Fierce Q&A: Lots of barriers to MU patient engagement rules

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 Donna StatonAs comments on the proposed requirements for Meaningful Use Stage 2 pour in, debate around the patient engagement requirement is heating up.

For example, in a recent column posted to The Health Care Blog, David Chase, CEO of patient portal and "relationship management" company Avado.com, advocated for the Office of the National Coordinator for Health IT to keep the provision. Meanwhile, David Lee Scher, an adjunct clinical associate professor of medicine at Penn State University's School of Medicine, told FierceEMR's Marla Durben Hirsch earlier this month that he worries whether physicians will be able to meet the requirement that 10 percent of their patients access their personal health records.

"Patient engagement is so hot now," Scher said. "But [it's] the clinicians who are stuck with the mandates."

In a recent conversation with FierceHealthIT, Donna Staton (pictured), CIO of Fauquier Health System in Warrenton, Va., expressed concerns on par with Scher's, adding that the stipulation also could be an issue for vendors.

FierceHealthIT: How is your organization preparing for Stage 2 of Meaningful Use? What are your concerns?

Staton: There are a couple of areas that jump out that I have some concern about patient engagement. Certainly, it's not a problem or challenge for us to put up a portal, but whether we'll be able to control patient behavior is a complete unknown.

The threshold of 10 percent of patients actively engaging and downloading information from your patient portal is going to be a challenge, depending on your patient demographic.

FHIT: Have you ever tried any patient engagement efforts similar those required in proposed Stage 2 rule? 

Staton: I think we kind of tip-toed into that a little bit in Stage 1 with making the patient summary available upon request. We have very low utilization of that. I think if that were any kind of gauge about what the level of patient engagement is going to be in Stage 2, that doesn't necessarily bode well.

For us, I think the biggest takeaway is that there has to be a strong communications strategy. I think the other part is physicians are going to be the ones who are going to have to be the ambassadors. And physicians don't necessarily want to engage with their patients in that way. They see it as another demand on their time, which time is very limited.

We've done some  precursor validation efforts with our physicians to see what their level of adoption would be, or their level of tolerance for introducing that kind of behavior, and they're not proponents of it. The minority are. They're not interested in secure messaging with patients. They like going in the patient room and treating the patient and then walking out and then they're done with that encounter.

Why do you think there was such low engagement on the patient side? Does it have more to do with your patient base or with effort on the part of physicians?

Staton: I think its two-part: It's probably the patient base, and also I think patients don't necessarily want to get the information in a written format because they may not understand what they're reading. So much of the content has to be put into a format that's much simpler. Let's face it, medical information is complex. I think it generates more confusion. I think they'd rather get that information through dialogue with their care provider than through a report.

It's difficult for the vendors to do, too. The way that the information is captured in the electronic health record and the ability to translate that is a subjective process. So there's another business layer that needs to be introduced that hasn't evolved yet. I think the technology is still immature.

Editor's note: This interview has been edited for length and clarity.