Patient Portal Helps Meet Meaningful Use Rules
Practice Management Feature – December 2011
Tex Med. 2011;107(12):51-54.
By Crystal Conde
Premier Family Physicians in Austin embraces health information technology to strengthen the patient-physician relationship. Kevin Spencer, MD, says the practice uses social media, an electronic health record (EHR) patient portal, and other technologies to engage patients and families in their health care.
"Our practice is attempting to move toward doing things that are more patient-centered. We want to reach out to patients and communicate with them in the way they choose," Dr. Spencer said.
The clinic, which has eight full-time physicians, has a Facebook page and sends text message reminders to its patients.
"The patient portal, social media, and the other communication outlets we use allow us to provide patients with more real-time information. We can respond to them electronically, streamlining the work our office staff does and expediting care," Dr. Spencer said.
Besides accessing their medical information, patients can use the practice's online portal to make appointments, pay bills online, ask clinical questions, request prescription refills and medical records, and update their conditions and medications. During the 18 months the patient portal has been active, about 60 percent, or some 11,000 of the practice's patients, registered to use it.
The patient portal also allows the practice to meet two of the Centers for Medicare & Medicaid Services' (CMS') meaningful use core criteria. To date, the physicians have earned about $108,000 in Medicare incentive payments, according to partner John Kurt Frederick, MD. Dr. Frederick says one part-time doctor will receive a Medicare incentive of $18,000, as well.
Physicians who meaningfully use a certified EHR may qualify for up to $44,000 under Medicare or up to $63,750 under Medicaid.
Texas regional extension centers (RECs) can help practices with the meaningful use measures through onsite technical consulting. Their services take a practice from its current state – whether starting with a paper-based system or looking to optimize a current EHR system – to meaningful use to qualify for the federal EHR incentives. (See "Time Running Out on Medicare E-Prescribing Bonus.")
The core criteria of Stage 1 meaningful use require physicians to engage patients and families in two ways. First, they must give more than 50 percent of all patients who request it an electronic copy of their health information within three business days. Second, physicians must give more than 50 percent of all patients clinical summaries – regardless whether they request them – within three business days.
The patient portal allows Premier Family Physicians to meet the requirements. Dr. Spencer says he simply clicks a button to make the clinical notes from the patient's visit available on the portal. If a patient hasn't yet registered to use the portal, the clinic provides a printout of the health information and clinical summary along with instructions on signing up for the portal.
"We're getting positive feedback in regard to patient satisfaction with our clinic. Patients say they feel more connected to their doctors thanks to the portal," Dr. Spencer said.
Premier Family Physicians used what Dr. Frederick describes as a "smaller EHR system the vendor couldn't support" for three years when it switched to a more robust product 18 months ago.
"Because our staff had experience with an EHR, we were able to implement the new system quickly," he said.
Drs. Spencer and Frederick encourage physicians to carefully plan for a successful EHR implementation, and they say ongoing training for the whole practice is active.
To document patient visits in the EHR, Dr. Frederick prefers entering data and typing notes during his time with the patient. He says some of the clinic's physicians use the computer as a repository for information during the patient appointment and then enter notes once the patient leaves.
"EHRs may slow you down a bit at first, but they allow you to collect good data that can be sent to insurance companies, specialists, and other entities," he said.
To avoid EHRs creating a barrier between the patient and the physician, Dr. Frederick advises physicians to review the data with patients and use unobtrusive hardware such as a tablet computer.
"Glance at the patient's record before going into the exam room, and periodically look at the electronic chart while informing the patient about what you're documenting," Dr. Frederick said.
Joseph Schneider, MD, chair of TMA's Ad Hoc Committee on Health Information Technology, uses "macros" to document patient visits in an EHR. Macros are commands that automatically generate predetermined text. By simply typing a short sequence of letters, Dr. Schneider is able to populate the record with a full normal exam and make notes specific to each patient. He also uses customized templates for conditions he treats most frequently.
"Many EHRs support templates and macros. Also, I have a partner who works closely with our HIT experts to build templates," Dr. Schneider said.
Other common methods of documenting patient visits include dictating with voice recognition software or hiring a transcriptionist or scribe. Dr. Schneider says voice recognition software may come with an EHR system or may be purchased separately.
