Terry and Diana recently blogged about the 2019 QPP Proposed Rule and all of the new changes coming down the pike. Diana’s July 30 Acumen blog post highlighted changes in the MIPS Promoting Interoperability (PI) category where some measures are being removed like “View, download, or transmit.” In its place is “Provide patients electronic access to their health information,” which is a required measure worth 40 points in the MIPS Provider to Patient Exchange category. This MIPS activity supports the CMS intention to reward patient access activity and drive interoperability.
The Acumen blog has focused on QPP, MIPS, and providers, so this week let’s look at the role patients play in “Provide patients electronic access to their health information.” What is happening on the patient/consumer side to foster access to health records? If you’ve seen the 1955 Disney movie Lady and the Tramp, think about the romantic spaghetti dinner scene. Two dogs from different worlds and backgrounds are united through dire circumstances and come together over dinner by sucking up opposite ends of a spaghetti noodle. Not a Disney fan? How about lyrics from the pop hit “The Middle” by Zedd, Maren Morris and Grey, “So why don’t you just meet me in the middle.” What trends will enable patients and providers to meet in the middle?
How are patients accessing health information today?
In April the Office of the National Coordinator (ONC) published a summary of patient data collected in the National Cancer Institute Health Information Trends survey from 2017. Based on this survey data, 52% of patients were offered online access to personal health information which may not sound like much, but it is a 42% increase from 2014. Of those offered access, about 30% viewed health data online. People who were encouraged by their provider to access online medical records were twice as likely to do so compared to those without provider encouragement. According to the survey, most people accessing medical records online looked at lab results:
- 8 in 10 viewed medical test results
- 6 in 10 performed health-related tasks like scheduling appointments and requesting prescription refills
- 5 in 10 communicated with providers
85% of people accessing online records found it “useful for monitoring their health,” and 44% of people with a smartphone or tablet used a health or wellness app for tracking or treatment support.
Speaking at HIMSS 2018 in March, CMS Administrator Seema Verma noted that billing-focused EHRs and legacy CMS regulations are barriers to providing electronic systems with easy health record access for patients. She described a recent experience involving her husband’s hospitalization for an acute illness, which was complicated by lack of access to outside provider records online. At hospital discharge her husband received his hospital records on a CD ROM. During her HIMSS speech she announced the launch of the MyHealthEData initiative to improve patient access to and control of online medical records. This initiative supports the CMS commitment to put patients at the center of managing electronic personal health data.
The MyHealthEData initiative is led by the White House Office of American Innovation, with support from various government agencies including the ONC. The initiative features an online resource, the “ONC Guide to Getting and Using your Health Records.” This is a very user-friendly website that walks through key aspects of online health records. It begins with an introduction explaining that people have a right to view, correct, and manage personal health records. There is a reference to HIPAA and a simple true/false game to reinforce some HIPAA concepts. The website transitions though an additional 4 web pages that include:
- “What’s in it?” provides examples of the types of records available, how they can be delivered (patient portal, personal email, thumb drive, mail), and the formats people can request (paper, text file, pdf). This section highlights “Blue Button” health-record access for active-duty military, veterans, and Medicare beneficiaries.
- “How to get it” describes patient portals, how to request records, and what to expect when you do.
- “Check it” encourages people to review their online records to look for mistakes or missing data they may have forgotten to share with their provider. This section suggests an organized approach to requesting corrections or additions to the medical record. This page also includes an interactive activity, “Medical Jargon Mastery,” which highlights common abbreviations like BID and N/V and provides definitions. It includes a link to Medlineplus, an extensive online list of medical abbreviations, what they stand for, and additional information.
- “Use it” encourages people to share their medical records with other providers and to use their records to actively manage their health. There is also information about the benefits of secure health apps and even links to the Apple App store, Google Play, and the Android App store!
Digital Health Technology Vision 2018
Accenture, a global company providing digital, technology, and business strategy consulting recently published their Digital Health Technology Vision 2018 noting that healthcare organizations are increasingly using technology “to deliver personalized, efficient and informed care.” The published paper explores 5 healthcare technology trends including:
- Citizen Artificial Intelligence (AI), suggesting that within the next 2 years AI will work next to humans “as a co-worker”
- Extended Reality (XR), which will blur the lines between reality and simulation to enhance medical training and improve clinical practice
- Data veracity, noting that much attention will be placed on the accuracy of data that underlies AI, algorithms, and other tools in clinical practice
- Frictionless business practices, like blockchain and microservices that will support rapid and robust expansion of technology-based partnerships in healthcare
- The Internet of THINKING (the new IOT), which represents a “hyperconnected healthcare environment” with connected devices and real time data
Accenture reports that mobile health adoption has tripled in use since 2014 and the use of wearables like Fitbits has quadrupled. Healthcare consumers are capturing, storing, and sharing health and wellness data as part of their personal health record. This is a big part of patients meeting providers in the middle to create value in online health records—powering you to a 40-point victory in the MIPS “Provide patients electronic access to their health information” measure.
For me this is reminiscent of the First Transcontinental Railroad story. I’m sure creating a railroad that spanned the continental U.S. seemed like a daunting task in 1863, but in just 6 years the Western Pacific Railroad Company and Central Pacific Railroad Company of California laying track from west to east met the Union Pacific track coming east to west. The Transcontinental Railroad officially opened on May 10, 1869, at Promontory Summit, Utah Territory, when Central Pacific Railroad president Leland Stanford drove in the gold “last spike” with a silver hammer. Imagine a day of gold spike celebration when 100% of engaged patients routinely download wearable data, access online records, and connect with multiple providers to lead their personal healthcare team. That’s the patient I want to be!
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.
Image from www.canstockphoto.com