MU Stage 2’s problematic measures

Why three core measures should be revised or removed.

By Daniel Patterson

Of the 17 required measures of meaningful use (MU) Stage 2, three measures stand out as problems for eligible professionals (EPs). All of the practices in our rural area with whom I consult will almost assuredly not meet MU Stage 2 due to at least one, if not all of the measures. These practices say the measures are difficult, require a tremendous amount of staff time and create large expenses for providers above the costs of adopting electronic health records (EHR).

Here, I analyze these measures and provide my suggestions for MU Stage 2 revisions that could ease EP compliance.

PATIENT ELECTRONIC ACCESS

Requesting e-mail addresses

Core Measure 7 requires EPs to provide online access to health information for at least 50% of patients during the MU Stage 2 reporting period, with the ability to view, download and transmit to a third party, which can be done through patient portals. However, many patient portal systems only work when the physician’s office acquires the patient’s e-mail address. Many patients hesitate to give out their e-mail address, even to a doctor’s office, citing security reasons or the desire to avoid more junk e-mail. My clients, including three practices across nine locations, receive 30% to 40% of all patients’ e-mail addresses.

While the measure doesn’t require EPs to personally walk patients through the portal, EPs who have met this measure say this helps to best generate patient interest. As an alternative, some facilities provide written patient portal instructions. However, patients often overlook handouts, which lack a personal touch.

My clients say they review the portals with about 50% of patients each day, a process that requires about five minutes with each patient. Therefore, practices that see about 100 patients daily may spend more than four hours assisting them with portals, resulting in a significant daily loss of productivity.

My proposed solution

Rather than over-subjecting practices to penalties based on whether patients choose to participate, simply require practices offer a patient portal. Then, if the patients choose not to use the portal, practice don’t need to waste time taking them through it. If they decide they want to use the portal and need help, it can be provided. This improvement would make the process easier for the practice and the patient.

SUMMARY OF CARE

Problems with communicating referrals

Core Measure 15 requires 10% of the EPs’ referrals during the reporting period to communicate through a secure direct provider-to-provider electronic messaging system. During transmission between providers the data are encrypted, similar to faxed documents, which has long been the desired method. However, faxing is outdated and EHR can pave a way to more secure and faster transmissions.

The problem: Many providers have not fully adopted EHR, and most of them haven’t advanced to Stage 2. In our area few providers are capable of secure online messaging, which makes it difficult to reach the 10% threshold when referring providers.

Also, no national database exists that displays all physicians who use secure online messaging. Without knowledge of which physicians have adopted EHR, staff members must call every office until they meet the 10% threshold to find out whether they have direct messaging. Then, staff must continue to check back with these offices to ensure the practice captures those who adopt EHR or reach Stage 2.

My proposed solution

Similar to my solution for Core Measure 7: Eliminate the threshold. Simply require EPs that have the ability to send direct, secure messaging to perform the direct messaging test that CMS has already in place. Similar to the way we’ve used fax machines, leave it up to the practices to decide how or when they want to use direct messaging if they feel it benefits their practice.

SECURE ELECTRONIC MESSAGING

Patients’ participation required

Core Measure 17 requires EPs to electronically receive secure electronic messages from more than 5% of unique patients during the reporting period. However, most patients call the practice to ask questions rather than wait for an electronic correspondence.

Therefore, my clients say the most effective method to comply with this measure requires them to call patients and ask them to log into their portal to send a message to the practice. This process goes against the intended purpose of secure patient messaging. As with other measures that require patient participation, the patient has no incentive to comply, yet the practice is penalized if it doesn’t comply with the measure. Also, the practice must again use staff resources to help patients log in and send the messages.

Without a doubt, secure messaging would save staff time if patients used it properly. We could reply to messages when it’s convenient for us. However, I feel practices should only be required to offer secure patient-to-practice messaging, and let the patients decide whether they want to use this feature.

CALL TO ACTION

EHR has potential

Remember that MU is just one reason you will use an EHR. Over all, an EHR has great potential. For instance, an EHR system can provide practices with great long-term benefits with fewer lost charts and billing mistakes, which can save valuable staff time.

However, penalizing an EP for missing just one of 17 measures is similar to receiving a zero on a 17-question math test with one incorrect answer. My solution: Give a percentage of what is due to the EP during a particular reporting period based on the measures he has successfully completed.

If you have similar concerns about these three rules along with the whole premise of MU, I strongly encourage you to call your congressional representatives. OM

About the Author
	Daniel Patterson is the owner of Daniel L. Patterson Group, LLC, a medical IT consulting company. E-mail him at daniel@pattersongroupllc.com.