MU patient engagement, TOC requirements continue to frustrate providers

According to the latest data from CMS, just 78 hospitals have attested to meaningful use stage 2 as of Aug. 1.

The low attestation numbers suggest providers are encountering serious challenges in meeting the requirements. Many of the challenges are outside hospitals' walls and jurisdiction.

Charles E. Christian, vice president and CIO of St. Francis Hospital in Columbus, Ga., has struggled with the patient engagement objective. While younger patients are more likely to appreciate or even expect online access to their records, it can be much harder to engage older patients. "For my 20- and 30-something-year-old children, getting them to see the benefit of having online, real-time access to their health information is a no-brainer," he says. "However, the conversation is much different with the 70- and 80-something-year-old patients, whose age bracket make[s] up a sizable portion of healthcare utilization."

W. Dan Morrell, CIO of Sierra Vista Hospital in Truth or Consequences, N.M., has had a similar experience. "One of the primary stumbling blocks [we've encountered] is engaging patients to use the patient portal," he says. "The majority of our patients are seniors and/or underprivileged... We have not, yet, reached the 5 percent necessary for attestation and have to be creative in doing so." The experience has lead Mr. Morrell to believe patient engagement should not be one of the core requirements for attestation.

The transitions of care requirement has also proven difficult for many providers. The College of Healthcare Information Management Executives has advocated for its removal from the stage 2 requirements, as fulfilling the objective depends on referring partners' technical abilities. This has proved a roadblock for many member CIOs.

For Mr. Christian, the requirement also seems to add another step to the patient transfer process that does not add value, at least for now. "Hospitals have been transferring patients to other levels of care safely for decades; many states also have mandated specific forms and standardized paper processes to ensure the necessary information travels with the patient," he says. "Now we have another layer of procedure that has to considered and woven into the transfer/discharge process."

Sending transitions of care documents electronically will be beneficial when all organizations in the care continuum have the necessary technology to receive and use them. But right now, many recipients of these documents from hospitals, including nursing homes and rehabilitation facilities, don't participate in meaningful use and therefore do not have the same incentive to implement EHRs. This is just adding to clinicians' workflows.

"When we can truly automate the distribution of a clinically valuable set of information and have it electronically flow into the receiving facilities' EHRs, then we've actually removed work from the process and made it better for the patients we serve… right now we're sending [other organizations] information that they are not prepared or required to accept and/or utilize."

More articles on meaningful use:

5 things to know about the global HIE market
3 CMIOs on Their New and Changing Role 
Lessons outside health IT: Q&A with ICA's Gary Zegiestowsky on his journey into the tech sphere

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