Taking the Good with the Bad: The Healthcare Community is Indeed Embarking On a Tumultuous Road Ahead

After a detailed conversation recently with a practicing physician, my long-held suspicions about meaningful use may be coming to fruition.

You see, though I’m a believer in meaningful use from a data collection perspective and for the benefits it provides the healthcare community in being better able to track outcomes and measure results, I’m also concerned with the amount of regulation and oversight required of the reform. Additionally, I’m concerned about how the overbearing amount of added reform is affecting the thousands of small businesses that are private practices.

With the added mandates and with the continual burdening requirements of the physician as educator to patients, there’s only so much room left for them to take on their tasks as caregiver.

All of that said there is some growing resentment in the healthcare community that suggests physicians are growing resentful of their educational assignment.

“Our job is not patient education,” the physician I spoke with said, asking that his name be withheld. “We’re on the precipice, teeter tottering on the verge of collapse and the system is going to fall down. We’re being pushed to the extreme with patients. We need to see more patients per hour just to cover our expenses because the margins have disappeared.

“We’re forced to focus on getting more patients through the door; we don’t have time to focus even more on patient care,” he said.

Besides meaningful use, there are other issues to address in healthcare, he said, like 5010, ICD-10, Medicare and Medicaid changes and insurance hurdles.

On top of these issues, physicians struggle with internal operations because of the financial cuts to their practices. With ever-changing reimbursement rates affecting the amount of money they can bring into their practices, practice leaders also have to worry about making payroll. Certainly, physician salaries are declining. Gone are the days when physicians were guaranteed lucrative careers.

The more likely model now will become the one where physicians become employees.

“Healthcare reform essentially is putting the private practice out of business,” he said.

In the long run, the only successful private practice model will likely come down to where large practices dominate the landscape. Anything less than a 300-physician group probably won’t survive, he said.

“This is the reality of what we’re seeing in the outside world.”

Add all of this to a physician shortage that’s only getting worse, and the healthcare community is indeed embarking on a tumultuous road ahead.

For the Laissez-faire Patient, there Will Be Some Push Back When Patient Engagement is Pushed

With the patient engagement quandary hanging its head over the next phase of meaningful use, healthcare leaders of all kinds continue to wrestle with how to meet mandates that are beyond their control.

Previously, the assignment was simple: do this, get that. But here, in stage 2, there’s a little outlier – required patient engagement – that has some physicians worried about how they are going to handle their second attestation.

Even though there are rumblings that CMS may look the other way when dealing with patient engagement, or decides not to enforce it, at least in the beginning, or chooses not to audit this measure, it’s still a mandate and it’s being taken seriously for all providers seeking the second set of financial incentives.

Some practices are taking measures that they haven’t had to in the past or at least with as much passion as they are now. They are marketing and advertising directly to patients, even if the campaign extends only to the interior of their own practices.

Such is the case for Dr. Stephen Bush, of Fox Valley Women and Children’s Health Partners in St. Charles, Illinois.

The first step in the process, Dr. Bush said is the implementation of a patient portal, which is though to help get the practice’s patients engaged or, in the very least, getting them more involved in their care protocols.

“The problem is, patients have to sign up to use the portal,” Bush said. His worry, though, is when pushing patients to engage, that if patients are pushed too hard, patients push back and essentially disengage.

“We receive significant push back from patients who get upset when trying to engage too much,” Bush said. Examples include posting too many times on Facebook or posting too many tweets to Twitter. According to Bush, patients will stop liking the practice on Facebook and stop following on Twitter if they feel the practice too involved socially.

Bush said his practice is working to implement new marketing and educational strategies to prepare for the patient engagement mandate, just to be safe, even though there’s little that can be done to audit how often patients use the portal after they have signed up.

There also may be too much attention put on patient portal’s capabilities, he said.

“They are not education tools, and they’re not meant to provide better healthcare, and in no way does it educate the patient,” he said.

