The document discusses optimizing EHR value through patient engagement. It lists several Stage 1 and Stage 2 Meaningful Use objectives related to engaging patients and families, such as providing clinical summaries and discharge instructions electronically. It describes ways physicians can use health IT to facilitate patient involvement, like arranging exam rooms so patients can see screens and using portals and PHRs. The document also discusses enabling engagement between visits through secure messaging, reminders, and accessing records online. It promotes joining ONC's Pledge Program to empower patient partnership in health.

1. Optimizing your EHR Value
through Patient Engagement
Judy Murphy, RN, FACMI, FHIMSS, FAAN
Deputy National Coordinator for Programs and Policies, ONC
HIMSS 2012
Physician IT Symposium

2. Conflict of Interest Disclosure
Judy Murphy, RN, FACMI, FHIMSS, FAAN
Has no real or apparent
conflict of interest to report.

3. Objectives
• List the Stage 1 and Stage 2 Meaningful Use objectives
that fall under the National Patient Priority of "Engaging
Patients and Families"
• Describe ways in which physicians can use HIT to
facilitate patients and families to become an integral part
of the care team
• Identify ways for physicians to prioritize use of
PHRs, including consumer portals for improving access to
healthcare and engaging with consumers in managing
their health
• ONC Program Update
2

4. Back in the Day…
“The obedience of a
patient to the
prescriptions of his
physician should be
prompt and implicit.
[The patient] should
never permit his own
crude opinions as to
their fitness to
influence his
attention to them.”
-- AMA’s Code of
Medical Ethics (1847)
3

5. And Now…
“Patients share the
responsibility for their
own health care….”
--AMA’s Code of Medical
Ethics (current)
“Patients can help. We can be a second set of eyes on our medical records. I
corrected the mistakes in my health record, but many patients don't understand
how important it will be to have correct medical information, until the crisis hits.
Better to clean it up now, not when there’s time pressure.”
– Dave deBronkart (ePatient Dave) 4

6. Why Should You Use Health IT
to Engage Your Patients?
• Patient as Partner
• Engaged patients demonstrate
better health outcomes
• Patients increasingly expect
engagement via IT, as in many
other aspects of their lives
• Meaningful Use criteria
66% of Americans say they would consider
switching to a physician who offers access to
medical records through a secure Internet
connection – according to a 2011 Deloitte
Survey
5

7. Stage 1 and Draft Stage 2 MU Objectives
From the June 8, 2011 HITPC Meeting
Engaging Patients and Families
Stage 1 Final Rule HITPC Proposed Stage 2
Key: Red indicates proposed change based on HITPC 5/11 comments
EH: Provide >50% of all discharged Hospitals: ≥ 25 patients receive electronic discharge instructions at time of discharge
patients patients with an electronic
copy of their discharge instructions
Hospitals: 10% of patients/families view and have ability to download [took out “relevant”]
information about a hospital admission; information available for all patients within 36 hours
of the encounter
EH Menu: Provide >10% of all unique Move to Core: EPs: >10% of patients/families view & have ability to download their
patients with timely electronic access longitudinal health information; information available to all patients within 24 hours of an
to health information (EP) encounter (or within 4 days after available to EPs) [P&S TT to consider whether a P&S
warning should be put in S&C criteria]
EP: Provide Clinical Summaries to EPs: patients are provided a clinical summary after 50% of all visits, within 24 hours
patients for >50% of all office visits (pending information, such as lab results, should be available to patients within 4 days of
within 3 business days becoming available to EPs; (electronically accessible for viewing counts)
EP Menu: Use certified EHR Move to Core: Both EPs and hospitals: 10% of patients are provided with EHR-enabled
technology to identify patient-specific patient-specific educational resources; make core; take out “if appropriate” instead of raising
educational resources and provide to threshold
patient if appropriate for >10% of all
unique pts.
EPs: patients are offered secure messaging online and at least 25 patients have sent secure
messages online
EPs: Patient preferences for communication medium recorded for 20% of patients
Stage 3: Provide mechanism for patient-entered data (supply list); consider “information
reconciliation” for stage 3 to correct errors 6

8. How can you use Health IT to
Support Patient Engagement?
 Within the clinical encounter
 Between clinical encounters
7

