The quest to prove meaningful use of electronic health records (EHR) has moved into Stage 2 this year. The focus has also turned to engaging patients directly with the provider’s EHR. “Providers are skeptical about exchanging information electronically,” says Carrie Gulledge, RHIA, director of electronic healthcare records at MediSYS. “They fear that patients will have access to all their records.”
But Gulledge says that should not be a concern. Most EHRs allow providers to choose which information is shared with the patient through the patient portal. “You can set it up to only show patients pieces of their office visits. There’s no open door to everything that happened to that person during their visit,” Gulledge says.
As part of Stage 2, however, providers must let patients view, download, and transmit their Continuity of Care Document (CCD). The contents of the CCD, outlined by the Centers for Medicare & Medicaid Services, covers a brief overview of their stats and visit, such as medications, allergies, a problem list and vital signs.
The information on the portal must also flow the other way. Patients must be able to interact with their providers, such as requesting prescription refills and asking questions. “That’s a real benefit from the patient perspective,” Gulledge says. Patients remembering in the evening that they need to renew their blood pressure medicine no longer need to wait until office hours to put in the request. “They can do it on the portal whenever they think about it,” Gulledge says.
That flow of information through the security of the portal creates benefits for providers as well. “It’s a huge time-saver, because you cut down on phone calls to the office and out to the patient,” Gulledge says.
With the portal, patients’ communications go directly through the EHR, so providers do not have to log into a separate website or email program to view new messages or prescription refill requests. “It allows providers to see the contact immediately and respond in a timely manner more easily instead of being stuck at the office every night returning phone calls,” Gulledge says.
It also avoids phone tag with patients and allows physicians to send sensitive patient information digitally. “You can send lab work and detailed responses in writing now. And they’re all secure, because the information goes through a secure website, just like when you pay bills online,” Gulledge says.
Unlike with email, the portal eradicates the possibility of sending information to the wrong patient. “If you type in ‘Jane’ as the recipient when you use email, a whole host of Jane’s may appear, and you can inadvertently send something to the wrong Jane,” Gulledge says. “But with the portal, you’re in that patient’s record on the EHR. There’s no question who you’re sending to.”
Along with activating the portal, Meaningful Use Stage 2 requires the EHR to coordinate patient reminders, such as for upcoming tests and immunizations. The provider writes a reminder using a template provided by the EHR. Then, for patients who marked email or the portal as their preferred communication method, the EHR sends out that digital message. For patients who prefer the phone, the EHR generates a call list.
“It’s all automated and tracked,” Gulledge says. “Many providers are used to keeping log books for this, but the day of keeping track in such an archaic manner is gone. It’s a laborious task no more.”
The secure exchange of information must also flow electronically between providers to complete Stage 2. Called direct messaging (DM), it requires a third-party service provider. “You have to verify your identity to them, like sending your licensing information. They validate it, so not just any person can sign up for direct messaging,” Gulledge says.
Providers then receive their own DM account. Like with an email account, they send from their DM account and must know the recipient’s DM account name, as well. “It’s not like you’re sending patient information through a Yahoo account though,” Gulledge says. “It’s all verified by the ONC.” The Office of the National Coordinator for Health Information Technology (ONC) certifies EHRs and direct messaging providers.
“When a provider sends information through their DM to a referring physician, that physician receives it inside their EHR. The information gets automatically loaded into their EHR, so they do no have to reenter it,” Gulledge says. Meaning more efficiency and far less chance of entry errors.
But the receiving EHR must be Stage 2 certified. “You can’t exchange data if they’re not, and you can’t meet Meaningful Use Stage 2,” Gulledge says. “You have to buy another EHR that has that certification.”
Gulledge warns not to take anyone’s word for EHR certification. Verify that particular software version has made the list at healthIT.gov before gathering any data as part of Stage 2. Her company has gained about six clients so far this year from non-certification. “We’ve seen practices do the work to meet Stage 2, but then not been able to attest successfully with their software, because it wasn’t certified. Do your homework.”