Despite the patient engagement portion of the Stage 2, Bush said meaningful use is needed and ultimately, will help patients become more informed and get them involved in their care, which may help reduce costs overall. “The management of healthcare for patients is important, and can make lives better and healthier,” he said.

“All physicians are concerned about their patients are being taken care of and informed. Meaningful use gets patients involved. Patients now deal with things when there is a problem occurs rather than managing a healthy lifestyle.”

Physicians are trying to engage patients, and always have. Eventually, a change will come to the landscape, but as long as patients remain laissez-faire, there will be some push back when they are pushed.

Creating an Engaged Audience Through Social Media: Some Tips

I heard a stat recently that it would take eight years to view all of the videos loaded to YouTube each day. With such a volume of content flooding the market, it makes sense to have a plan.

Social media isn’t such a new phenomenon and it absolutely has an impact. As far as patient engagement is concerned, many say it’s one of the only ways to draw patients into the fold; especially important now, of course.

According to a new post from ClickZ, a marketing news site, almost 90 percent of all businesses are utilizing some sort of social media effort (I think that number is a bit high), but it’s very obvious that not as many of these campaigns are even remotely as impactful as they could be.

Establishing a successful program takes a little practice and patience, and probably a little luck. It helps, though, to identity mistakes and to try your hardest to avoid them.

Here are some of the biggest, courtesy of the folks who know at ClickZ:

Not having a plan. No matter the business sector or the business, you have to have a plan. The plan includes strategic objectives and, well, planning. Simply opening some accounts and posting your thoughts isn’t a plan. Plans include goals, and goals are something you work toward and attempt to measure. Just posting any old thing typically doesn’t produce anything of value and, therefore, is pretty much a waste of time.

Not optimizing content. Don’t simply post the same content to all of your social sites. It will grow redundant and bore your audience. According to ClickZ, you have to optimize your content. If you don’t, “You’ll end up with content that isn’t right for the medium, and people will start to ignore you. Take a few extra minutes to customize your post for each medium.”

Posting whatever comes to mind. Don’t simply write whatever comes to your mind and throw it on the web for the world to see. This seems pretty intuitive, but it’s a good reminder that there are often boundaries, especially in healthcare. Think about what you want to write, try to make it interesting and relevant. Think, think, think.

Forgetting not to show not tell: I quote directly from ClickZ. “Stop telling people what you want them to believe about your business and start showing them.” Show them with reports, videos, blog posts and observations. ‘Think about your key value proposition and point of difference, and figure out how to show people via social media.” Good point.

Are you boring? If you don’t have a “voice” and come of as un-insigthful, chances are, you’re boring. “Think about how to make your message interesting to your audience: compare it to something else; use a picture or video; find a more relevant way to share your angle. Just stop being boring.”

Losing focus. Stop trying to speak everyone’s language. Reel it in. Focus your message and stick to your strong points. You know what you do well, why you’re an expert; it’s time to focus speak your mind, but speak of the things in which you know well. Speak your mind, and speak your heart, but stay on point.

With these tips, and your best practices, there’s a good chance you’ll develop an engaged audience.

Engaging Patients Requires Your Letting Them Know that You Are Trying to Engage Them

Amit Trivedi

Perhaps one of the easiest ways to engage patients in the patient engagement process, especially as it relates to meaningful use Stage 2, is to let them know that you are trying to engage them.

Since CMS announced the patient engagement requirement as part of meaningful use, physicians and practice leaders who hope to attest and receive federal incentives have voiced their concern over the requirement since it’s the one element beyond their control.

“The push back from providers is because it’s the one thing they can’t control; they can’t make patients ask for a patient summary and force them to download it,” said Amit Trivedi, healthcare program manager at ICSA Labs, which is a vendor-neutral testing and certification firm that works with EHR vendors. “Originally, I thought it would be upheld. I still don’t think they’ll drop it, but it’s possible they (CMS) may modify it or choose not to audit it.”

