Beginning in 2014, the bar has been raised for physicians participating in the Meaningful Use program. Those attesting for Stage 2 will have to show their patients have access to an online method of viewing, downloading and transmitting health data, as well as have a certain amount actually use the ability. As providers prepare to step up to meet the so-called VDT requirements, patients are excited about the improvement in digital engagement.

The core measure specifically calls for physicians to provide patients with the ability to view online, download and transmit health information within four business days. At a minimum, this includes the Common MU Dataset, which should be presented in an English, non-coded form.

Those in the ambulatory setting also must include the provider’s name and office contact information, while hospitals in the program also provide patients with admission and discharge information along with the reason for hospitalization.

To satisfy the VDT attestation requirements for MU Stages 1 and 2, at least half of all unique patients seen by the eligible professional or who had an inpatient stay during the reporting period must be given online access to their information to view, download and transmit. Those attesting for Stage 2 also have to attest to at   least 5 percent of patients following through with one or a combination of those functions.

Consider the options

There was some initial confusion among providers, acknowledges Rebecca Mitchell Coelius, MD, medical officer and chief strategist for innovation at ONC’s Division of Science and Innovation. Yet, ONC clarified that the 5 percent use threshold is for any combination of viewing, downloading or transmitting. However, providers and institutions cannot simply turn any of the functions off; all three must be made available.

While the Direct protocol is required as part of ONC certification and thus built into certified EHRs, providers can use alternative transmit methods when attesting to CMS, says Coelius.  Any means of electronic transmission according to any transport standards, such as SMTP, FTP, REST and SOAP, may be used. The relocation of physical electronic media such as a USB or CD doesn’t qualify.

As providers prep for Stage 2, a number sought clarification on the requirements so they could hit the ground running. “We’ve had good, open dialogue with CMS to clarify questions,” says Michael Lampman, senior systems analyst, information technology, for Geisinger Health System, headquartered in Danville, Penn.

Geisinger had a head start in their efforts because it has offered a patient portal since 2001, and currently has 240,000 users, making the “view” part of the VDT measure easy to realize. For downloading and transmitting, Chanin Wendling, director of Geisinger’s eHealth division of clinical innovation, says the organization is working on creating functionality that’s easy for patients to use and also protects patients by ensuring information is transmitted correctly.

“If you can make that tool more meaningful for [patients], they’re more apt to be engaged, and the more likely you are to see some success with Meaningful Use across the various measures,” says Lampman.

Building a system

In Massachusetts, the statewide health information exchange (HIE), MassHIWay, was implemented in October 2012. Based on the Direct protocol, the HIE has the ability to transmit data, including continuity of care documents for VDT requirements in Meaningful Use Stage 2, says Manu Tandon, CIO for the Massachusetts Executive Office of Health and Human Services.

Users can connect to MassHIWay in three different ways: natively from a Stage 2-compliant EHR system; through a local access network device that can take information from a provider’s EHR and send it in a Direct-compliant message; and through a browser-based method.

More than 100 organizations are up and running on the MassHIWay, says Tandon, and while it doesn’t yet have patient-facing functionality, a PHR system that can consume the Direct protocol standard can connect to the HIE.

“Hopefully it means people won’t have to carry paper and CDs around,” says Tandon. “That data can be sent electronically and safely from point A to point B through the HIE.”

He acknowledges that the PHR market has not really taken off, but says the challenges are related more to the business equation rather than technical hurdles. “We think that by connecting on the HIE and having the providers exchange data with each other, we will make the data more liquid, which in the long run would result in that data making their way to the patients directly.”

Based on banking

The Midwest Health Exchange in Iowa was inspired by the banking industry’s model when designing its method of allowing patients to access and control their data. Micah Mosher, CMO for Midwest Health Exchange, makes the comparison to paying bills online. There are different sites for the bank, utility companies and so on, which makes systems that allow for auto-deposit and auto-payments so attractive. Anything that simplifies the process is valued, and this translates to patients managing their own health data.

“The things doctors hate about EHRs, patients hate about PHRs—they don’t want to do the data entry,” says Mosher.

To make the process easier for patients, Midwest Health Exchange can tap into data—currently focused on lab reports but can expand in the future to include any information provided by a practice’s patient portal—communicated between providers and laboratories. With patient consent, data can automatically be directed to a patient’s health bank, where they can be viewed and even auto-withdrawn back to providers selected by the patient.

Mosher observes that providers can’t meet Stage 2 requirements on their own and must rely on what the patient is doing. “That goes for the lab they choose. You can’t force them to go to the laboratory you have a discrete data connection with and you can’t force them to use the portal.”

Down the line, information that patients consent to share could be used to offer them additional information on their health or coupons for relevant healthcare supplies, Mosher says.

Future planning

When considering all the uses of healthcare information, it seems satisfying VDT requirements is not an end, but the beginning of a new era of digital patient engagement.

“If you are really talking about patient engagement, it’s about how the patient behaves, not how the clinician would like he or she to behave or hope he or she will behave,” says Chanin, who adds that Geisinger offers other kinds of digital engagement including text messaging and mobile apps. “We try and follow consumer trends. We’re trying to adapt technologies that people already are using in their lifestyle. Everybody is spending all their time on their smartphone. How can we leverage that device to help people track their diabetes and better manage it?”

And while some health information, like imaging, is not covered by the VDT requirements, tools do exist that allow patients direct access to this additional data, and they will value the opportunity. “One thing that I always encourage providers to do is not think about the VDT requirements as the ceiling on what they could possibly provide patients but as the minimum of what we’re asking people to do,” says Coelius. “There are lots of ways to give people access to their data.”