In a recent conference call at the California Association of Physicians Groups in Los Angeles, SearchHealthIT.com asked U.S. health IT coordinator Farzad Mostashari, M.D. whether meaningful use stage 2, in practical terms, was steering the health care system toward mandatory patient data access via provider portals, "Blue Button" style downloads in the vein of federal sites, or through health information exchanges (HIEs).
"Yes!" he answered, gleefully, meaning "all of the above."
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More seriously, he and other stakeholders on the call described facets of meaningful use stage 2 -- both in vendor data standard requirements as well as physician mandates to make data available in some fashion online -- as "building blocks" of a national health IT strategy that will be flexible enough to accommodate whatever preferred method emerges for connecting patients to their data.
Their hope was that meaningful use will provide a standards toolkit to enable consumer use of the system, much like the banking industry enabled nationwide proliferation of consumer-friendly ATMs.
"We're doing this while we're waiting for the perfect solution to come," Mostashari said, referencing Health IT Policy Committee member Neil Calman's description of their intentions in a recent meeting.
"What we're learning is that this is the solution -- it is pluralistic, it is 'all of the above.' If we have the building blocks on trust, if we have the building blocks on value for care coordination, there's going to be all sorts of people exchanging information using those building blocks in a consistent way but according to their business needs."
Mostashari admonished stakeholders in the room representing software vendors and employer-based health plans to develop mechanisms to enable patient data access sooner than later, and not to drag their feet to the last possible moment dictated by deadlines.
David Lansky, president and CEO of Pacific Business Group on Health -- a national group of large employers including Boeing Co., Wal-Mart Stores Inc. and academic institutions -- said his organization agrees that opening up health IT for patients is one of the ways that will help stem the rise of health care costs, to the tune of 10% per year.
That problem, which Lansky said is causing "terrible anxiety" among employers, needs to be solved, and fast. "Right now, what employers are paying is more than the minimum wage -- which they are often paying their workers -- for health care," he said. "So health care costs are actually exceeding the cost of labor."
Building a platform that integrates coordination of patient care -- and giving patients more access to their data -- will help increase care quality while decreasing costs, he believes. Right now, employers are frustrated with the lack of care coordination between providers. That, in turn stifles patient engagement and frustrates family caregivers, who often want to play a more proactive role in managing patient care but can't, for lack of access to the same data the providers get.
Health care costs are actually exceeding the cost of labor.
David Lansky, president and CEO, Pacific Business Group on Health
Consumers also want more robust access and they want to see more complete health information exchange, said Mark Savage, senior attorney for Consumers Union. While federal officials promise a patient-centric health IT system, so far Savage has instead seen more of a focus on providers than consumers. He'd like to see the next stages of meaningful use get patients more involved -- and give more concrete deadlines to push providers to get it done.
In late 2010 the Consumers Union issued a position paper that laid out nine principles for building a more patient-friendly HIE system in California. The paper called for equality of access, consumer privacy protection, developing HIT literacy and prevention of health data misuse.
How is the U.S. health system progressing toward those goals, 18 months later? "We're making progress," Savage said, "but a lot more needs to be done."