|By the Innovations Exchange Team, based on an interview with Mary P. Griskewicz, MS, FHIMSS, Senior Director of Health Information Systems, Healthcare Information and Management Systems Society|
“There’s a gap in educating patients that they have a right to their health information and need to become active participants in their health care.” —Mary P. Griskewicz, MS, FHIMSS
Patients with Internet access can use patient portals or personal health records (PHRs) to access their health information and communicate with their providers. Generally, medical providers manage the information in patient portals while patients manage the information in PHRs. The data from electronic health records (EHRs) may be integrated into patient portals and PHRs, thereby helping patients gain access to their health information, and helping providers meet a key requirement for patient engagement in the “Meaningful Use” Stage 2 criteria for EHR technology.
Innovations Exchange: What factors have increased EHR adoption by medical practices and hospitals?
Mary Griskewicz: Advances in computer technology and the advantages of storing and retrieving information in digital formats have contributed to EHR adoption by health care providers and facilities. In addition, the Federal Office of the National Coordinator for Health Information Technology (ONC) has played a key role in driving EHR implementation by offering incentive payments to eligible providers—specifically primary care physicians and eligible hospitals—based on evidence that they are meeting criteria for the Meaningful Use of EHR technology.
How has Meaningful Use contributed to patients being engaged in their health care?
An important Meaningful Use objective is promotion of patient engagement. The aim is to improve patients’ understanding of their health and related conditions and to encourage them to take a more active role in their health care. Patients’ families are also encouraged to become involved, since many patients depend on them for support. For Meaningful Use Stage 1, the eligible professional must provide, for more than 50 percent of all patients who request it, an electronic copy of a clinical summary of their current health care within 3 business days. For Meaningful Use Stage 2, the eligible professional must provide clinical summaries to patients within 1 business day for more than 50 percent of office visits.
Now that ONC has released the Meaningful Use Stage 2 objectives and measures, what is new related to patient engagement?
The Stage 2 requirements include measures designed to engage patients more actively in their health care. By 2014, eligible professionals must provide more than half their patients with secure electronic access to their health information within 4 business days, and ensure that at least 5% of those patients view, download, or transmit their health information to a third party. The goal is to encourage patients and providers to use the technology and enlist patients as partners in their care and wellness. When patients take greater responsibility for their own care, the ultimate result may be more effective health care and reduced costs.
What role do patient portals play in engaging patients in their health care?
Patient portals can give patients secure access to a wide range of health information available in EHRs, including laboratory test results, care summaries, and educational resources. Patients benefit by knowing their medical progress and being able to act on that information. They can facilitate care coordination by sharing their care summaries with other medical providers. Using secure messaging, patients can schedule medical appointments and communicate with their providers. Increasingly, EHR systems will include patient portals that will help providers meet Stage 2 patient engagement measures.
What is significant about the OpenNotes® program for patient engagement?
The primary care physicians at three participating sites in the OpenNotes® demonstration program sent their visit notes (including patient care summaries) from the EHR system to secure patient portals. The aim of the study was to determine whether making doctors’ notes available to patients would increase their engagement in their health care. The preliminary results showed that 80 percent of patients thought that seeing their notes would help them manage their health better, 90 percent thought it would make them feel more in control of their care and better understand their medical conditions and care, and one-third thought it would help them take their medications more appropriately.
These results are significant, because providers often state they can’t control what patients do outside of their office. The OpenNotes® demonstration program shows that patients can engage with clinicians after they leave the office, if they understand their medical condition and are partners in the process.
A limitation of the study was that a significant number of physicians did not participate. A common concern they expressed was that patients might misunderstand their notes and become worried or confused. In my recent discussions with pediatricians, they expressed concerns about the need to share information with patients that is meaningful to them, and the potential problems that can arise when sharing information that patients may not understand due to its complexity, such as false-positive results from laboratory tests. I recommended that physicians limit the information patients receive to what they consider to be relevant for each patient. For example, a healthy woman might want to receive information about mammography screening, flu shots, and annual physical examinations. To address the challenge of ensuring that patients understand the information they receive, it may be necessary in some cases to provide additional patient outreach by a case manager or care coordinator.
How have PHRs evolved and contributed to patient engagement?
PHRs were initially developed so patients with Internet access could create a complete and accurate record of their health information and authorize the electronic release of their health information to designated providers. PHRs are offered by Kaiser Permanente and other health plans, physician groups, the Department of Veterans Affairs, and private companies. Some PHRs are freestanding, enabling patients to receive and share personal health information with several health care organizations, while others are “tethered” and share information with just one organization. PHRs have become more dynamic over time, reflecting both providers’ desire to educate patients and improve patient adherence to recommended care, as well as patients’ desire to communicate and interact with their providers. Some PHRs enable doctors to engage patients in educational activities and documentation, which is helpful for patients with chronic conditions. Patients can use PHRs to make appointments and communicate securely with providers.
What is the future direction of PHRs?
Over the next 2 years, more PHR products will be certified and integrated with EHR products. This will be a stepping stone for meeting Meaningful Use Stage 2 requirements, especially those related to patient engagement.
The BlueButton PHR offered by the Department of Veterans Affairs to veterans has reached more than 1 million subscribers. Private health plans, including UnitedHealth Group, Aetna, and Kaiser Permanente, recently announced that they will be offering the Blue Button PHR service to their patients. Mobile applications of PHRs are now on the market, including the Department of Veterans Affairs BlueButton and Microsoft’s HealthVault.
However, PHRs have not caught on yet with a large segment of the general population. A barrier is the lack of Internet access, especially among the elderly and the poor. Another barrier is that patients don’t know that they have the right to request and obtain their health information. Patients also need to become active participants in their health care.
Closing these gaps will require a cultural shift and a huge amount of education. As part of its effort to educate the public about the benefits of PHRs, the ONC announced a video contest in July 2012 to collect stories from the public about how they are benefiting from health information technology, and to motivate and inspire individuals to get more involved in their health. These and other education and outreach activities will help ensure that patients and health care professionals reap all of the potential benefits that PHRs offer.
About Mary Griskewicz, MS, FHIMSS
Ms. Griskewicz is the Senior Director of Health Information Systems for the Healthcare Information and Management Systems Society (HIMSS). She leads the HIMSS ambulatory, connected consumer, payer, and life sciences initiatives, including strategic, tactical and outreach activities. She has held other management and consulting positions in the health care industry, working in both provider and payer settings.
Disclosure Statement: Ms. Griskewicz reported that she has no direct financial interests and/or business professional affiliations that are relevant to the work described in this perspective. She receives payment for lectures and educational presentations related to health information technology as a lecturer at Northeastern University.