9. Within the Clinical Encounter
Some Relevant Information
2011 ONC-funded survey & focus group research on EHRs (by Mathematica):
• Most patients have favorable perceptions of EHRs
• Majority believe EHRs improve quality of care
• < 5% lack confidence in security of EHRs
• < 10% feel computer in exam room negatively impacts interaction/quality of care
Top perceived benefits of EHRs:
• Convenience to patients
• < Efficiency and accuracy of recording information and tracking patient progress
• Better coordination of care
Top perceived potential drawbacks of EHRs:
• System breakdowns
• Privacy concerns
• Inability to completely eliminate human error
• Inability of systems to communicate with each other
8

10. What You Can Do
• Arrange the exam or hospital room so you and the
patient can both see the computer screen/device
• Sit at the same height as or lower than the patient
to make them feel at ease
• During the transition from paper, explain that you’re
still learning and there may be some bumps while
your practice is “under construction”
• Less important than any technology is the sense of
connection you create through
empathy, posture, gesture and tone of voice (It’s
not about the EHR!)
• Customize delivery of information to the patient -
electronic copy of discharge instructions and
summary of care
• Advocate for use of portal/PHR during clinic
encounter or hospitalization 9

11. Between Clinical Encounters
Some Relevant Information
• Approximately 50 million Americans (roughly
20%) have accessed their health information
online . (Manhattan Research, 2011)
• More than half (52%) of Americans say they
would use a smart phone or PDA to monitor their
health if they were able to access their medical
records and download information about their
medical condition and treatments. (Manhattan
Research, 2011)
• 26% of Americans use mobile phones for health.
This has more than doubled since the previous
year. (Manhattan Research, 2011)
• Remote patient monitoring is expected to grow
by 25% per year (Kalorama Information, 2011)
10

12. What You Can Do
• “Patient as Partner” - increase patient accountability for and participation in
their own health and wellness care
• Give patients easy, electronic access to their own health information
(portal, “blue button”, tethered PHR)
• Encourage patients to look at their information and ask questions, help
identify and fix data quality issues
• Use electronic reminders to help patients schedule a
screening or regular checkup
• Communicate via e-mail (or text) using recommended
best practices (See next slide)
• Participate in health information exchange activities –
EHRPHR, EHREHR, EHRpublic health, etc.
• Improve care coordination between all care venues -
hospitals, clinics, physicians, home care, pharmacies
11

13. Best Practices for
Provider eMail Use*
• Establish a turnaround time for messages (don’t use for urgent matters)
• Talk to patients re privacy issues, such as who will see the messages
• Use subject lines to help filter (e.g. “prescription”)
• Configure automatic reply to acknowledge receipt of message
• Save and file e-mails in a folder for each patient
• Make sure the patient's name and yours are on each message
• Be careful about sending messages to more than one patient at a time
(they may see each other’s e-mail addresses)
• Do not deliver bad news via e-mail
• Establish clear guidelines patients should use, and remind them when
they do not adhere to them
* Developed by Danny Sands, MD and Beverly Kane, MD for the AMIA
Internet Working Group (this is a partial list)
12

14. ONC Consumer Pledge Program
Join ONC’s Pledge Program!
www.healthit.gov/pledge
ONC’s Consumer Pledge Program is
designed to support organizations that are
working to empower individuals to be
partners in their own health and health
care.
There are two types of pledges:
1. Data holders -- Make it easier for
individuals to get secure electronic access
their health info (through Blue Button or
Direct) – and encourage them to do it.
2. Non-data holders – Spread the word about
the importance of getting access
information, and develop tools to make that
information actionable. 13

15. Pledge Program
More than 250 organizations have taken the Pledge.
Collectively, they will provide access to personal health
information to 100 million (1/3 of) Americans…
14

16. Benefits of Pledge Program
• Public recognition of consumer access
to/use of information efforts
• Opportunities to network and partner
with other organizations who share a
similar goal of greater consumer
engagement in health
• A forum to elevate issues and provide
input on policy barriers/challenges for
the federal government to address
• Input into the development of and access
to materials/tools to spread the word
• Opportunities to exchange best practices
and learn from leaders in consumer
engagement
15

17. Pledge Participation…
To learn more or to take the pledge: www.healthit.gov/pledge
16

18. ONC Program Update
• ONC Websites
• Putting the “I” in Health IT Campaign
• Meaningful Use Update - Attestation Activity
• AHA Survey – Health IT Supplemental Questions
• Health IT Resource Center
• Health Information Exchange
• Beacon Communities
• Workforce Training
• The HITECH Story and Three Part Aim
17