He says the software isn't yet perfect, resulting in varying levels of accuracy depending on the product and the user's proficiency.
EHR scribes are present in the exam room and complete the documentation for the physician.
Jeremiah Brown Jr., MD, an ophthalmologist and owner of Brown Retina Institute in Schertz, employs a scribe. He says that improves efficiency in his practice; results in more complete documentation of findings, medical topics, and alternative treatments; and allows him to focus on the patient during the appointment, leading to a strong patient-physician relationship.
"Employing a scribe lets me review the completed note and make additions and corrections, rather than clicking and typing and entering all the data while I'm with the patient," he said.
Engage Patients and Families
According to CMS, the electronic copies of health information that patients receive should include diagnostic test results, medication lists, and medication allergies.
CMS excludes from meeting this objective any eligible professional who doesn't receive requests from patients or their agents for an electronic copy of patient health information during the EHR reporting period.
CMS permits but does not require physicians to limit the measure of this objective to those patients whose records are maintained by using certified EHR technology.
Should physicians choose to charge patients for this information, they should refer to Section 165.2 of Texas Medical Board (TMB) rules that allow physicians "to receive a reasonable, cost-based fee for providing the requested information." TMB defines a reasonable fee as no more than $25 for the first 20 pages and 50 cents per page for every subsequent page.
Dr. Spencer finds that giving patients clinical summaries enhances their satisfaction, increases their knowledge, and improves follow-up compliance.
Clinical summaries give patients relevant information and instructions, including:
- Patient name;
- Office and physician contact information;
- Date and location of visit;
- Updated medication list;
- Updated vitals;
- Patient symptoms;
- Visit summary;
- Procedures and other instructions;
- Immunizations or medications administered;
- Summary of topics covered;
- Time/location of next appointment/testing, if scheduled;
- Laboratory and other diagnostic test orders; and
- Test and/or laboratory results (if received before 24 hours after visit).
If physicians choose to make the information available to patients electronically, they must be able to generate a paper format upon request. Physicians can withhold certain patient information, such as HIV status, if they believe substantial harm may arise from disclosing that information.
CMS says physicians shouldn't charge patients a fee for clinical summaries.
Patients should receive clinical summaries following all visits in which a physician renders clinical judgment. The meaningful use measure will count any billable visit, including:
- Concurrent care or transfer of care visits,
- Consultant visits (when referred by another physician or health professional), and
- Prolonged physician service without direct (face-to-face) patient contact (e.g., telehealth).
Dr. Spencer says physicians may want to consider making the clinical summary part of their regular workflow. Some EHRs have a template for clinical summaries or allow physicians to create templates or manipulate existing templates to hold all of the necessary elements for a clinical summary.
He advises physicians to develop procedures within their offices to give patients clinical summaries in the required three business days.
Meaningful use rules exclude physicians who have no office visits during the meaningful use reporting period from providing clinical summaries.
Out of the 10 meaningful use menu criteria, physicians must choose five. Among them, physicians can choose to engage patients and families by providing patient reminders, timely access to patients' health information, or patient education.
For more information on the core and menu sets of meaningful use measures, visit the CMS website [PDF].
Crystal Conde can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email.
How TMA Can Help
TMA can help physicians and staff identify coding patterns and reduce the risk of third-party audits due to over-coding or lost revenue due to under- and incorrect coding. Correct coding techniques can help practices avoid delayed or incorrect reimbursement or recoupment.
TMA Practice Consulting offers evaluation and management coding and documentation audits by certified professional coders and medical auditors. Consultants review medical record documentation to determine if practices follow the Centers for Medicare & Medicaid Services guidelines and if the documentation sufficiently supports the level of service billed. Practices can choose between an abbreviated checkup and a comprehensive audit and can receive continuing medical education credit.
In early 2012, TMA Practice Management Services will offer various educational opportunities, including hands-on ICD-10 coding workshops for physicians and staff, documentation training for physicians, and on-demand webinars.
Stay abreast of TMA's ICD-10 education programs by emailing Heather Bettridge. She maintains a database of physicians and staff members who request special notification of TMA's upcoming ICD-10 workshops, seminars, and webinars as details become available.
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