Will meaningful use spur growth of patient portals?

Even though the number of practices adopting electronic health record systems is on the rise, the number of practices offering patients the ability to view, print or download their records from an online patient portal has remained consistently low.

But soon, physicians planning to collect incentive pay for the second stage of the Centers for Medicare & Medicaid Services’ meaningful use bonus plans not only have to implement the technology, but also ensure at least 5% of their patients use it.

The rule, some medical organizations say, will force physicians to decide if the incentive money is enough of a return on what could be a very costly investment. Practices can earn up to $44,000 per physician over five years from Medicare, or up to $63,750 over six years from Medicaid if they meet meaningful use. Starting in 2015, practices must demonstrate meaningful use annually or face pay penalties.

Proposed meaningful use stage 2 requirements, published in February, said physicians had to make available to patients a portal that would offer them the ability to access, print, share or download their records, and make sure that at least 10% of their patients use the technology. The final rules reduced that requirement to 5%, but many physician organizations say the requirement is unfair, because meeting it involves factors outside of their control. The American Medical Association and other medical societies recommended that the portal requirement and other patient-driven measures be optional.

It’s hard to determine how many practices have patient portals available to patients, but experts agree it’s very few. And those that do have portals are more likely to have systems that offer only administrative functions, such as scheduling or online bill pay, or read-only views of the patient records, a capability for which one study found that patients weren’t all that interested in using. A survey published in October 2011 by Manhattan Research found that although 56 million patients said they have accessed their records through their physician’s EHR system, another 140 million reported that they have not accessed their records, nor are they interested in doing so.

Rob Tennant, senior policy adviser with the MGMA-ACMPE, the entity formed by the merger of the Medical Group Management Assn. and the American College of Medical Practice Executives, said the business case is more easily made for portals that offer patients the ability to perform administrative tasks such as scheduling, requesting refills and paying bills online. These systems push some of the administrative work that is typically handled in-house to an online, self-service platform, reducing the practice’s administrative costs. The case isn’t as easily made for portals that don’t produce much cost savings or revenue generation.

“At first blush, it makes a lot of sense, and it’s wonderful for the patient to have this ability,” Tennant said of systems that give patients access to records. But “it’s not surprising it’s not offered in many of the smaller practices.” The business case just hasn’t been made, he added.

Starting up portals

Much of the patient portal technologies meant for small practices are sold as third-party add-ons to EHR systems but lack the necessary capabilities to meet the meaningful use requirements. Vendors are now looking at ways of offering the patient portal feature, given the new regulations. And, according to Tennant, some are exploring creative ways of making them more attractive to physicians. Models being explored include some that would charge patients for access, or display advertising. In many cases, pricing for portals hasn’t been determined.

One of the technologies that has gotten a lot of attention by the federal government in recent months is the “blue button” technology, developed and first put into use by the Dept. of Veterans Affairs and the Centers for Medicare & Medicaid Services in 2010. The technology allows patients to view, print, share or download their records by clicking on a blue-button icon. The program is open access, meaning that anyone can incorporate the technology into an EHR system.

But any add-on to an EHR system, including the blue button, would need to go through meaningful use certification before it can be used to qualify practices for meaningful use, said Mary Griskewicz, senior director of ambulatory health information systems for the Healthcare Information and Management Systems Society.

If you build it, will they come?

One group applauding the new regulations is the National Partnership for Women & Families. Christine Bechtel, vice president of the NPWF, said in a statement that the rule “recognizes the essential role that providers and their staff play encouraging patients to use this online access.” A NPWF survey released in February found that this kind of feature gives patients more confidence in physicians’ use of EHRs.

Tennant said that although getting 5% of patients to access their records doesn’t seem like a lot, many MGMA-ACMPE members said their experiences with stage 1 have them concerned about the stage 2 requirements. Under stage 1, practices had to make copies of patient records available in an electronic format, but the regulations did not specify the type of technology that had to be used, or place a number on how many patients had to receive the records. Many practices reported having no requests for records at all, Tennant said.

“It’s all about practicality,” he said. “It’s one thing to offer it to patients, but I have not seen any hard data showing patients are clamoring for a copy of their record online.”

Jeff Smith, assistant director of advocacy for the College of Healthcare Information Management Executives, which also expressed disappointment with the 5% rule, said now that the requirement is in place, the organization is focused on developing ways to help its members buy the technology, and get patients to use it.

“Somehow providers are going to have to encourage patients to actually seek out that information in addition to, or instead of, what they really came online for, which is schedule and appointment,” Smith said. “That’ll be the trick.”

But there are steps being made in that direction, he said.

Griskewicz agreed, saying she expects that physicians will hear more requests from patients for such access as more aspects of health reform take hold and patients become more engaged in their own care. HIMSS will spend the next several months looking at ways care will be affected by the technology, she said.

Meanwhile, physicians also should ask vendors some pointed questions, Griskewicz said.

“You’re going to ask those questions before you sign the contracts or before you do the upgrades and the updates: ‘What is this going to do for our practice? How is this going to help with patient outcomes or the administrative burden overall? Can this truly return our investment to us?’ ”

Smith said the government also can help by highlighting examples of how small practices have implemented and benefited from the technology.

“If they can’t find somebody who is currently doing this, then we have a bit of a situation on our hands,” he said.