This article is published in sponsorship with Berkeley Research Group (BRG).
By Jeffrey Becker, PMP
Healthcare’s Digital Renaissance
Healthcare has the unfortunate distinction of being one of the last major US industries to transition away from paper-based recordkeeping. Underpinning the largest and most risk-sensitive industry in the nation, business operations have been managed almost entirely on paper for generations. While data analytics upended conventional business practices across banking, telecommunications, manufacturing, and other major industries, healthcare entered the twenty-first century looking as though it would be left out of the digital renaissance.
In 2009, the American Recovery and Reinvestment Act (ARRA) introduced legislation aimed at spurring technology adoption in healthcare. Within a provision called the Health Information Technology for Economic and Clinical Health (HITECH) Act, ARRA established a carrot-and-stick approach to moving healthcare forward in its adoption of technology. HITECH offered federal stipends to help defer the cost of procuring and implementing complex healthcare IT systems. Further, HITECH created a penalty for those healthcare organizations that failed to move into the digital age. Called the EHR Incentive Program, or colloquially “Meaningful Use,” this effort drove electronic health record usage within acute care US hospitals from 13.4 percent in 2008 to 88.3 percent in 2015.
With medical records now stored on servers rather than just in filing cabinets, regulatory guidance issued under the Meaningful Use program has shifted its focus toward a new goal: increasing patient engagement within this new digital ecosystem.
The Need for an Engaged Patient
In 2007, the Institute for Healthcare Improvement published the “IHI Triple Aim,” a framework for improving healthcare delivery within the US. This approach to systemic improvement in healthcare found widespread support within the industry and calls for efforts that focus on: 1) improving the patient experience; 2) improving the health of populations; and 3) reducing the per-capita cost of care. Based in part on these recommendations, the Centers for Medicare and Medicaid Services (CMS) developed new “value-based” reimbursement models designed to financially reward health systems that successfully manage both the health and the cost of care within their patient populations.
A Health Affairs study from that time period investigating the impact patient engagement has on outcomes and cost of care found that patients with the lowest levels of engagement generate costs 21 percent higher than more involved patients. The study concludes that “patients who are more actively involved in their health care experience better health outcomes and incur lower costs.” For organizations operating under new value-based reimbursement models, patient engagement quickly shifted from an altruistic goal to a core business need. Revenue growth in a value-based reimbursement organization requires all parties—including the patients themselves—to be fully engaged in the care delivery process.
Based on the potential benefits associated with increased patient engagement, CMS moved to expand the core requirements established within the EHR Incentive Program to include a requirement that patients be offered secure online access to their medical record data through “patient portals.” CMS sets an expectation that 10 percent of discharged patients access the patient portal, and that functionality be made available for those patients to contribute their own data to their records and to exchange secure messages with their providers.
HIM Enters the Limelight
From the outset, the expectation was that traditional record requests made by patients would also migrate from the paper-based world to the digital age, but a pervasive disconnect remained between IT and HIM. While online access to records was introduced to ensure health systems complied with the Meaningful Use requirements, patients continued to report issues when requesting electronic copies of medical records from HIM departments.
In response to these complaints, the Office for Civil Rights issued a warning in 2016 clarifying that patients are not to be denied electronic copies of their medical records, reiterating that unreasonable per-page fees are no longer authorized, and assuring providers that if a patient asks for protected health information to be emailed, health systems should comply and will not be held responsible for data breaches that stem from fulfilling those requests.
An HIM Manager’s Role in Patient Engagement
As HIM managers regroup to adjust internal policies to accommodate these electronic medical record requests, consideration should be given to the larger role patient-facing HIM staff can play in increasing patient engagement. HIM plays a unique role within the healthcare system as the only patient-facing representative responsible for helping patients access their medical data. This single-patient interaction deserves careful consideration by health system leadership, as it is a potentially pivotal impact point for driving increases in patient portal awareness and enrollment.
Development of patient portal awareness and enrollment campaigns should include direct input and guidance from an organization’s HIM leaders. As record request policies are rewritten to accommodate email and other electronic record requests, thorough discussions should take place to ensure that HIM is promoting the patient portal throughout the record request process. HIM managers should work closely with their counterparts in IT to establish a plan for enrolling interested patients with portal access during the process.
Record request procedures should be updated to include distribution of written education materials describing the types of visit information available on the portal. The education materials should also provide instructions for accessing the portal, exchanging secure messages with providers, and contributing patient-generated data. Where staffing levels permit, HIM leaders should consider enrolling patients with portal access as a standard part of the record request process.
Between reimbursement penalties stemming from non-compliance with EHR Incentive Program requirements, and additional revenue opportunities generated by improving outcomes and care coordination within value-based organizations, the need for improved patient engagement has never been higher. HIM management must play an important role in developing actionable plans to bring these goals to fruition, and the medical record request process is quickly being recognized as a key opportunity for driving these improvements.
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