patients with an electronic copy of their health information (in-
cluding diagnostic test results, problem lists, medication lists,
medication allergies) upon request.”
In order to meet this objective, professionals must provide this
information within three business days in electronic form to 50
percent of patients who request it.
This is a big step toward providing patients with easy, electronic access to their health records, but it is still just a start,
according to Christine Bechtel, vice president of the National
Partnership for Women & Families, based in Washington, DC.
Bechtel was appointed to the ONC Health IT Policy Committee
by the Government Accountability Office to serve as a patient
advocate, and she also serves on the committee’s meaningful
use workgroup. Both entities develop recommendations on the
meaningful use criteria for ONC, with Bechtel serving to ensure
patient interests are maintained throughout the process.
The electronic access measure and other stage 1 patient-centric outcomes help lay the groundwork for requiring providers
to offer patients online access to their personal health information, Seidman says.
One of the optional objectives for professionals requires them
to provide patients with timely electronic access to their health
information within four business days of the information being
available to the provider.
This would likely be met by offering patients an online portal where they could view information like lab results, problem
lists, and medication lists. However, it could be met by e-mailing
the information or providing it on portable media, such as a CD.
Providing patients timely, electronic, and direct access to their
information has the potential to vastly improve a patient’s en-
diagnosis code generated in the EHR that then links to educa-
tional content on how to manage diabetes. This information is
then provided to the patient through a secure portal or sent via
e-mail.
Was a Foundation Enough?
While most agree that the meaningful use patient-centric objectives were a positive step toward better engaging patients in
healthcare, others point out the limited reach of the objectives’
actual measures.
A majority of the patient-centric objectives are included in
the menu set of stage 1, where participants need select only five
of the 10 options. Some patient advocates commented to ONC
that these patient-centered outcomes should have been in the
required core set.
In addition, many of the patient-centric measures require
physicians provide the service to 50 percent or fewer of their patients. Only 10 percent of an eligible professional’s patients are
required to receive electronic access to their health information
within four business days. Hospitals are entirely excluded from
the objective.
The final objectives and measures are a weaker set than those
put forth in the proposed meaningful use rule. The original
measures set higher standards but were lowered after industry
comments claimed they were too ambitious. In addition, all objectives were required in the proposed meaningful use rule.
Rein notes that the scope of the objectives
themselves has limited reach. “Gaining ac-
cess to information isn’t enough to generate
‘patient-centered care,’” Rein says. “It is a sig-
nificant portion, but it is one piece.”
Truly redesigning the healthcare system
to make it patient-centric is going to require
more than just the “information generation delivery compo-
nent” that came out of stage 1 meaningful use, she says.
Seidman asks that people be patient with the program.
Developing stage 1 measures required ONC committees to
perform a tricky balancing act. If they made the measures too
easy to meet, then healthcare outcomes would not significantly improve. If they made the measures too difficult, providers
would not participate in the program.
What stage 1 primarily has done is formally encourage providers to change their once self-centric mindset when it comes to
the use of health IT, Seidman says. Getting providers to use their
systems for patient-centric activities is a major win for patient
advocates and a large shift in industry mentality.
In the past EHRs were built for providers, and patient access to
information was an afterthought, Seidman says. Now the expec-
ONC “is wise to be doing it in a step-wise
fashion… It’s too early to tell whether stage 1
was enough or not enough.”
—Alison Rein
gagement in their healthcare, Seidman says.
“There is certainly an expectation now that patients have
much more timely access to their electronic data than they previously would have had,” he says. “There are requirements under HIPAA that require providers to provide records to patients,
but that used to be a matter of weeks. Now it is a matter of days.
“It is an important paradigm shift, because if there is some-
thing serious going on in terms of your own health, there is a big
difference between a few days and a few weeks.”
Stage 1 not only helps improve patient access to their health
information, but it also helps patients better understand their
information. One optional objective requires providers use EHR
technology to identify patient-specific education resources and
provide those resources to the patient.