Essentially, the patient engagement portion of Stage 2 most likely won’t be dropped, but, according to Trivedi, enforcement of the mandate may not happen right away.

Still, Trivedi says the healthcare community shouldn’t walk away from the patient engagement debate simply because patients don’t seem interested in or accessing their health record. On the contrary, now is the time to begin moving in the direction of creating more awareness with the consuming public.

By taking the approach that if patients don’t ask for something because they don’t want it is faulty, Trivedi said. The same arguments were made by technology vendors prior to meaningful use who he said claimed certain enhancements just were not important to physicians and their patients. However, once incentives were announced and mandates issued, vendors quickly jumped on board to upgrade their systems to meet the new need.

Patient portals are an example of one such tool. Prior to meaningful use, they were considered Cadillac-like add ons that were wanted only by a few practitioners. With meaningful use, they are necessary and required component of the systems.

“You may never be able to make patients download their records, but you have to advertise and make the data available” said Trivedi.

Healthcare is entering the age of a new demographic and though there may be little desire to engage with the current generation, upcoming users are not going to be so patient in seeking their health information. For many, having access to their records will be a right, Trivedi said. Making data available to the public and encouraging patients to access and use it is nothing more than a cost of business.

Other than advertising to patients about the capabilities, Trivedi suggests taking the message to those who truly need access to it, for example, parents of young children and caretakers of the elderly. Though there’s simply no way that a majority of consumer patients will be engaged patients, at least in the short term, it’s much more likely that targeting specific population sets, like those mentioned, will help move the population forward and get people to take greater ownership of their care (or at least the care of those they are caring for).

After all, even with all the data collection and its analysis, its potential for improving greater health outcomes across the population and the move toward structured and transportable data, it ultimately we won’t find the results we’re looking for if the patients are not engaged.

Really, Where is the Soul of Meaningful Use?

Help me understand, if you will, where the soul of meaningful use lies. I’ve seen the rules that have been made final and I’ve heard the stories of folks in the field that have had their lives and practices changed because of it.

But all of this just doesn’t seem to lead to a very innovative end.

Sure, the technology is needed in healthcare as the antiquated use of paper continues to overwhelm, but what’s the real proposition here? As far as I’m concerned, some of the real questions remain unanswered, and I am slightly suspicious as to why the feds are so heavily involved.

Granted, I shouldn’t be surprised given all the money that’s been spent in numerous non-government areas (like cars, banking and solar), but let’s peel back here a little and ask why the industry really needs the incentives. Let’s agree that on its own, the healthcare industry would have adopted the technology and was doing so; the incentives just moved adoption along much more quickly. So, why are the feds involved? Agree with me or not, they want our data.

This is the coup d’état. Collected data leads to predictive analysis and evidence-based treatment protocols. This leads to the dissolution of independent care protocols and removes independent will and turns healthcare into committee care.

Getting care is going to be similar to applying to government grants and scholarships. I’m oversimplifying the matter here, but please, let’s admit that there is a price that’s going to be paid for the federal incentives.

That said, my soap boxing out of the way, I’m back to my original question: Where is the soul of meaningful use?

Let’s take a look at the upcoming Stage 3. In large part it’s a lot of increased measures and new “patient engagement” provisions such as: giving patient the opportunity to request amendments to their records online, requiring electronic health records to receive, generate or access appropriate immunization recommendations, and requiring EHRs to be able to query other entities for outside records.

(Yawn.) (Wipe my eyes.)

These are valiant efforts and worthy of exploring, certainly. But, where is the real innovation that we’re supposed to be seeking? Where’s the game-changing approach to healthcare information that blows our minds? This is a technology based process after all and I think we need to begin demanding more of the technology we employ.

The technology is not holding us back, either. It’s us and our continually lowered expectations. If we’re going to take some risks then those risks need to be real risks and not some marketing speak for a data grab slight of hand.

