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In Remaining HIT Priorities for 2015, Payers, Not Patients, Will Get the Love

 |  By smace@healthleadersmedia.com  
   April 21, 2015

At this year's HIMSS conference, the patient engagement provision of Meaningful Use stage 2 was a major casualty. Is that a problem?

Another HIMSS conference has come and gone, and what do we know now that we didn't before?

Without even a hint of a new ICD-10 delay, I will go out on a limb and predict that the transition will occur as scheduled this October 1. Payers will love it. Providers will endure the pain and the vast majority will survive unscathed.


Russ Branzell
President and CEO of CHIME

Meaningful use stage 2 rules will be relaxed, as proposed in the CMS/ONC NPRM released just before HIMSS, to permit 90-day attestation in 2015, avoiding many payment penalties throughout healthcare. Providers will endure the pain of meeting the 90 days of compliance, and the vast majority will survive unscathed.

There has been a major casualty in HIT priorities, however. The patient engagement provision of MU stage 2 is being thrown under the bus by CMS and ONC, aided and abetted by providers.

You may recall that one provision of stage 2, as initially approved, was that providers demonstrate that 5% of their patients had viewed, downloaded, or transmitted some portion of their medical record. The provision was never popular with providers, but no one expected CMS and ONC to relax the requirement to a single patient. That's right—evidence of a single patient doing so will now be sufficient to attest for stage 2 through 2016, and if the provider chooses to, extended through 2017 as well, according to the new NPRM.

Patient advocates are livid, but CHIME CEO Russell Branzell says many patient records will remain inconsistent and incompletely downloaded while meaningful use is still a work in progress.

"I would love for [patient records] to be successful now," Branzell tells me. "With lack of patient matching, with lack of true data quality, some of what is occurring now is you're seeing data corruption and in some cases errors, because we haven't done some of the building blocks."

Thus the act of viewing, downloading, or transmitting a portion of the patient record, by itself, is often of little or no value, Branzell says. "Do I want [view, download, and transmit] now? I want it yesterday."

But what about patients with serious conditions who want to make sure that physicians down the line have the proverbial longitudinal record, which empowered patients or their caregivers strive to carry with them everywhere?

"My daughter had a serious heart condition—she's better now," he says. "Eight specialists, three hospitals, 11 patient portals. Tell me the value [of downloading the data]. It actually made it worse, not better.

"Ask CIOs out there: Is true viewing and downloading working and workable today? There's many challenges still."

What patients have to say

Still, the MU rule change weighs heavily on patient advocates such as Regina Holliday, who often tells a heart-wrenching story of seeing her husband die due to gaps in his medical record that she says could have been averted by an empowered patient or caregiver playing an active role in averting medical errors in care.

Forged by the crucible of her ordeal, Holliday is the patient advocate's advocate now. She was all over the HIMSS conference, expressing her outrage at the gutting of the patient experience requirement in the new NPRM. She certainly played a role in the unprecedented theater of former ONC chief Farzad Mostashari breaking with protocol and criticizing the ONC/CMS decision at a patient engagement HIMSS pre-event.

In a YouTube video, Holliday urges patients to weigh in on the current public comment on the rule relaxation, and also calls for all patients to download their data electronically on July 4—a "day of action" for patient data independence.

There's plenty of blame to go around on why the portal technology strategy in the stage 2 final regulation was dead on arrival—see my HealthLeaders magazine article on how the Direct protocol fell short, for example—but for CHIME and other providers to point to lack of demand doesn't show the kind of leadership I would think providers could muster at this point.

Of course, HIMSS had its usual "just around the corner" technological panaceas. Call it FHIR, call it a public API, or point to various vendor pledges to not charge for this or that download for some period of time; the fact remains that the health IT industry has yet to produce evidence that a workable solution to patient downloading, or interoperability in general, is imminent. As I've written before, the Internet itself displays a continual tug-of-war between companies that embrace standards when it suits their business interests, and large players who suddenly cut off that openness, also when it suits their business interests.

The default referee in all of this is ONC head Karen DeSalvo, who dodged my question about whether the market will resolve these issues, or if more regulation will be necessary later on, perhaps when ICD-10 and the rest of stage 2 are implemented.

"Our commitment to consumers and consumer access to their health information is unwavering. It is thematic and central for me as a doctor and as a person that that control is meaningful," DeSalvo told me. "What's really exciting about the last few days is the dialogue that has ensued, and what's going to be essential is that … consumers sit down and talk to providers and maybe some of the other important developers in the ecosystem to understand where there may be technology and cultural challenges so that we can overcome them."

DeSalvo and her team note that nothing in the proposed regulation takes away the requirement that patients be able to get their data—just that the provider no longer has to prove that a sizable number of patients are actually doing so.

Holliday believes the issue is akin to voting laws in the 1960s that made voting so cumbersome it became a civil rights issue. She may be right. But I would point out that the answer to that issue wasn't necessarily making precincts prove that people of one or another demographic had actually voted. The civil rights struggle was about discrimination against some people. Lack of patient engagement is not a discrimination case. Patients are afflicted everywhere you look. Some analogies can only go so far.

At first I thought CHIME and the patient community were simply going to line up on different sides on the view-download-transmit issue. After talking further with Branzell, it seems clear that everyone wants the patient engagement aspects of meaningful use to succeed. But it will take every trick in the book to pull it off, ranging from Holliday's national day of action to efforts such as CHIME's recent initiative to crowdfund a privately-inspired national patient identifier.

"Will we get to true interoperability and those type of things?" Branzell asks. "I sure hope so. That's our plan. That's the nation's plan, and everybody's calling for it."

Editor's note: The original version of this column was updated to clarify Russell Branzell's statements.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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