not handled with care they are subject to loss and breach. Electronic records if moved via a physical medium (CD, thumb drive, etc.) are subject to the same problem-especially if the information is unencrypted. If the information is moved electronically, interception is an issue, as well as it being received by an unauthorized individual. To mitigate some of these risks, we suggest encryption and decryption technology be used whenever information is transferred.

Electronic copy of discharge instructions upon request
This criteria is applicable only to hospitals. It requires that hospitals supply 50 percent of the requested instances immediately, at discharge, and from the EHR. The main risk here is ensuring that the correct information is going to the right patient. A check must be built into the workflow to confirm this.

At this point, this is not a high compliance risk as the numbers of patients who actually request this information in electronic format remains small.

Clinic summaries each visit
This item is for eligible providers only and requires that 50 percent of all patient office visits receive a clinical summary within three business days. This applies to all patient records that are stored in you EHR.

Having this information finalized and available and into patients’ hands within three days is another workflow change for most physician practices. This issue is best resolved by handing patients their information (either paper or CD) before leaving the office. Once the patient leaves, the complexity and risk greatly increase.

Physician practices do not typically have the staffs or budgets to comply with these criteria after patients leave the office. In fact, it is difficult to meet the criteria within the three days for many physicians. Outsourcing the production and delivery of clinic summaries may become common practice for medical groups, clinics and individual physician practices.

Electronic health record upon request
Upon patient request for an electronic copy of their records, the facility must provide the copy to at least 50 percent of requesting patients within three business days. Thus far, the number of these requests is very low, but projected to rise dramatically over the coming years. This rise will partially be driven by the expected growth in personal health records and the increased attention being paid to health and wellness.

Timely electronic patient access to their health information

This criterion must be accommodated not only electronically, but also online. The EPs must accommodate more than 10 percent of all unique EHR patients who have a health care encounter. Information must be made available within four days of being updated in the certified EHR and achievement is based only on the availability of access and the timeliness of the data, not on the patient actually accessing the information. In stage one this is a menu option and not a requirement, but in stage 2 and 3, it is expected to be required.

This MU criterion is best accomplished via some type of patient portal. After the EHR is updated, the system pushes data out to the portal for secure viewing by the patient. Most physician systems will need to be upgraded to meet this goal.

Consumer-driven healthcare begins with access
These five MU criteria are the starting blocks for greater consumer participation in healthcare delivery. Whether participation is spurred by consumer demands for higher quality providers or healthcare reform’s controversial mandate for personal health insurance, the onus is on providers to improve patient access to information. And in doing so, support the consumer's role in meaningful use of electronic health records.

The end game for healthcare executives is to better engage populations in their own health and wellness. As accountable care organizations evolve and quality drives reimbursement, your ability to grant electronic information access will be a major driver of success.

Whether done in house or through an outsourced release of information service company, weighing the need for greater patient access against the risk of information breach will be an increasingly difficult balancing act; and a more complicated process. Begin early and engage your HIM professionals. They are experts at reading fine print — where risk is often hiding.

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