From my perspective, about 90 percent of the technology vendors in the space do just enough and nothing more. Their investments are in sales teams, not in research and development.

But how can you blame them when the one leading body of the mandated changes is asking so little of the community.

What this is beginning to feel like a bunch of self-appointed “decision” makers trying to affect change of a program that’s been in place for decades, in the end, no matter the tinkering, may be nothing but waste having been accomplished.

How Small Businesses Spend Their Time on Social Media: What We Can Learn

The importance of social media can not be understated, and as a vehicle for communication, for many there is just no better option for cheaply and efficiently getting their message out.

However, just because something exists doesn’t mean you have to jump right in and use it without a plan (though your excitement in doing so is remarkable.)

And as you know, I spend quite a bit of time on this site encouraging physicians and practices to take the plunge into social media. But, as a small business, you might find some comfort in knowing you are not alone. There are countless other small business throughout the United States using (or trying to use) social media to engage prospective customers and bringing their message to the masses.

They’re efforts may not be entirely beneficial, but at least they’re trying.

Take a look at the following graphic, and let me know if anything resonates.

As far as social media use, 43 percent are using social media six or more hours a week. Remarkably, though, a third of CEOs and business leaders want to spend less time on social media, though, 63 percent of them spend just five hours or less on social media per week. The statement seems oxymoronic, but I shouldn’t be surprised; everyone is always trying to do more with less.

What’s not surprising, though, is that for the most part, small businesses are spending more time using social media to communicate their messages.

Where are they spending their time? Facebook has a 90 percent share; Twitter occupies 70 percent.

Finally, small business leaders are not overlooking the power of blogs (I haven’t). More than 55 percent of businesses just like yours are utilizing blogs to carry their message and to allow their thought leaders to share their, um, thoughts. Almost half of businesses with blogs spend between one and three hours to create each blog post, and finding and posting content is the most time-consuming part of the blog process (it is, by the way).

As you can imagine, I believe in social media and blogging (as is apparent from this publication’s existence) and it’s the future of communication and message development (take it from me, I’m a former reporter who watched the newspaper industry collapse because of web advancements like social media and blogs) and would like to see more prolific and active engagement from the healthcare community. Engagement on your befall means engagement on your patients and customers behalf.

Sure, some are doing it well, but not enough have gotten on the bandwagon. At least it’s encouraging to see that small businesses’ social media budget are on the rise.

Small Business Social Media

White Rose Family Practice, a Patient Centered Medical Home, on the Benefits of Adopting an Electronic Health Record

White Rose Family Practice
White Rose Family Practice

Serving patients is a fundamental value of White Rose Family Practice and so is maintaining a work/life balance for the practice’s physicians and physician assistants. To make this combination of values work, Cathy Carpenter, MD, founder of the York, PA, practice, was naturally drawn to using new technology to improve patient care while finding efficiencies in delivering that care.

From its founding in the 1990s, White Rose has been ahead of the curve: adopting electronic prescribing before pharmacies had ever heard of the technology, assigning one of the earliest-available tablet computers to its physicians, and hiring part-time physicians long before that was considered acceptable.

According to Whitney Almquist, Business Manager, even in the transition from a paper record to the clinical module, White Rose went against the grain.

In converting some 14,000 charts from paper to electronic encounter notes, White Rose decided to scan entire charts, not just recent visits. It took about four years for a crew of several part-time college students using high-speed scanners to complete the task.

The payoff is two-fold: 1) no more paper charts in the building, and 2) all the data White Rose physicians need to determine how their patients are doing – and how the physicians are doing in treating them – is as close as the nearest computer, thanks to the reporting capabilities of the electronic record.

“Now there is so much clinical data that we can mine and report on,” Almquist says.

White Rose had a yen for reporting well before the purchase of its system. Using a practice management system in the years leading up to the EHR purchase in 2003, Almquist admits she was entranced by the practice management system’s power to easily produce custom reports based on claims data, patient visits and other practice management data.

