Electronic Health Reporter

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:

• Five percent of more of patients must send secure messages to their physicians (yes, I said “must”)
• Five percent or more of patients must access their health information online (yes, I said “must” again)

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.