Patients Access under Stage 1 of MU changes in 2014

As a national recognized advocate of patient centered design in Health IT , the biggest concern I have with the proposed rule to delay both stage 2 and the use of 2014 certified EHR's is the impact it will have on patient access to their data.

I believe that patients are not just the center of the care but should be viewed as full-fledged members of their own care teams. We in fact increasingly are holding patients accountable for costs (over 40% of all health care costs are currently born by the patients) and outcomes (with penalties if you fail to participate in employer based wellness programs).
There are multiple ways under the new rule to avoid implementing even the most basic requirements to share data with patients. (by using 2011 or 2013 certifications and/or staying in stage 1 see here . Here is what was supposed to happen this year for stage 1 for example (and even higher standards for stage 2)

#1. Does meaningful use (MU) Stage 1 change in 2014?

Yes, the 2014 reporting period marks the beginning of a restructured meaningful use Stage 1

Even though MU stage 2 is proposed to be pushed back under new CMS/ONC rule making (for those providers who are unable to implement or upgrade to a 2014 certified EHR) that doesn't change the 2014 Stage 1 requirements for patient access to their data (which changed from both 2011 and 2013).

Stage 1 Certification requirements are as follows for patient access to their EHR.

New Objectives and Measures

New EP Objective: Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP.

New EP Measure: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (within 4 business days after the information is available to the EP) online access to their health information subject to the EP's discretion to withhold certain information.

New Hospital Measure: More than 50 percent of all patients who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH have their information available online within 36 hours of discharge.

People often mix up what EHR vendors are required to do to become certified vs what eligible providers (EP's) and hospitals (EH's) are required to do via attestation (to receive the incentive payments from CMS)

Not a perfect analogy but think of a car - in which all manufactures are required to offer seat belts (view download AND transmit)  but you can in fact start and drive the car without physically wearing one. (50% could view, download OR transmit). So this doesn't mean that 50% of your patients do any of the three only that the functionality is there for half of them.  (NOTE there is a measure in stage 2 that 5% of the actually use the functionality)

So although EHR's must provide the capability to view, download AND transmit but EH's and EP' only need to be using a certified EHR with this functionality for 50% of the patients not that the patients actually use it. It is however hard to fathom why you would only offer this functionally to half your patients since it is part of the EHR.

FYI - link above - here are the proposed ways you can opt out of using either Stage 2 or 2014 stage one

	You would be able to attest for MU:
If you were scheduled to demonstrate:	Using 2011 Edition CEHRT to do:	Using 2011 & 2014 Edition CEHRT to do:	Using 2014 Edition CEHRT to do:
Stage 1 in 2014	2013 Stage 1 objectives and measures	2013 Stage 1 objectives and measures -or- 2014 Stage 1 objectives and measures	2014 Stage 1 objectives and measures
Stage 2 in 2014	2013 Stage 1 objectives and measures	2013 Stage 1 objectives and measures -OR- 2014 Stage 1 objectives and measures -OR- Stage 2 objectives and measures	2014 Stage 1 objectives and measures -OR- Stage 2 objectives and measures