Posted by: Jenny Laurello
CEHRT, EHR, Meaningful use, meaningful use stage 2, Stage 2
Guest post by: Wendy Whittington, MD, MMM, Chief Medical Officer, Anthelio Healthcare Solutions, Inc.
In the recently released stage 2 MU proposals, CMS sought to correct some problems with the menu choice for providing patient education materials. I don’t think they quite made it, though, and I’ll tell you why. First, let’s examine the requirement.
Patient-specific education resources identified by Certified EHR Technology are provided to patients for more than 10 percent of all office visits by the EP. More than 10 percent of all unique patients admitted to the eligible hospital’s or CAH’s inpatient or emergency departments (POS 21 or 23) are provided patient- specific education resources identified by Certified EHR Technology.
At first blush it sounds as if the CEHRT (certified EHR technology) will store the patient education information, but that’s not the case. To further explain, CMS said that the CEHRT must be used to identify the resources, not necessarily store them. They indicated that the patient education resources from the National Library of Medicine, for example, can be queried by the CEHRT. The technology hook is that the CEHRT should identify the resources based on the patient’s problem list, medication list or laboratory results. There are choices about the delivery of the information. Paper, of course, is included, but so is an electronic copy, or an electronic link through a patient portal or PHR.
The measurement, 10%, was chosen because of language and literacy issues. These exist, to be sure, and need to be addressed, but MU is a staged process and CMS clearly thought it was too soon for higher numbers. The National Library of Medicine provides primary resources in both Spanish and English and also offers links to other languages. They have a wealth of audio and video materials, as well as some easy-to-read materials.
I think the problem will be with asking the CEHRT to select materials based on the patient’s information. How will the technology know which of the patient’s problems, medication or tests are the most important for them to receive information on today? How will the provider review the materials and decide if they are accurate and relevant for this patient? I’d be surprised if there are any algorithms like those used by Match.com to take into account the patient’s needs, age, language, reading level and interest in the materials. For example, how will the patient who is taking Cymbalta for fibromyalgia feel when the computer presents patient education materials on depression?
For the most part, patients do this matching pretty well for themselves. According to the Pew Research Center, eight in ten internet users have looked online for health information.  We hear more every day about e-patients and online patient communities. Certainly, social media is having a huge impact in this area – more, I think than a computer-selected hand-out from a physician’s office.
The other possibility that worries me is that the provider may meet the 10% threshold by giving information to the patients who need it the least. Anyone (or maybe any computer) can select a pamphlet for someone who has had well-controlled hypertension for years. AHRQ says that low health literacy is linked to more emergency room visits, hospitalizations and higher risk of death.  That is what needs to be addressed! While I agree whole-heartedly with the goals of patient education and health literacy, I don’t think this core measure is going to get us there.