19. HealthIT.hhs.gov website
18

20. HealthIT.gov website
19 19

21. Health IT Buzz Blog
20 20
http://www.healthit.gov/buzz-blog/from-the-onc-desk/consumer-health-information/

22. 21

23. 22

24. ePatient Dave Cancer Survivor and Proud Father
23

25. Nikolai “Koyla” Kirienko Crohn’s Disease Patient and Trailblazer
24

26. Lillianne Smith Diabetes Patient and Loving Mother
25

27. Donna Cryer Liver Transplant Survivor and Style Maven
26

28. HITECH Framework for
MU of EHRs
Taken from: Blumenthal, D.
“Launching HITECH,” posted by
the NEJM on 12-30-2009.
27

29. Meaningful Use Takes Off
– 52% percent of office-based physicians intend to take advantage of
EHR incentives
– The percentage of primary care providers who have adopted EHRs in
their practice has doubled from 20% to 40% between 2009 to 2011
– ONC’s Regional Extension Centers (RECs) have signed up more than
100,000 primary care providers
– This means that roughly one third of the nation’s primary care
providers have committed to meaningfully using EHRs by partnering
with their local REC. Momentum is building!
– Hospital adoption has more than doubled since 2009, increasing from
16% to 35%
– Most (85%) of hospitals intend to attest to Meaningful Use by 2015
28

30. 2011 Medicare and Medicaid Eligible
Provider EHR Incentive Payments
Note: Figures reflect number of unique
professionals who have registered or
received a payment from either the
Medicare or Medicaid EHR Incentive
Payment Programs. Figures may be
slightly different than the number of
payments that have been made to
eligible professionals by the programs.
Source: Number of professionals
registered and paid are from CMS EHR
Incentive Program Data as of
12/31/2011.
29

31. 2011 Medicare and Medicaid Eligible
Hospital EHR Incentive Payments
Note: Figures reflect number of
unique hospitals that have
received a payment from either
the Medicare or Medicaid EHR
Incentive Payment Programs.
Figures are different than the
number of payments that have
been made to eligible hospitals by
the programs because hospitals
can receive payments under both
programs.
Source: Number of hospitals
registered and paid are from
CMS EHR Incentive Program
Data as of 12/31/2011.
30

32. 2011 AHA Survey Data
Key points – in one year, from 2010 to 2011:
• Hospitals increased their use of Basic EHRs from 19% to 35% (84%)
• Hospitals doubled their use of Comprehensive EHRs from 4% to 9% (125%)
40
35
35
30 27
Percent of hospitals
25
19
20
16
14
15 13
10
9
10 8
4
5 2
3
0
2008 2009 2010 2011
At Least Basic At Least Basic (Rural Hospitals) Comprehensive
31

33. AHA Survey – implementation %
by state of at least Basic EHR
32

34. Health IT Resource Center
Work with REC Work with external
community and shares communities and shares
knowledge knowledge
Tools
Beacon
HIE REC Resources
Communities
CCC SHARP
of Practice
National
(CoPs) Learning
System
33

35. HITRC Resources
Customer
Relationship Knowledge Sharing Communities of
Management Network (KSN) Practice (CoPs)
(CRM)
Learning Practice
Training Services Transformation
Systems Support
Tools &Support Collaboration Public Website
for Adoption Portal
and MU
34

36. Health Information Exchange
Number of e-Prescribers in US by Method of Prescribing
400,000
350,000
300,000
250,000
Stand-alone
200,000 e-Rx System
EHR
150,000
Total
100,000
50,000
0
Oct-07
Oct-08
Oct-09
Oct-10
Dec-06
Dec-07
Dec-08
Dec-09
Dec-10
Aug-07
Aug-08
Aug-09
Aug-10
Apr-07
Apr-08
Apr-09
Apr-10
Apr-11
Feb-07
Feb-08
Feb-09
Feb-10
Feb-11
Jun-07
Jun-08
Jun-09
Jun-10
Jun-11
When will we see this Curve for Transition of Care Summaries or Lab
Exchange? 35

37. Hospital Exchange Activity with
Ambulatory Care Providers
60.0
54.0
53.1
51.9
50.0
Proportion of U.S. Hospitals
42.0
40.7
40.0
33.7 34.3
30.0 28.5
19.4
20.0 18.0
10.0
0.0
Patient Demographics Radiology Reports Lab Results Medication History Clinical Care Records
Within system 2010 Outside system 2010
36

