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EHR regulations, interoperability top patient record concerns

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Providers fear meaningful use penalties, push to delay stage 2

Meaningful use stage 2 is pushing providers to engage their patients, something not all specialties can hope to achieve.

Meaningful use stage 2 is supposed to start in 2014, but many healthcare providers are not feeling ready, and national medical organizations are seeking extensions to avoid penalties. Stage 1 was designed to prepare providers and hospitals to collect health information in an electronic format. Stage 2 is pushing providers to engage patients in their care and also calling for functional HIEs. Individual physicians who are eligible providers are leaving those challenges to the hospitals and health systems.

Physicians and other providers are burdened as they look ahead to stage 2 requirements. While some physicians have only been using EHRs for a few years, others have been using EHRs for more than a decade. These physicians have mastered the basics, such as data entry, of their EHRs. Still, many are not prepared to meet the stage 2 core objective that states providers should "use secure electronic messaging to communicate with patients on relevant health information." It would be one thing if the objective was written to tell providers to be able to use secure electronic messaging. However, the objective will be measured based on the volume of secure electronic messaging providers use to communicate with patients. So, doctors better get ready to send and receive a lot of electronic messages.

Some patients are already engaged and they are thrilled about the idea of having digital access to their providers. They have been eagerly waiting to send secure messages and use online patient portals to manage their health. How about the rest of the patient community?

Some physicians serve a patient population that isn't likely to become digitally engaged. For instance, physicians who specialize in geriatrics are often treating patients who are over 70 or 80 years old and also have multiple chronic health conditions. These patients may not use a mobile phone or have a computer in their home. How can you demonstrate patient engagement with this population?

Other obstacles to achieving stage 2

Medication reconciliation a tall task

ID verification needed for sharing patient data

Care coordination standards guiding EHRs

There are also psychiatrists who treat patients with severe mental illness such as schizophrenia or bipolar disorder. These patients may not trust that their digital health information is going to be safe if they send it over the Internet. Psychiatrists may also feel that if they open the channel for digital communication with their patients, the flow of incoming secure messages may never end.

Right now, most physicians are not reimbursed for communicating with patients through secure messaging. There are plenty of independent physicians who are reluctant to start this practice because they think that it will decrease patient visits if patients can get information through secure messages. Since patient visits provide reimbursement and secure messages do not, you can understand their reluctance.

Will meaningful use stage 2 get delayed? Given the obstacles -- largely around HIEs and secure messaging -- I would venture to guess that it will be delayed. Many providers and hospitals are simply not ready to implement the necessary processes to achieve compliance and avoid meaningful use penalties.

As our country experiences major transformations in healthcare, physicians and hospitals are being pulled in many different directions because of changing priorities and policies. We will eventually reach meaningful use, but the necessary infrastructure to support proper adoption is lacking -- a shortcoming for which physicians and hospitals should not be punished.

About the author:
Joseph Kim is a physician technologist who has a passion for leveraging health IT to improve public health. Dr. Kim is the founder of NonClinicalJobs.com and is an active social media specialist. Let us know what you think about the story; email editor@searchhealthit.com or contact @SearchHealthIT on Twitter.

This was first published in October 2013

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Essential Guide

EHR regulations, interoperability top patient record concerns