According to GAO, HHS has invested more than $35 billion in health IT since 2009, some of which has gone toward improving patient access to EHRs. For example, the 2009 economic stimulus package created CMS' meaningful use program which allowed eligible professionals and eligible hospitals who demonstrate meaningful use of certified EHRs to qualify for Medicaid and Medicare incentive payments.
For the report, GAO reviewed Medicare meaningful use attestation data for program year 2015 submitted by 3,218 hospitals and 194,200 physicians to evaluate:
- Electronic access to health data available to patients; and
- The extent to which patients access their health data electronically, as well as actions providers take to encourage such access.
GAO in the report also evaluated HHS' efforts to increase patients' ability to access their health data electronically by reviewing data from HHS and other sources, as well as strategic planning documents. GAO also surveyed providers who participated in the program in 2014 and interviewed HHS officials and a random sample of patients, providers, and health IT product developers.
Few patients access EHR data, report finds
Overall, GAO said CMS data show that "providers participating in the Medicare EHR program in 2015 reported that relatively few patients electronically accessed their health information when it was made available to them."
For instance, for the 2015 program year, GAO found that:
- All participating hospitals reported offering electronic access to health information to 88 percent of their patients, on average, but only 15 percent of patients accessed their EHRs; and
- Nearly all participating professionals reported offering access to electronic health information to 87 percent of patients, on average, but only 30 percent of patients accessed their EHRs.
According to GAO, older patients were less likely than younger patients to access their health data electronically. Providers attributed the trend to older patients being less likely to use the internet in general when compared with younger patients.
GAO also found that many patients who accessed their EHRs expressed concern about the lack of a single, coherent record of their longitudinal medical history. GAO wrote, "Patients we interviewed said that the type of information made available in their portals was incomplete and inconsistent across providers." Further, GAO said patients "expressed frustration with the amount of time and effort it took to set up electronic access through their providers, managing multiple passwords for their many portals, and understanding each portal's user interface."
Report findings on HHS efforts
GAO said HHS does not have an effective process for measuring whether efforts to increase patients' engagement with EHRs are working. According to GAO, HHS through CMS and the Office of the National Coordinator for Health IT (ONC) tracks a range of outcomes related to its efforts, but the department does not look at whether individual efforts to improve EHR access boost patients' EHR use. "While HHS's investment in health [IT] is significant, HHS lacks the ability to determine whether, or to what extent, CMS' and ONC's efforts are helping HHS achieve its goals," GAO wrote.
GAO recommended that HHS direct ONC to:
- Create performance measures for assessing the effects of efforts regarding to "patients' electronic access to longitudinal health information"; and
- Make adjustments to its programs based on the findings of those assessments.
HHS said it agrees with GAO's recommendations and that ONC will develop performance measures for programs intended to boost patients' use of EHRs (Monica, EHR Intelligence, 3/16; GAO report, March 2017; Sweeny, FierceHealthcare, 3/16; Conn, Modern Healthcare, 3/16).
Advisory Board's take
Dan Clark, SVP, Clinovations
There are two big reasons why patients' engagement with portals is so low.
The first reason is technological. Although EHRs have offered patient-facing portals for some time, many providers still provide only the barebones portals they put in place initially, mostly just to "check the box" that they had a portal. Some forward-thinking providers and EHR vendors are optimizing the portal to enhance and boost patient use—such as by sending reminders to get flu shots and other wellness care.
The second hurdle preventing patient engagement with portals is the physician's encouragement, or lack thereof. Patients are more likely to access labs or send messages through the portal when a physician suggests that they do so. And more patients are likely to access their portals if a physician encourages it or offers to help set the portal up.
So how can providers overcome these obstacles? In working with our Clinovations clients to help implement and personalize their EHR systems, I find that physicians are more likely to talk up the portal to patients if their workflows are set up to optimize EHR use. But that can't happen if providers are using only the basic functionality of the EHR—and many still are.
To learn how your system can better use its EHR, check out how Advisory Board partnered with NYC Health + Hospitals to pull off the biggest-ever EHR implementation and go-live at a public institution.