Reporting is essential for the White Rose physicians. It’s also been key to the practice’s successful participation in a statewide Chronic Care Initiative led by the Pennsylvania Governor’s Office of Health Care Reform. Taking part in the program and its intensive training has paid off in the form of new insights into the care of diabetic and other patients with chronic conditions, as well as experience in quality reporting.

Since beginning participation with the program, the practice has created and used clinical reports to monitor its patients. For example, with diabetes patients, the practice’s care manager uses reports to track those patients’ blood pressure, cholesterol, and A1C levels, among other measures.

Almquist can quickly determine what percentage of the practice’s diabetic patients have had an annual flu shot or recently received an eye exam. She and the staff then can run reports showing the names of those who have not had the exams and contact those who need to come in – something not practical to do without an electronic health record.

Almquist also can quickly run a report to show providers exactly where each one stands compared to others in the practice care results and, importantly, how they match up to the goals the practice has set for chronic care.

If there was any doubt as to the usefulness of an electronic record, that was all expunged when White Rose applied to participate in the Governor’s Chronic Care Initiative, which was built on a model developed by Dr. Ed Wagner of Seattle, Washington.

From the beginning, White Rose did a good job of getting its diabetes patients back into the office for regular follow-up exams, Almquist says.

“What we did not realize, until we looked at the data as a whole, was that some of our patients had high A1Cs, high LDL cholesterol [and] blood pressure that needed better control,” she admits. “There has been improvement and I credit the reporting capacity of our EHR in helping us fight against clinical inertia – not taking more aggressive action. It’s helping us continue to push our patients to make changes in their behavior.”

Some practices have struggled to get on board with chronic care initiatives, like Pennsylvania’s, because their EHR was simply not designed to do population management or patient registries, says Colleen M. Schwartz, RN, Quality Improvement Coach for Improving Performance In Practice (IPIP). The national program, which trains chronic care providers in team-oriented approaches to treating patients with asthma and diabetes, is sponsored in part by the Robert Wood Johnson Foundation and the American Board of Medical Specialties.

“I’m not sure you can be a highly successful medical home without an EHR,” Schwartz says. “White Rose has been able to do incredible things and leapfrogged to the head of the group of practices we’re training.” Schwartz concludes: “White Rose Family Practice has been an incredible beacon and leader for the South Central Pennsylvania Region collaborative teams.”

Almquist says the increased focus on reporting has some unexpected side benefits, too. It has helped the practice to solidify its own care team by spreading around more of the duties to staff who haven’t always had a direct role to play in patient care. In the front office at White Rose, for example, a receptionist runs a weekly report that shows which diabetic patients, who are scheduled for near-term a follow-up appointment, have not yet had lab work done. She calls those patients, which allows her to get involved in care management, a key part of the chronic care model, as well as expands the variety of work roles she experiences.

“What is the purpose of collecting the data if you’re not going to use it to improve patient care?” asks Almquist. Good question.

White Rose Family Practice plans to begin tracking its success in scheduling colorectal screenings for patients. The plan is to have one of the practice’s nurses to follow up on patients who were scheduled for colonoscopy but didn’t get one.

Additional areas where the practice is doing more intensive follow up are immunizations and medication reconciliation for patients discharged from the hospital or seen in the emergency department within the past 24 hours. That reporting is helping improve staff productivity, too. Almquist says nurses use the reports to hone in on patients who most need the counseling.

Schwartz agrees with the utility of an EHR and adds that it also extends to improve patient care and education: “People are visual. When you have a report card from the EHR, people can see their blood pressure is trending down, their A1C going down. They can see that they have met most of the measures and are doing a good job of self management.”

Cathy Carpenter, MD, founder of White Rose, sums up the practice’s experience in using the EHR to manage and involve the practice’s providers and chronic disease patients in working as a team.

