Policy & Regulation News

Stage 3 Meaningful Use Changes Can Support Patient Engagement

Policymakers should make some modifications to Stage 3 Meaningful Use patient engagement requirements to better allow patients health data access.

By Sara Heath

As the optional reporting period for Stage 3 Meaningful Use approaches, healthcare industry stakeholders and CMS should consider modifications to the patient engagement requirements, according to a study published in the American Journal of Managed Care.


The study, conducted in partnership with the Agency for Healthcare Research and Quality, investigated trial implementation of Stage 3 Meaningful Use patient engagement requirements at Intermountain Healthcare and Geisinger Health System.

The two health systems picked four draft patient engagement requirements, primarily focused on patient access to electronic health information, and implemented them between 2013 and 2014 to test their feasibility, finding that with some policy modifications, they could improve patient engagement.

“The draft objectives first proposed for MU Stage 3 (MU3) in 2013 increased expectations about patients’ ability to access and control the content and dissemination of their EHR information,” the researchers explained.

“However, there are technical and resource limitations to realizing the potential of EHR technology for engaging patients, including a lack of patient awareness and tools for accessing information, and a still-evolving technology and information infrastructure.”

Through qualitative interviews with senior staff at either health system, as well as a data analysis of how each system performed, the researchers found areas in which policymakers could improve four of the program’s tested requirements.

According to the researchers, requirements related to patient-directed health information dissemination will require more clarification from CMS. Both health systems suggested “more specific guidance to define potential recipients, EHR functionality to designate recipients and the information they can receive, and organizational policies about acknowledging and using this information.”

Improvements in this area are key to improving patient engagement. When patients have a say in who does and does not have access to their care summaries, it supports patient rights to privacy and helps them engage with their various providers.

To improve the patient-generated health data requirement, the researchers found a need for better technological support.

“Geisinger found that additional vendor functionality is needed for patients to easily provide self-generated information, such as health histories, symptoms, or substance use,” the researchers reported. “They should have access to their health records through multiple modes, be asked for relevant content, and know how this information will be used.”

After-visit summaries also need to be easier for patients to understand. During the pilot, these materials were insufficient for patient education, the researchers reported, and kept Intermountain and Geisinger from accurately assessing their effectiveness.

Additionally, the researchers stated that other patient education materials must be catered more specifically to the patient and offered in the patient’s preferred language.

“In our study, Geisinger and Intermountain raised concerns that generic education materials not tailored to individual patient circumstances may have little value, especially when clinicians do not speak the patient’s language,” the research team explained. “Additionally, the limitation of educational materials to published references must be balanced against personalized educational materials that offer an actionable, meaningful care plan.”

In addition to determining policy improvements, Geisinger and Intermountain informed several technology improvements.

Overall, the two health systems showed that a semi-automated approach will be helpful for meeting Stage 3 Meaningful Use patient engagement requirements. For example, patient authorization for disseminating health information is best served as a manual process.

Likewise, verifying patient and clinician identity and treatment relationships will require manual maintenance.

Because this pilot was conducted between 2013 and 2014, the researchers acknowledged progress that CMS has made since its implementation. For example, the agency is currently adjusting elements of meaningful use, including aligning requirements with the Merit-based Incentive Payment System and shortening reporting periods.

These changes reportedly mitigate some of the researchers’ suggestions.

“Still, meeting these requirements will be difficult without infrastructure improvements to ensure a basic level of functionality and access for providers and patients alike,” the researchers concluded.

“The pilot implementation experience of the 2 advanced healthcare systems suggests that, at least in the short term, a semi-automated approach will be necessary to meet many of the MU3 Patient and Family Engagement objectives, given the lack of infrastructure, standards, and functionality for full automation.”

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