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Christmas in July: Meaningful Use as a Gift for the Consumer

Everyone was expecting the new meaningful use rules to include some important, but relatively basic advances for the consumer—and it did. However few of us expected meaningful use would include a real consumer gift: the requirement that EMRs help doctors deliver information prescriptions to each patient. That addition is a game changer for advancing the patient’s role in a patient-centered health care system.

Page 225 of the rules includes this Stage I Measure for demonstrating the “meaningful use” needed to qualify for the federal subsidy for EMR investments:

More than 10% of all unique patients seen by the provider are provided patient-specific education resources.

That simple requirement represents a sea-change in use of the EMR as a tool to advance the role of the patient. It will bring into mainstream American medicine a recognition that medical care is of high quality only if it includes relevant information to help the patient do appropriate self-care and better participate in treatment decisions.

The requirement gives mainstream life to the decade-old concept called “information therapy” or Ix for short. Ix promotes the need to prescribe the right information to the right patient at the right time as part of the process of care. The new rule promotes the exact same thing.

While Ix may be the greatest consumer “win” in the new rules, it is accompanied by at least ten others. Here is a quick listing:

  1. You can now see your own health care records.
  2. You will now get reminders for preventive services (just like most vets send to your pets)
  3. Your doctors will now better share with each other the information they know about you. (That will help you avoid paying double for duplicative testing.)
  4. Your doctors will now be less likely to make a mistake in prescribing your drugs.
  5. Your records will follow you when you leave one doctor or hospital for another.
  6. You will be better able to tell if your doctor or hospital is above or below average for quality.
  7. The privacy of your health records will be better protected.
  8. Your advance directive will be more likely to be respected.
  9. Your doctor’s poor handwriting will be much less of a risk to your health.
  10. Your costs should be lower. (Still an arm and a leg, but at least a little lower)

All of this adds up to a big movement toward “patient-centered” care in the true sense of the word. It is a gift for the consumer—and makes this July seem like a part of the holiday season, for sure.

As chairman and CEO of Healthwise Mr. Kemper is a passionate advocate for raising the quality of patient engagement in health care. By prescribing prevention, self-management, and decision-support tools relevant to each patient’s needs, clinicians can engage and motivate their patients to become active partners in their health and wellness.Mr. Kemper co-authored Information Therapy: Prescribed Information as a Reimbursable Medical Service with Molly Mettler. The Ix book lays out both the concept and the practical details of how information prescriptions will become a core and expected part of health care. More information can be found at Healthwise.

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13 replies »

  1. once again more top down medicine masquerading as change-let exchange 80 percent of expert in DHHS for regular citizens-then well see real progress in medical care

  2. The real doctor will be relating to the patient and not the box.
    The real doctor will be seeing the next patient after he/she is done with you. Lengthen the time for each encounter with worthless confetti and build bigger waiting rooms. Maybe a stadium.

  3. The real win here is that it will now become much easier for a doctor to provide succint, relevant, well-written and evidence-based information at the click of a button on his or her EMR screen. Most doctors would like their patients to be informed but don’t have the time or the resources to provide the education. If their EMR makes it easy, they will both do it and enjoy the thank you’s they get from their patients.

  4. “The real doctors (from the Latin–“teachers”) will embrace this requirement and revel in it. Those doctors will increase the amount of time they spend educating their patients (as they should have been doing all along). With the advent of patient-centered medicine–of EHR-enlightened medicine–educational supplements will be sent automatically via email. Short notices will be tweeted. No junk handouts to throw away.”
    This paragraph is a microcosm of the central-planner mind. It deserves to be highlighted, parsed, even contemplated like a mandala.
    The “real doctors” — presumably, the doctors whose values are right, who put patients at the center — will “revel” at this government rule, because it will… make them do what they should have been doing. They’ve been good all along, they know in their hearts they should be doing it, but up till now they haven’t, because the Federal Register hasn’t told them to do it. Or something.
    So the reaction to the rule is the sign we should watch for so we can divide the sheep from the goats. If you are a good doctor, you’ll love it; if you are — presumably — a doctor with the wrong values, you’ll not “revel” in it. If you don’t like the government telling you you must educate your patients, you do not value educating patients. If you value educating patients, you will revel in the government telling you that you have to. And the very fact that you will now start to do it after you’ve been told to start doing it IS WHAT MAKES YOU THE GOOD SORT OF DOCTOR.
    Because, up till now, these good doctors have wanted to do the right thing for their patients, but the LACK OF A GOVERNMENT EDICT PREVENTED THEM.
    This is all nonsense on a cracker.

