"That's a lot to ask the provider, not only to ensure that the information is available to the patient electronically, but also to require the provider to meet a targeted percentage of patients who have actually accessed their information electronically," she adds.
On the health information exchange front, both NMPG and Baptist deployed McKesson's RelayHealth technology to provide a secure patient portal. This eliminated the need for time- and labor-consuming faxes and phone calls to affiliated physician practices, Lucas says.
"You improve quality, and it's also more secure," she says. "You don't have a fax lying around on a fax machine, curled up on the floor, or somebody punches the wrong number accidentally and sends that fax to the wrong location."
Other providers are still sorting out exchange strategies. "South Carolina has a statewide initiative, and we are participating with that," says Beaufort's Ricks. "But we're looking at building our own sort of health information exchange for the community, so a clinician can see a current picture of what's going on with that person across the community." For now, fax machine referrals will continue to some degree, he adds.
Ricks is determined to move ahead on patient engagement not just because of meaningful use regulations, but also because "we just know that somehow over the next five or seven years, there's going to be an evolution of the way we're reimbursed. It has to happen.
"We're looking at some solutions, very new in the marketplace, that are an adjunct to a patient portal. The intent is to engage patients with real-time monitoring of things," Ricks says. "I hate to use the word gamification, but that's the word I keep hearing, a social media aspect to some degree."
For example, to cut down on 30-day readmissions, discharged congestive heart patients might be sent home with a Bluetooth-enabled scale, Ricks says. The system would alert staff if measurements stopped or if the patient gained weight for two or three days in a row.
"Meaningful use is less about a technology implementation and more about policy and work flow implementation," says Beth Israel Deaconess' Halamka. "Think of the medical record as Wikipedia for each patient, where it's the collective editing of the entire institution that results in a record that's complete enough."