Personal health records and health information exchanges offer alternatives to meet Meaningful Use mandate of giving patients access to their data.
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Hospitals and physicians will need patient Web portals to meet the view/download/transmit requirements of Meaningful Use Stage 2, according to a recent article in American Medical News, a publication of the American Medical Association. But there may be viable alternatives to having a portal that's linked to a particular electronic health record (EHR), said Jim D'Itri, a partner in the healthcare group of the CSC consulting firm, in an interview with InformationWeek Healthcare.
The final rule for MU Stage 2 requires that hospitals and eligible professionals give patients online access to their health records and ensure that at least 5% of patients view, download, or transmit those records. One way to do that is to post the information on a secure portal linked to an EHR. However, D'Itri pointed out, the MU Stage 2 rule specifies a "portal or similar capabilities."
That includes the option to send the data to a personal health record (PHR). The PHR could be part of a patient portal linked to an EHR, or it could be on a platform not tethered to that EHR, such as Microsoft HealthVault, noted D'Itri.
Any such platform would have to be "certified EHR technology" to qualify the user to meet the MU requirement. But EHR modules, as well as complete EHRs, may be certified. Microsoft HealthVault, for example, "is already certified for Meaningful Use Stage 1, and will likely get certified for Stage 2," D'Itri observed.
Another possibility is that a health information exchange (HIE) could provide a single patient portal to its members. That way, instead of each provider having to buy its own portal, hospitals and eligible clinicians could send clinical summaries to an HIE, which could make them available to patients.
To provide such a service, D'Itri said, HIEs would have to get their portals certified as EHR components for MU. "If they met all the rules, there's no reason they couldn't do that," he said.
Physicians are concerned about the cost of patient portals, whether they're purchased from EHR vendors or third-party firms. But D'Itri pointed out that the cost of a portal for an ambulatory-care EHR can vary widely, depending on the vendor and on whether they provide volume discounts. "With hospital vendors, it's not unusual to spend half a million dollars on a portal," he said. "A lot of them are starting to move toward more volume-based pricing."
The American Medical News article observes that physician use of patient portals is low today. It also notes that most of the current portals would not help providers with MU because they focus on administrative functions such as appointment and prescription refill requests and online bill payments.
D'Itri agrees, but he doesn't think EHR vendors would have much trouble adding clinical summaries to their portals. "That would be relatively straightforward. It wouldn't require a major development effort." One reason, he said, is that the software vendors already enable hospitals to post clinical data on physician portals. "You're just opening up a similar gateway to patients."
If patient portals become widespread to meet the Meaningful Use requirement, he said, "it can't help but spur additional uses of portals," including the administrative functions mentioned above.
The major obstacle to portal adoption, according to D'Itri, is physicians' concern that portals will increase demands on their time and their staffs' time. Based on his conversations with doctors, he said, "They're afraid patients will ask questions about what's in their record." And doctors are reluctant to give up control, not only over clinical data, but also over their schedules if patients can make appointments online.
Some physicians also question whether enough patients will want to view their records to meet the 5% minimum. The American Medical Association has made an issue out of that requirement, even though it has been reduced from 10% in the MU Stage 2 proposal. But a new Optum Institute study found that three of four consumers want online access to their medical records.
D'Itri believes the 5% floor will be easy to achieve in metropolitan and suburban areas. But in some rural areas, he says, it could be a different story.
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