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BOSTON -- Meaningful use stage 2 is coming, along with its requirements for patient engagement for physicians and hospitals who want to earn its incentives and avoid CMS reimbursement penalties earmarked for those who don't sign up. One requirement for attesting to meaningful use for eligible providers is confirming that at least 5% of their patients view, download or transmit their health data, which may have some users wondering how they will inspire hitherto-uninterested patients to jump on the tech bandwagon.
Judging from the stories of four small group practices at the athenahealth Inc. 2013 user conference, that's not going to be much of an issue. They discussed how health IT is not only driving patient engagement, but how it is already changing work methods and healthcare workflows -- meaningful use requirements notwithstanding.
The hard part about implementing EHR software, the devices to access them and the companion patient portals, said Allen Gee, a neurologist in Cody, Wyo., is customizing use to the patient's wishes, which typically break along generational lines.
In his practice, he said the young Millennial generation expects smartphone access to their health data and physicians, while middle-aged Generation X-ers are comfortable with tech, but aren't necessarily gung-ho about it. Some Baby Boomers are staying young by getting into all the whistles and bells of health IT software and hardware at home and in the exam room, while others would rather not deal with it.
"They are a more difficult generation to engage, sometimes," Gee said. His patients older than that, he said, [aren't] very interested in tech at all, and they're more focused on getting around safely and maximizing their time and health.
Touchscreen tablets remixing the office visit
Tablets are a big boon in improving office visits, Gee said, who added he'd struggled previously to lay out his exam rooms in such a way that the computer wasn't an intrusive third party coming between him and the patient. With a tablet, he can share the screen view with the patient, who can also listen to his dictation into the EHR system and help correct and clarify the data that's saved.
"I tell them I'm going to talk to the computer," Gee said. "I use a Bluetooth [earpiece] so I don't have the wires and everything connected, and I say 'Wake up!'" to activate the speech-recognition system and begin dictating the patient's symptoms and storylines into the computer.
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In neurology, that often adds up to a complicated two- or three-paragraph narrative with several plot twists, he said. "When I finish in front of them, I say, 'Did I get that right?'"
Dictating in front of the patients isn't just making results more accurate because [they] get to review them, according to Gee. He believes, as physicians get older, it's harder to remember everything needed in patient records from multiple visits during traditional end-of-day documentation sessions. Getting it down in the EHR in the moment helps capture more needed details for a patient.
Online portals changing the language
For better or for worse, when physicians know a patient will easily see what they enter into a record online, it makes them choose their words more carefully in order to express themselves more precisely and cut down on follow-up messaging.
Evaporating from use may be terms such as S.O.B. abbreviating "shortness of breath," and even other terms that sound scary or upsetting to patients, such as "congestive heart failure," said one attendee at the user conference, who posed the question to the panel: How is exposure of your notes on a patient portal changing the way you write them?
Robert Winnmedical director, the Mazzoni Center
Jargon can be "alarming, confusing or off-putting," said Steve Bien, M.D., of Wilson Stream Family Practice in Farmington, Maine. Knowing his summaries will be viewed by patients is revolutionizing how he communicates -- in a good way, he said, making him more effective in how he engages with patients.
Robert Winn, M.D., medical director of the Mazzoni Center in Philadelphia, said he has to do a lot more explaining now that patients can see every single detail of their record, such as lab reports that might indicate an "abnormal" result that is slightly off the expected mark, but is nothing to be worried about in regards to clinical outcomes.
"[A patient might ask], 'What about this little thing here? It looks like it's abnormal. What does that mean? Does it mean I'm going to die?'" Winn said. "I have to do a lot more explaining, but I'm not so sure that's a bad thing. I think I'm probably now talking better with the patients about their results."
Sharing radiology imaging can drive engagement, too
Meaningful use stage 2 will also require quick turnarounds on radiology images so they can be shared with patients. Physicians are already seeing how that drives patient engagement. Gee, for example, said that saying the words "atrophy of the brain" to a patient is one thing, but showing them a scan "means a bit more," and like Winn's lab results experience, requires more explaining and repetitive conversations. However, he said, patients seem to understand more information.
Winn said he still prefers not to send images and reports for fear of alarming patients unnecessarily, and that some patients would prefer not to see them.
Carrie Peacock, administrator for Pulaski Surgery Clinic in Little Rock, Ark., said her facility has begun uploading radiology images and written summaries to its portal so patients can access them before surgery. In the past, the clinic's five surgeons had handed out written pre-surgery care summaries, but now they are even more aware of the patient's perspective and go over upcoming procedures in detail at the office, knowing their patients will be able to see documents when they get home.
Making this data available requires more explanations and more effectively addressing fears patients may harbor about their upcoming procedures, but greater information access is a positive step for patient education and engagement, Peacock said. "It's helpful for the patients to see the scan."