Ray Kinsella May Be Able to Help Meaningful Use Stage 2 Reach Patient Engagement’s “Field of Dreams”

Will meaningful use Stage 2 reach patient engagement?

Patient engagement now requires patient action. So says the Department of Health and Human Services in meaningful use stage 2.

As a patient, your physician is counting on you to engage with him or her. It’s up to you, folks, to bring it home. Your physician’s incentive, and ultimately his or her potential non-penalty for Medicare, is on your shoulders.

That’s an awful lot of weight to bear. Can’t you feel it? It’s overwhelming. I’m exhausted just thinking about it.

Seriously, though, I’m confused. Someone please set me straight; seriously.

Meaningful use is now up to the patient? Whether or not I choose to interact with my physician via electronic means determines his/her level of success as gauged by the government?

I’m sure I don’t need to recite the language from the ruling, but I’ll do so for good measure.

In short:

The language isn’t written in an inviting tone, but one that tries to demand respect. It doesn’t say “may’ or “can,” if says “must.”

Is this a Ray Kinsella moment and HHS’ field of dreams?

“If you build it, he (they) will come,” sounds the whispered voice across the sky.

Cue the sound of rustling corn fields blowing in the wind as each of us imagine memories of our happy places where dreams live on forever.

If this gets built, will we all come and play? How can this be a requirement of our physicians? How can their level of success, the quality of the care they provide, be gauged based on whether or not I choose to interact with them via the web? After all, I want healthcare, not a Facebook friend or a Twitter follower. (I’m using obvious over exaggeration to make a point.)

I am all for patient engagement and believe it will increase given time and effort behind it, but forcing me — as a patient — to do something makes me a little less likely to follow so easily along. I’m not a lemming, and I don’t intend to be.

Sure, five percent seems like a manageable number; not that big of a deal. Surely, it’s just a few people, right?

Until next time, when the number increases to 25 percent of the overall patient population then 50 percent then 75 percent and so on until it’s just mandatory.

What might be the most troubling, though, is how this affects physicians and practices. Engaging patients to receive incentives and keep from being penalized becomes a marketing function, not a care function.

I can see it now: Your doctor will start offering club-type discount cards and try to cajole you with attractive terms like, “Sign up today for the patient portal and after you send just one email to your physician, you’ll be receive a $5 credit to your account.”

Or, perhaps the whole thing will have physicians sounding like to cashiers at Target: “Sign up for your patient portal access today and you’ll not only receive a nifty tote bag for your things, but you’ll get 25 percent off of of your next purchase!”

Lastly, I’m reminded of the lines of credit card pushers lining the student union of every college in the U.S. trying to convince our young and inexperienced that credit is the same as cash, don’t you know.

As noted on HealthWorks Collective, meeting this portion of the stage 2 requirement will take everyone in the practice, not to mention the support of those outside it.

But portals can only facilitate access to patient’s information, but it can’t force the participation of people to do something they don’t want. Requiring physicians and their practices to encourage me to engage with my care providers is up to me, and no matter how useful or entertaining, whether I choose to engage is something I commit to on my own terms.

Just because “they” build (read as “require”) it doesn’t mean I’ll come.

 

Things Babies Born Now Will Never Know: Practices Built on Typewriters, Telephones and Paper Records

I can’t help but think of some of the things kids born this year or last will never know.

For example, video tape and video stores are virtually gone already. Watches, paper maps and newspaper classifieds are on their way out; and perhaps newspapers, too.

Wired phones are hard to find (though my children will probably see a land line in my house because of their benefit in hurricanes and other natural disasters.)

Printed encyclopedias (some of the last were printed this year) and, likewise, encyclopedia salesmen are history. Printed phones books I still get, and use, but they will one day stop coming to the door; CDs, film and fax machines are all but obsolete, though, there are still enterprises trying to make their livings peddling their wares to help organizations send secure faxes.

I don’t consider myself to be old by any means; just part of a transitional generation. I remember paying $1 for a gallon of gasoline and I remember protestors picketing gas stations in Southern California when the prices topped $1.50 a gallon.

I was introduced to the web via dial-up Internet and wondered when its value would be achieved, as it was difficult to imagine a life lived through the web one AOL minute after another.

Now, the Internet is considered one of the most innovative advancements of all time. Healthcare, and nearly every other business sector, will never be what it once was because the technology allows for continuous advancement and the development of tools like EHRs, patient portals, HIEs and mobile devices.

Why all the reminiscing, then, about all of the gadgets that my children will never know?

Simple. My primary care physician uses paper charts. She has no plans to change and is unapologetic about it. Her patients sometimes ask her why and she shrugs it off like it’s not important, an overly hyped issue. One that she’d rather not discuss and one she might wish went away.

The wall of charts behind the reception desk is a symbol of her success. They represent patients she’s treated, conditions faced by the people she cares about, meetings with those of us she’s counseled. Perhaps that wall of record is her trophy case, a testament to her professionalism, outstanding demeanor and nature, and the trust she’s earned with all of us.

She doesn’t want to be forced into any kind of decision that affects her business – that’s how she sees her practice, as a business — even if she’s ultimately penalized because of it.

Though she’s got the paper to sift, she claims to be organized and just as efficient as any machine could make her. The notes enclosed are her own and won’t be shared with anyone. The only incentive for paper these days is the recycle bin.

But, she carries on. For now.

In the end, though, she’ll probably close shop, shred the records and move on to retirement if her decision not to implement an electronic health record means she can’t continue to do what she loves – practice medicine and provide care.

She has that luxury. She’s of a certain age. She remembers things that many of us have never experienced. She grew her business on typewriters, dial telephones and paper records.

And soon, she will become one more thing my children will never know.