“We use the clinical data that we have created to provide better patient care. With an EHR, we are in position to cut down on healthcare costs, and to make people’s lives better.”

HIE Expansion Will Most Likely Come Down to Business 101: Supply and Demand

HIE expansion about supply and demand? Well, if you read this blog regularly, you’ll know that I spend a good bit of time perusing HealthIT.gov. Though it’s not flashy and overwhelming, the site is informative and actually provides a great deal of information, which says a lot since it’s a government property.

What HeatlhIT.gov does well is provide a nice primer of information about a variety of subjects from meaningful use, electronic health records and health information exchanges.

In addition, the site puts everything in plain and simple language for all the world to understand.

For example, take a look at the reasons why health information exchanges are important to the healthcare landscape:

The ability to exchange health information electronically is the foundation of efforts to improve healthcare quality and safety. HIE can provide:

And for good measure, here are a few examples of how health information exchanges are benefiting the healthcare landscape. Some of these concepts are a bit obvious and overstated here, but still this provides a nice starting point in support for the soon to be possible movement.

Benefits of health information exchanges:

I’m not alone in the belief that I feel HIEs’ most important role is one of creating interoperable opportunities to connect physicians and their patients to a web of other care givers and health community members.

It seems that the closer we get to HIEs and their overall acceptance in healthcare, doesn’t it seem like we take two steps back?

What are some of the hurdles keeping HIEs from reaching their full potential? Glad you asked.

Cost has to be the clear front runner. As I’ve previously stated, the questions remain – who’s going to pay for them? The government clearly wants a healthy HIE community because it is believed that they will lead to greater adoption of EHRs while vendors want part of the action so they can charge physicians to transfer data through the networks. Vendors can’t figure out a financial model for them and until they can get someone to pay for them, there may be little movement here.

Another hurdle of HIEs is that for those that exist, the data often exists in silos. Problem with siloed data is that the data doesn’t go anywhere. Sounds a lot like an EHR, but an EHR may be more user friendly and robust. Just saying.

Finally, lack of standards impede their advancement. More development for standards is required for the variety of HIEs to be able to communicate. Profiles, like the need for structured data in EHRs, will help advance the cause and promote their development.

Ultimately, HIE expansion will most likely come down to basic business 101: supply and demand. When the population demands it, we’ll see the supply increase and in so doing, we’ll see cost containment, industry wide standards and completely interoperable systems that will completely open up the health IT market place.

Will Healthcare Interoperability Become the Next Health IT Mandate?

Lack of healthcare interoperability continues to throw its weight in the road of progress, stopping much traffic in its tracks.

But you know that already, don’t you; you work in healthcare IT. That electronic health records lack the ability to speak with their counterpart systems is no surprise to you. In fact, it’s probably caused you a great deal of frustration since the first days of your system implementation.

From my perspective, things are not going to change very soon. There’s not enough incentive for vendors to work together, though they can and in many cases are able to do so. The problem, though, is that vendors are not sure how to charge physicians, practices, hospitals and healthcare systems for the data that is transferred through their “HIE-like” portals that would connect each company’s technology.

The purpose of this piece is not to diverge into the HIE conversation; that’s a topic for another day. However, this is a piece about what have recently been listed as the biggest barriers physicians face when dealing with the concept of interoperability.

According to a recent report by Internal Medicine News, “Technical barriers and costs are holding back electronic sharing of clinical data.”

The magazine cites a study in which more than 70 percent of the physicians said that their EHR was unable to communicate electronically with other systems. This is the definition of a lack of interoperability that prevents electronic exchange of information, and ultimately will fuel health information exchanges.

It is notable that 30 percent of physicians said that their EHRs are interoperable with other systems. That makes me wonder if this is a verified fact or perception only verified by a marketing brochure.

Another barrier, according to the report, is the cost of setting up and maintaining interfaces and exchanges to share information. According to this statement, physicians are worried about the cost of being able to transmit data, too, which puts them in line with vendors, who, like I said, are worried about how they can monetize data transfer.

