CMS Full Speed Ahead on Patient Engagement

June 25, 2013
After the CMS released the proposed rule for Stage 2 of meaningful use, it received a ton of pushback from providers on the patient engagement requirement, which asked for 10 percent of patients look at their data, download it, or transmit it to others through a portal. While it lowered the threshold by five percent, the point has been reinforced. Whether you like the patient engagement requirement or not, it’s time to push forward.

Back in March, after the proposed rule for Stage 2 of meaningful use under the American Recovery and Reinvestment Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act was released, the Centers for Medicare & Medicaid Services (CMS) got a ton of comments about one issue in particular. As our Contributing Editor David Raths wrote then, the patient engagement measure, requiring eligible providers have at least 10 percent of patients look at their data, download it, or transmit it to others through a portal, was not exactly well-received. Raths even called it the least popular thing about Stage 2.

In the blog, Raths quoted one provider who said the threshold was unrealistic. He also quoted Asish Jha, M.D., an associate professor of health policy and management at Harvard University, who rightly predicted there would be complaints from the provider community on that 10 percent requirement. David Chase, CEO of, a start-up out of Bellvue, Wash. offering patient portal solutions, in his post for The Healthcare Blog, later mentioned the pushback from not only providers, but large-scale vendors as well. CMS even acknowledged that “many providers expressed concerns regarding this proposal,” when it released the final rule.

As you all know by now, that 10 percent threshold was lowered to five percent in the final rule. It was a slight nod to all of those who criticized the 10 percent, while essentially, as many have told me in the past few days, reinforcing the same point. That point is this: eligible providers need a patient portal, and they need to demonstrate that at least some of their patients are using it.

John Halamka, M.D., CIO at the 631-bed Beth Israel Deaconess Hospital (Boston, Mass.), told me in an exclusive interview that it could have been 10 percent, five percent, or one percent – it still accomplishes the same thing.  

“I think what this does, it’s a nice forcing function that ensures every hospital and ambulatory care site implements a fully functional patient portal,” Halamka said. “It allows gradual adoption for those that haven’t implemented the technology, recognizing in some ways the transmission of data is a novel concept.”

This is not novel for Beth Israel. Halamka told me that since 1999, at least 20 percent of patients at his hospital have been doing this. With this experience in hand, Halamka advised others that the threshold is “definitely doable” based on your marketplace.

I don’t think anyone is against increased patient engagement through portals in the industry, especially based on various reports I’ve seen. The hard part is actually getting it done, especially considering how new this idea is, as Kate Berry, National eHealth Collaborative (NeHC), told me in a recent podcast.  While many are skeptical, and will remain that way, it’s time to push forward, regardless of personal beliefs. I’ll leave it at what Ferdinand Velasco, M.D., chief health information officer of the 25-hospital Texas Health Resources in Arlington, Texas, said to HCI Editor-in-Chief Mark Hagland and Senior Editor Jennifer Prestigiacomo, in this recent article on Stage 2 Final Rule.

“I can well appreciate the perspective of those critical of that requirement, but that’s where healthcare is going in general. And providers increasingly are having to take some responsibility for their patients doing the right thing. So I think [CMS] is making a very clear statement that patient engagement, and interoperability, another one of those controversial areas, are key focus areas, despite the pushback from the healthcare providers,” Velasco said.

Well said. The point has been made.

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