Policy & Regulation News

Breaking Down the Role of Patient Engagement in Meaningful Use

Patient engagement plays a great role in meaningful use, despite much industry debate and conflicting interests.

By Sara Heath

Patient engagement is not just a new patient-centered care philosophy. For providers and hospitals participating in the EHR Incentive Programs, patient engagement is a critical part of receiving incentive payments.


Between the different stages of meaningful use and new rule proposals amending the program, the requirements for patient engagement are not always clear.

Below is a summary of all of the information providers and hospitals need to know about patient engagement requirements in meaningful use:

Stage 2 meaningful use patient engagement measures

At the moment, the patient engagement measures for Stage 2 of meaningful use are as follows:

  • READ MORE: Patient Portal Use Growing as Engagement Efforts Take Priority

    One patient seen by an eligible provider during an EHR Incentive Program reporting period must view, download, or transmit their electronic health data.

  • One patient seen in an eligible hospital or critical access hospital during an EHR Incentive Program reporting period must view, download, or transmit their electronic health data.

Additionally, EPs, EHs, and CAHS must be able to answer a yes/no question regarding whether or not EPs and EHs enable secure direct messaging between patient and provider.

Previous patient engagement measures created controversy

Although CMS has a clear cut set of patient engagement measures as of now, the development of these measures was met with some controversy in the past.

READ MORE: Patient EHR Note Input Boosts Patient-Provider Communication

Originally, the Stage 2 Meaningful Use patient engagement measures were more difficult. They called for five percent thresholds for patients accessing their health data via patient portal, and a five percent convert measure for secure direct messaging.

Such requirements were met with pushback from the healthcare industry. Upon further investigation, CMS concurred that there were some issues with the requirements. The high patient engagement requirements were too difficult for providers to meet, especially considering the fact that much of meeting these requirements depended upon the patient.

Program participants had also cited the technology as a barrier to meeting these measures. They argued that EHRs and patient portals weren’t sophisticated enough to produce the results required by meaningful use.

“Providers and system developers have noted…an overall immaturity in the market with health IT equipped with the functions required to support the transmission of health information by a patient or the delivery of a secure message from a patient to a third party,” CMS wrote in a proposal for their eventual Meaningful Use Modifications Rule.

Despite the difficulty in meeting these measures, several healthcare professionals also praised the value of high patient engagement levels. When CMS released their modifications rule proposal, groups like the National Partnership for Women & Families argued that lowering patient engagement requirements hindered the industry’s ability to move forward into patient-centered care models.

READ MORE: Physician Review Sites List Inconsistent Patient Satisfaction

“Secretary Burwell announced in January that there are going to be some significant delivery system reforms. ACOs are doing some things in order to benefit from shared savings,” said the organization’s Director of Health Information Technology Policy and Programs Mark Savage in an interview with

“Those all depend upon people being engaged and moving toward better health, which means lower cost. That doesn't happen if they are not part of the process and seeing their own health information. Both individually and systemically for the nation as a whole, this is a critical component of achieving the national goals, the triple aim.”

Despite some provider support for patient engagement measures, CMS changed them in October 2015 when it released the Meaningful Use Modifications Rule.

How can providers be successful in these requirements?

The primary tool for meaningful use patient engagement measures is the patient portal. The portal is included as a separate requirement, and should also be used for secure direct messaging and patient engagement.

However, the challenge isn’t simply having a patient portal for patients to use – it’s getting them to use it. According to the Office of the National Coordinator for Health IT (ONC), part of this lay in having a portal that patients feel is of interest to them.

“A patient portal that mostly provides administrative functions, such as scheduling appointments and getting lab results, will not be as interesting or useful to patients,” the agency said in an educational document aimed at helping with meaningful use attestation. “Patients will be more likely to use a portal that is designed and configured to address their personal interests and needs.”

Providers, as well as other professionals in the hospital, can also drive patient portal adoption by advocating for the technology. ONC says that patients are far likelier to adopt the portal when their providers suggest doing so.

“To simplify the portal registration process, have staff assist patients with the process, and consider providing a registration kiosk in the office,” ONC explained. “Staff can educate patients about how to use the portal’s features, and can offer guidance about the kinds of communication that are appropriate between providers and patients.”

What does patient engagement look like going forward?

The Stage 3 Meaningful Use rule, released alongside the modifications rule in October, also called for patient engagement requirements. In the Federal Register, CMS explains that patient engagement measures will be consolidated into one overarching rule.

In the Stage 3 Patient Electronic Access Objective, we proposed to incorporate certain measures and objectives from Stage 2 into a single objective focused on providing patients with timely access to information related to their care. We also proposed to no longer require or allow paper-based methods to be included in the measures (80 FR 16753) and to expand the options through which providers may engage with patients under the EHR Incentive Programs. Specifically, we proposed an additional functionality, known as application programming interfaces (APIs), which would allow providers to enable new functionalities to support data access and patient exchange.

Stage 3 has also set a requirement for 25 percent patient engagement, a component that has been met with opposition from the American Medical Association, CHIME, the American College of Cardiology, and Congress.

“For example, MU measures currently define patient engagement in a narrow manner without recognizing the vast opportunities of new technologies,” AMA’s CEO James L. Madara said in a letter to CMS. “Similarly, the MU program’s pass-fail structure is at odds with moving towards measuring and assessing care improvement. Since the future of value-based reimbursement depends upon leveraging health IT, we believe the MU program must be reassessed.”

Since the publication of Stage 3 Meaningful Use rules, CMS has made major announcements regarding meaningful use, namely that the program will undergo a major overhaul. At the JP Morgan Healthcare Conference at the start of the new year, CMS’s Andy Slavitt announced that this program will be changed to stay aligned with protocol in the Medicare Access and CHIP Reauthorization Act (MACRA).

The CMS meaningful use program as it has existed will now effectively be over, and replaced with something better,” Slavitt stated. “Since late last year we’ve been working side by side with physician organizations across many communities, including with great advocacy from the AMA and have listened to the needs and concerns of many.”

Stage 2 and Stage 3 of meaningful use will forge ahead as is until the agency releases the details of the changes they intend to make on the program. Because of this, the Stage 3 meaningful use requirements for patient engagement are still in effect, however this is room for them to change prior to the 2017 start date for Stage 3 meaningful use.


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