06 August 2013

ACA Without Meaningful Use = Failure

Healthcare be damned, full speed ahead for rationing. The author of this healthcare blog did not state it this way, but he should have. I have had the suspicion that patient engagement was not intended and Adrian Gropper, MD at least states this. Most physicians don't want patient engagement in the first place just like they do not want patients to have access to their electronic health records (EHRs) as I stated in my blog here.

Dr. Gropper had this to say about patient engagement, “Not surprisingly, patient engagement is an afterthought (talking about EHR).” Then he continues, “Patient engagement, from a health economics perspective, is incidental in care coordination but essential in avoiding the perception of rationing.” Ouch, the perception of rationing when rationing is planned. Many Medicare and Medicaid patients are already feeling the pinch of rationing as Accountable Care Organizations (ACO) and hospitals are attempting to make their funds stretch and grow their profits.

This statement is also worth quoting, “By paying ACO institutions instead of individual service providers, health insurance companies and Medicare provide direct economic incentives to reduce waste, lower costs and, if we’re not careful, withhold needed care. An ACO is by definition an organization or institutional construct.” Bold is my emphasis. “The book on patient engagement is yet to be written. EHRs still treat patient engagement as a liability and state health information exchanges (HIEs) are still being designed without any patient engagement at all. (Opt-in and opt-out is still as far as they go.) Both EHRs and HIEs still perceive strong privacy principles and fair information practices as obstructionist.”

At least Dr. Gropper recognizes the changing landscape and the need for stronger doctor/patient relationships. He acknowledges that patients and doctors need our Internet-age tools in a form for privacy and communications. Patient engagement is a euphemism for communication and I personally don't like the obtuse way they express this. Patient engagement is also used to describe meaningful use.

Dr. Gropper concludes by saying, “Let’s start by making sure our data can be liberated from the various EHRs via Blue Button Plus (see explanation below) and that every federally certified HIE includes provisions for a patient-accessible EHR Record Locator Service. These are the foundation of patient engagement (meaningful use) and essential to the success of the Affordable Care Act.

Blue Button Plus is a blueprint for the structured and secure transmission of personal health data on behalf of an individual consumer. It meets and builds on the view, download, and transmit requirements in Meaningful Use Stage 2 for certified EHR technology. Read more about this at this link.

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