Meaningful Use 3 and Access to Health Data: An Introduction

This is the first entry of a blog series discussing Meaningful Use, interoperability in healthcare, and the future of healthcare innovation.

In today's digital age, it is surprisingly difficult to obtain access to one's personal health information (PHI). For example, at Los Angeles County (LAC)+USC Medical Center, patients can request their records either by making a workday trip to the hospital or via snail mail. Patients eager to analyze their own data will be disappointed -- paper copies are then made available within 15 work days, and electronic copies (CD format) are only available for imaging.

This process is not unique to LAC+USC - many healthcare providers have similarly onerous systems in place. Consequently, "lack of patient access to their PHI" is consistently the third most frequent complaint to HIPAA compliance officers. To make matters worse, dumps of information from systems built for use within healthcare settings can be difficult to comprehend, and the amount of data can be overwhelming for patients and their families to interpret.

Inaccessibility of PHI is problematic not just from a legal standpoint (HIPAA gives patients the right to receive a copy of their medical records), but also for innovation that would allow patients to become more engaged in their healthcare.

One potential solution lies within the Meaningful Use (MU) program, which was established in 2009 as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act. MU establishes Medicare and Medicaid incentives for the use of electronic health records (EHRs) to improve care, in part by providing patients with timely access to EHRs. MU has evolved through three stages, each with increasingly advanced requirements. Currently, requirements for the third and final stage (MU3) are in development, and the rule is set to take effect in 2017. MU3 proposes 8 major objectives, of which two are particularly pertinent to accessibility of PHI:

• Objective 5 (Patient Electronic Access to Health Information)requires that the eligible provider (EP) provide patients with access to PHI through an Application Programming Interface (API) within 24 hours of its availability.
• Objective 6 (Coordination of Care through Patient Engagement)requires that the EP meets two of the following measures: .. 25% of patients interact with their PHI from the EHR by downloading it or accessing it through a third-party application using an ONC-certified API. .. 35% of patients communicate with their provider using secure messaging. ..* 15% of patients provide patient-generated health data or data from a non-clinical setting, which is then incorporated into the EHR.

Although a significant portion of MU3 is dedicated to improving access to data, succeeding in doing so may not be straightforward. Past iterations of MU have faced significant challenges with adoption - the first year of MU1 saw only 12% of EPs attesting (meeting requirements) to the rule. MU2 has fared only somewhat better - as of February 2015, only 25% of EPs had attested to the rule. This is worrisome, as the penalties faced by EPs unable to attest could cost them valuable resources for future improvements. Some reasons behind the slow uptake of MU include:

• Lack of interoperability of electronic health information. For example, MU requires EHRs to accept coded laboratory data, but many labs do not provide data in the correct formats.
• Tight timelines for EHR vendors to bring their systems up to MU standards.
• Confusion among EHR vendors and hospitals about "usability testing" requirements of MU.

MU3 faces these challenges as well, in addition to the new challenges surrounding its updated proposals. It is tricky to balance (a) ensuring that MU3 is a realistically attainable jump from MU2 with (b) designing MU3 to effectively improve care and accessibility to data. Though the transition may come with some growing pains, MU3 is a step in the right direction toward bringing healthcare up to speed in the digital age.

Tune into our blog for ongoing discussion on the role of APIs in MU3 and health IT!

Hugh Gordon and Kaeli Yuen work for Akido Labs, a new company that brings modern data management technology to hospitals. Learn more at www.akidolabs.com.