Latest healthcare 'meaningful use' rules require patient involvement

Patients must access health information for providers to qualify

The latest set of proposed government rules to push healthcare providers to roll out electronic health records (EHRs) requires that patients use the digital technology.

Health insurance specialist Robert Anthony detailed the nuances of Stage 2 rules during a webinar this week sponsored by the National eHealth Collaborative.

Last month, the U.S. government's Centers for Medicare & Medicaid Services (CMS) published to the Federal Register the second of three sets of guidelines that the healthcare community must follow in rolling out EHRs. Stage 2 proposed rules are currently undergoing a six-month comment period.

Anthony, who works for the CMS, said Stage 2 rules require healthcare providers to offer EHR access to more than half of their patients. Clinics and private practices must also prove at least 10% of their patients are actually accessing healthcare information on EHRs. That includes radiological imaging results, which can be accessed directly in an EHR or through a link in the EHR to the images.

"This is a change from Stage 1, where really anything a patient did or didn't do could not interfere with a provider meeting meaningful use," Anthony said. "We believe providers are in a unique position to encourage patients to take an active role in their healthcare."

Another core objective of Stage 2 is that eligible healthcare professionals prove that at least 10% of patients use secure, electronic messaging platforms that are native to EHR systems to communicate with healthcare providers.

"This is just another instance of patient action being a requirement of meaningful use," he said.

The new rules have moved beyond merely providing an electronic copy of health information to patients, such as an email document. "This is the ability for them to view their health information, download it or transmit it online," Anthony said.

Just as with Stage 1 rules, under Stage 2 criteria, clinicians must meet (or qualify for an exclusion to) more than a dozen core objectives and choose from another menu of objectives. Among the changes: Offering up lab results in EHRs is no longer an option; It is now a core requirement.

Eligible heathcare professionals and hospitals must now use electronic prescriptions 65% of the time. And computerized physician order entry (CPOE) systems must be used for at least 60% of all orders, including laboratory and radiology orders. Stage 1 only covered medication orders.

Healthcare providers must also provide a summary-of-care document within 24 hours after patients finish their treatment. In Stage 1, providers only had to provide a patient problem list, an active medication list, a medication allergy list and diagnostic test lab results when they were available.

Now all those fields are required within 24 hours, meaning providers will have to maintain lists, along with 15 to 20 other fields such as care plans and patient address information, Anthony said.

Physicians and hospitals also must now record new demographics, vital signs and the smoking status for at least 80% of patients.

"Generating patient lists and providing reminders for preventative or follow-up care for patients have also moved from a menu item to a core item in Stage 2," Anthony said.

Another first for Stage 2 is that at least 10% of summary-of-care documents must be sent electronically to an unaffiliated healthcare provider with an entirely different EHR platform. "The idea here is really to be moving beyond closed networks of information exchange," Anthony said.

Hospitals and private physician practices must adhere to Meaningful Use rules to qualify for Medicare and/or Medicaid EMR reimbursements , which admittedly only cover a fraction of the costs to implement the technology. Eligible practices can receive up to $44,000 over five years under the Medicare EHR Incentive Program. To get the maximum incentive payment, Medicare professonals who are eligible must begin participation this year.

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed . His e-mail address is .

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Copyright © 2012 IDG Communications, Inc.

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