38. 17 Beacon Communities Eastern Maine Healthcare
Systems
Western NY Clinical Brewer, ME
Information Exchange
Buffalo, NY
Inland Northwest Health
Services Mayo Center Clinic Rhode Island Quality Institute
Southeastern Michigan
Spokane, WA Rochester, MN Providence, RI
Health Association
Detroit, MI
Geisinger Clinic
Indiana HIE Danville, PA
Indianapolis, IN
HealthInsight
Salt Lake City, UT HealthBridge
Rocky Mountain HMO Cincinnati, OH
Grand Junction, CO
Southern Piedmont
Community Care Plan
Community Services Concord, NC
The Regents of the Council of Tulsa
University of California Tulsa, OK
San Diego, CA
Delta Health Alliance
Stoneville, MS
University of Hawaii at
Louisiana Public Health Institute
Hilo New Orleans, LA
37

39. Sample Beacon Early Results
Colorado Beacon Consortium Bangor Maine Beacon Community
Uncontrolled Diabetes Admissions Cardiovascular Disease: Blood Pressure Control
(AHRQ PQI #14) (< 140/90 mmHg)
100
6.0 94
90 92
5.18 85
5.0 80
Rate (per 100,000)
70
4.0 4.19
Rate (%)
60
3.34 50
3.0
40
2.0 30
20
1.0
10
0.0 0
1 2 3 1 2 3
Measurement Period Measurement Period
Utah IC3 Beacon Community
Diabetes Control: HbA1c (575) < 8
100
90
80
70
60 58
Rate (%)
52 54
50
Source: Self-reported
40
30 data from Beacon
20 Program Quarterly
10
0
submission.
1 2 3
Measurement Period
38

40. Community College Consortia
Workforce Program
REGION A
REGION C
REGION E
REGION B
• 5 regions REGION D
• $6 – $ 21 M per region
• April 2010 award
• 2 Years
• 10,500 to be trained
39

41. Workforce Training
Enrollment and Graduation
Community College Students
6,000 November 2011
5,000 917
Students Enrolled or Completed: 16,065
Attrition Rate: 18%
4,000 750
1018
3,000 375
3322
813 720 2253
2,000 1441
1107
1,000 2104
1370 1252 1398
1005
0
Bellevue Los Rios Cuyahoga Pitt Tidewater
(8 Colleges) (13 Colleges ) (17 Colleges) (20 Colleges) (22 Colleges)
Successfully Completed* Actively Enrolled Dropped-out
* Enrollment to date includes unique students reported in December 2011 cycle
40

42. Community College Consortia
Students Enrolled and Students Completed
(Cumulative)
25,000
21,022
20,000
15,000
10,000 7,129
5,000
0
May-11
Jun-11
Nov-10
Nov-11
Feb-11
Sep-11
Sep-10
Jan-11
Aug-11
Aug-10
Jul-11
Oct-10
Oct-11
Mar-11
Dec-10
Apr-11
Enrolled Completed
41

43. In Summary … the HITECH Story
Why does America need to
modernize using Health IT? What is America doing to modernize its Healthcare System
• Enable providers to securely through Health IT?
and efficiently exchange
patient health information. Showing
• Give providers the right Outcomes
information, at the right time
to offer their patients the Engaging
right care. Consumers
• Give consumers tools to know
their health information so Promoting
that they can improve their Exchange
Keeping
health.
Patients Safe
• Foundational to building a Protecting
truly 21st century health Privacy and
Accelerating Security
system where we pay for the Meaningful Use
right care, not just more care.
How is ONC
- Promoting Standards & Interoperability (HIE)
helping
- Stimulation Innovation (Beacon, Sharp) America
- Helping Providers Adopt (REC, Workforce) modernize?
2012 42

44. Health IT lays the Foundation for
New Payment and Delivery Models
to Enable the Three-Part Aim
Better healthcare Improving patients’ experience of care within the Institute of
Medicine’s 6 domains of quality: Safety, Effectiveness, Patient-
Centeredness, Timeliness, Efficiency, and Equity.
Better health Keeping patients well so they can do what they want to do.
Increasing the overall health of populations: address behavioral
risk factors; focus on preventive care.
Reduced costs Lowering the total cost of care while improving quality, resulting
in reduced monthly expenditures for Medicare, Medicaid, and
$ CHIP beneficiaries.
Health Information Technology
43

45. Thanks!
Judy
Judy.Murphy@hhs.gov