A recent report by CMS detailed statistics on how many health providers had actually received Meaningful Use (MU) incentive payments. As of March, 2013, 160,890 eligible professionals had received Medicare incentive payments and 83,765 professionals had received Medicaid incentive payments. While these numbers seem impressive, the question we have to ask is how many of these health professionals are changing the way they deliver care to patients by engaging them in health care decisions, communicating health information to them and treating them as a part of the health care team.
The mandate for physicians to engage patients in their care is part of Meaningful Use Stage 2 which becomes law in 2014, and includes specific requirements that physicians must adhere to including:
- Provide patients with their health information (via a web portal) on 50% of occasions and have at least 5% of these patients actually download, view or transmit that data to a third party.
- Provide a summary of the care record for 50% of transitions of care during referral or transfer of patient care settings.
- Provide patient-specific education resources identified by Certified EHR technology to more than 10% of patients with an office visit.
- Engage in secure messaging to communicate with patients on relevant health information.
- Make available all imaging results through certified EHR technology.
- Provide clinical summaries to more than 50% of patients within one business day.
The question is not the existence of the regulations and their incentives but whether or not these regulations are changing physician behavior. Do a majority of physicians remain steadfast in dominating the physician/patient relationship, convinced that engaging patients in their care is a burden? Or are many of them beginning to realize that engaging the patient in their health care decisions will make health care more efficient and cost effective, and improve patient outcomes?
The Annals of Internal Medicine recently reported on a study, primarily funded by the Commonwealth Fund and the Robert Wood Johnson Foundation that evaluated physician reports of EHR adoption and ease of use and their ability to use EHRs for patient panel management. The study concluded that using the basic data input capabilities of an EHR does not translate into better management of patient populations and adherence to the Stage 2 MU criteria.
Those of us who are committed to participatory medicine want to give the benefit of the doubt to our physicians who are under extreme pressure to contain costs and improve results. We know that most physicians are driven by a passion to help their patients achieve better outcomes. However, our own personal experiences and interactions tell us that many doctors have a long way to go to improve communication and patient engagement. We know that the patient population, for the most part, is more than willing to become more participatory, although many, perhaps the majority, of patients are ambivalent about access to their physician’s notes in the electronic health record, and only about 40% sign up for access to patient portals for secure messaging with their health care providers — a sure way to facilitate open communication, patient access to information, and e-visits. So there is more work to be done.
On the physician side, something beyond legislating these changes and dangling incentives in front of physicians has to happen in the delivery of health care. The training of new physicians and the retraining of established practitioners in communication skills and interpersonal relationships would be a good first step. Medical educators have given a lot of lip service to teaching their students to be better communicators, however, only a few medical schools have established courses that incorporate communication skills training. There are also some CME courses that focus on communication skills training for doctors, available online or as seminars and workshops. This is too little, but it is not too late. Our participatory medicine evangelists must continue to work on educators, physicians and the medical establishment to convince them that communicating with, and engaging their patients, is the right way to practice medicine.