  5. Well, Tim, you’re probably right, the lazy response to the education requirement will be to hand out useless brochures that offer less than what you could find on Wikipedia. That’s okay. It just provides the empowered patients with one more tool for determining that it’s time to find a new PCP.
    The real doctors (from the Latin–“teachers”) will embrace this requirement and revel in it. Those doctors will increase the amount of time they spend educating their patients (as they should have been doing all along). With the advent of patient-centered medicine–of EHR-enlightened medicine–educational supplements will be sent automatically via email. Short notices will be tweeted. No junk handouts to throw away.
    Will some patients simply delete the supplements without reading? No doubt. Not all of us are readers and researchers. Those of us who want the information, however, will have it at our fingertips.
    Thanks, Don, for sharing this gem of Meaningful Use. I’m just sorry it wasn’t a 90% requirement.

  6. > Patients do not want to read most of that
    > inforamtion nor do they want to read their records.
    Right.
    The meaningfully used EMR will burn a Blu-Ray or download a movie to the patient’s iPod so he can watch it. If it isn’t a 1080p at 35 Mbps or better, it can’t possibly be useful because it’ll be insufficiently entertaining. And a choice of sound tracks is a must: you know Sinatra for The Greatest Generation, The Byrds for the Boomers, and so-forth. Patient engagement is king you know. Wouldn’t want `em to tune out.
    I think I’m going to go form a medical information video production company right now and start lobbying. I knew I’d find a creative outlet somewhere. Its gonna be BIG I tell ya! I wonder if I can get Clooney, Halle, and Cosby…
    t

  7. Patients do not want to read most of that inforamtion nor do they want to read their records. That was borne out in the UK where care records were made available on line. No one looked at them.
    This is such a crock of C$HIT.

  8. Don’s post highlights an important inducement to clinicians to meet the information needs of patients. At Group Health we have built in tight integration of patient ed materials to our EHR, which patients have access to online (63% of our patients are online with us). Instead of reams of paper as the default we have intelligent links from visit summaries online to plain language health information. Easy for the clinician and great for the patient. I love the quote from my colleague Ted Eytan – “the same information in the living room and the exam room”. Integrating content searches for diagnoses and problem list entries does what EHRs have always promised to do – make the right thing to do the easy thing to do.

  9. The biggest complaint coming from every patient satisfaction survey today is that the doctor did not give them enough information to understand what they should do themselves, why a test was needed or why they should take a drug. If we make it part of the workflow to give patients good information, even the patients of un-enlightened doctors may be left less in the dark.

  10. I agree with you that providing patient-specific education resources is a step in the right direction. Over time, we will refine this approach. Providing information is one thing. Having the patient understand it is another. Some people learn better by reading, others visually and others aurally. The questions are: How can we customize the education approach to best meet the patients’ needs? How can we provide the physician enough time to truly educate those patients who need it?
    To me, interconnectivity requirements between EMRs of various providers and reminder notices to encourage compliance are tools that will have a significant and quick impact on the quality and cost of care.
    Robert Kaminsky
    MedSpan
    http://www.medspanresearch.wordpress.com.

  11. “More than 10% of all unique patients seen by the provider are provided patient-specific education resources.
    That simple requirement represents a sea-change in use of the EMR as a tool to advance the role of the patient.”
    I predict it will produce a huge amount of paper handed to patients that they will throw in the trash on the way out the door. For those who actually take it home and read it, there will be nothing in it they couldn’t find on the internet.
    But we’ll all check that box, get our check from CMS, and the left will sit around at resorts and talk to each other for decades about how they emancipated the American patient.

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