An interesting observation from the piece: “Making progress on interoperability will be essential as physicians move forward with different care delivery models such as the patient-centered medical home and the medical home neighborhood.”

What amazes me about this conversation is that given the purported advantage employees gain from the mobile device movement and how BYOD (bring your own device) seems to increase a staff’s productivity because it creates an always-on mentality. I don’t think it’s a stretch to think the same affect would be discovered if systems were connected and interoperable.

An interoperable landscape of all EHRs would allow physicians and healthcare systems to essentially create their own always on, always available information sharing system that would look a lot like what we see in daily lives with the devices in the palm of our hands.

Apparently, everyone wants and interoperable system; it’s just a matter of how it’s going to get paid for. And moving the data and the records freely from location to location opens up the health landscape like a mobile environment does.

Simply put, this is one issue that seems to resemble our current political landscape: a hot button issue that needs to be addressed but neither side wants to touch the issue because no one wants to or is able to pay for it.

One of the problems with this approach is that if we wait long enough, perhaps interoperability also will be mandated and we’ll all end up on its hook.

So, let’s take a lesson from the mobile deice world and allow for a greater opportunity to connect healthcare data to more care providers on behalf of the patients and their outcomes.

Stage 2 Patient Engagement is a Tough Hurdle, and It’s a Toothless, Un-enforceable Mandate

The fact that mandatory Stage 2 patient engagement is considered one of the largest meaningful use hurdles should come as a surprise to no one. If it is, that’s somewhat similar to saying that the day before a presidential election you still haven’t decided who you are going to vote for.

I think at this point it’s pretty short sighted to disregard this fact. Healthcare reform does not (yet) reform patients; it’s still a set of mandates for those in the field, practicing in the field and drawing money from the system.

Meaningful use is meaningless as far as patients are concerned. In almost every case they don’t know what it is nor do they care. They’ll only care when one of two things happen. You can take this to the bank: 1.) they are forced to pay or contribute financially in some way or 2.) you take away their right to care (in other words, you mandate them to do something in some way.)

I speak from experience gained from my time leading communication programs for a mandated statewide health insurance program.

If we want to hold patients responsible for their health outcomes, we need to either take away their right in some regard or tax them for their behavior. This is also commonly known as a sin tax. You smoke and you pay the tax on cigarettes.

I’m being a bit overly dramatic on purpose and I don’t recommend either of the two points above, but we should be fully aware that putting meaningful use in the hands of the patients are going to produce disappointing results for every physician and practice hoping to achieve Stage 2.

Just because a practice implements a patient portal doesn’t mean patients will use it. I have used my doctor’s patient portal. Even as a technology enthusiast and healthcare writer, I don’t particularly find it fun to use nor do I find it really helps me engage with my physician. Sure, I can send some emails and pay some bills through it, but that’s just the case. To me, it’s more of a bill pay system and I’m sure I’m not alone here. How many of you enjoy using your credit card company’s online bill pay system?

The only good news on this front is that Centers for Medicare and Medicaid Services might have finally figured this out and may allow for an exception to the ill-conceived requirement, despite Kathleen Sebelius’ insistence that a measure of patient engagement be included in the Stage 2 requirement.

But, I’m not holding my breath that what’s best for physicians in regard to meaningful use attestation will be upheld, though, when the only response to physician frustration over the requirement because patients are not showing any interest is for physicians to “push” their users to use it.

In principal, that response is a lot like breaking a toothless law. Sure a law is on the books, and you broke it, but there’s nothing that you can do about it.

And, as anyone who works in communications understands, push communications only goes so far in the 21st century and not nearly as far as it may have 15 or 20 years ago.

Push and pull; now that’s the kind of conversations that engage. You give, you take; you speak, you listen.

Anything else is nothing but mandatory arrogance from political forces far from the field of actual care.