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Get your practice ready for patient portals, care summaries

November 23, 2012

Two emerging health information technologies (HIT) – patient web portals and standardized electronically transferable summary-of-care records (SCR) – promise to become important elements in health care practice over the coming years, according to Farzad Mostashari, M.D., the U.S. Department of Health & Human Services’ (HHS) national coordinator for HIT.

Together, these two electronic messaging functions could represent “a giant leap” in health care communications, Dr. Mostashari and many other public and private sector health care policymakers believe.

“For practicing optometrists and their office-staff, maintaining common data sets for patients, making personal health data available to patients on portals, and exchanging standardized patient data sets with other health care practitioners are about to become core functions in all health care practices and institutions,” said Ian Lane, O.D., who is helping to develop optometric patient portal and SCR functions for AOAExcel’s new XNetwork HIT (Health Information Technology) connectivity and interoperability service.

Patient portals – special websites maintained by health care practitioners to provide patients online access to their basic health information – could greatly enhance communications between patients and their health care providers.

Electronic summary-of-care records – uniform patient e-records designed to provide a concise and timely summary of basic patient information (identification, vital statistics, health care history, and treatment information) when a patient is transferred or referred – could similarly enhance communications among the various health care practitioners who provide care for a patient.

At a minimum, these two new electronic messaging functions – soon to become standard features in electronic health records (EHR) systems – could vastly improve the efficiency and effectiveness of routine patient-provider communications as well as record transfers among health care professionals, proponents believe.

Ultimately, they could usher in a new era of comprehensive health care with patients taking a more active interest in their health and practitioners adopting a cooperative, integrated team approach to care, proponents believe.

Both patient portals and summary of care records will be built around a common patient dataset, announced recently by the federal Office of the National Coordinator for Health Information Technology (ONC) (see below).

Patient portals and electronic summary of care exchange will be required under the Medicare and Medicaid Electronic Health Records Incentive Program Stage 2 Meaningful Use criteria that take effect in 2014 (see AOA News, October), meaning practitioners will have to adopt and meet utilization criteria for both messaging functions in order to earn incentive bonuses under the program, Dr. Lane noted.

However, both patient portals and care summary exchange will also be required for participation in emerging care models such as medical homes and accountable care organizations, Dr. Lane added.

Increasingly, they will be required under emerging value-based insurance reimbursement programs, he said. Just as important, patient portals and SCRs are widely anticipated to rapidly become health care industry norms, expected of health care practitioners by both patients and their fellow practitioners.

Most major EHR vendors plan to have updated systems, with portal and care summary functions, available to practitioners by the end of 2013. However, health care practitioners will also need EHR connectivity, meeting federal Nationwide Health Information Network (NHIN) standards, for both care summary exchange and the providing of secure portal services for patients.

Conventional practice websites will not be acceptable for use as patient portals, according to Dr. Lane, because they will generally not meet federal Health Insurance Portability and Accountability Act standards for the privacy and security of protected patient information.

For optometrists, AOAExcel’s planned new XNetwork, slated for introduction in early 2013, will offer NHIN-grade connectivity, sufficient to support both patient portals and care summary transfers in a convenient, cloud-based format that can be interfaced with practically any EHR system.

“The XNetwork will effectively ensure optom-etrists will be able to meet the new portal and record transfer requirements even in parts of the nation without health information exchanges (HIEs),” Dr. Lane said.

Applications in optometric practice

Overall, Dr. Lane believes optometrists and ophthalmologists appear to have a good reputation for exchanging adequate records when referring or co-managing patients.

However, information that is mailed or faxed needs to be manually added to a patient’s medical record.

“The new EHR interoperability protocols mean that the patient information is not only transported electronically, but is consumed directly into the receiving doctor’s EHR and becomes a part of the patient history,” Dr. Lane said.

Moreover, optometrists often do not receive any records when a patient is referred by a general practice medical doctor (who, for example, might simply tell a patient with diabetes to “go get an eye exam”), Dr. Lane noted.

And some optometrists, when referring patients for treatment of systemic conditions, may still feel their records are not welcomed by other health care practitioners, he observed.

The coming of electronic care summaries will greatly facilitate referring patients in need of eye care, such as those with diabetes or at risk for conditions such as glaucoma. It will ensure that optometrists have all the clinical information they need when patients are referred to them.

The inclusion of the patient’s optometrist in the care summary’s list of health care providers will also solidify the optometrist’s position as an integral part of the patient’s health care team, Dr. Lane noted.

In addition to providing an online listing of patient health information, patient portals must provide secure e-mail functions designed specifically to allow for communications between patients and health care practitioners regarding protected health information.

Patient portals could be used in optometric practices to enhance follow-up, encourage compliance with care regimens, facilitate appointment scheduling and recalls, and help ensure patient retention.

Practitioners could use patient portals and their secure messaging functions to follow up with patients after their appointments to see if new eyeglasses or contact lenses are providing adequate vision, to remind contact lens patients to comply with wear and care instructions, or to check on medical eye care or post-surgical patients to see if they are responding to treatment or experiencing adverse events.

At a minimum, electronic care summaries and patient portals will greatly reduce the time and expense required for communications in a health care practice, proponents note.

Dr. Lane urges optometrists and their staffs to begin integrating patient portals and care summary exchanges into their offices as soon as possible.

“These potentially important new HIT functions are expected to change the way in which optometrists interact with both patients and other health care practitioners,” Dr. Lane said. “It may take a little time to incorporate these new functions into day-to-day practice. In some cases, practitioners and staff may need to become familiar with the specific terminology, such as the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT) that will be required in the common dataset.”

“In addition, offering patients online access to health information before other practitioners could be an excellent way for an optometrist to establish a reputation in a community as a provider of high quality, state-of-the-art care,” Dr. Lane suggested. “Being among the first to utilize patient summaries could be a good way to establish an optometric practice as a leader among the health care providers in a region.”

Practitioners can view examples of patient portals and care summaries, as well as other EHR functions, in the “Toolkit” section of the AOAExcel website (www.excelod.com/toolkit).

AOA members can log in using their AOA membership number and password.

Summary of care records

The new summary of care records are designed to provide a concise “snapshot” of the pertinent information needed when a patient is transferred or referred from one health care practitioner or care setting to another, according to the U.S. Centers for Medicare & Medicare Services (CMS). The uniform care summary is part of a package of continuity of care documents (CCD) developed in part by the U.S. Centers for Disease Control and Prevention (CDC) and required for used under the Stage 2 meaningful use standards.

The Stage 2 standards call for health care practitioners and institutions to issue a summary of care document with a minimum of 12 elements (see box on page 38). To earn Stage 2 EHR incentive payments, practitioners will have to provide care summaries for more than 50 percent of the patients they refer or transition.

A “transition of care” is defined by the CMS as the transfer of a patient from one clinical setting to another (inpatient, outpatient, physician office, home health, rehabilitation, long-term care, etc.) or from one setting of care to another (hospital, ambulatory primary care practice, ambulatory, specialty care practice, long-term care, home health, rehabilitation facility).

EHR systems certified for use in federal incentive programs will allow practitioners to proactively “push” a care summary to another health care provider or institution using a special form of secure email. Those certified EHRs must have the ability to produce a “machine-readable” care summary, in a format such as XML, which can be read by and incorporated directly into another EHR system, Dr. Lane noted.

Although the CMS prefers that summary of care records be transferred electronically, agency officials acknowledge that the necessary technological infrastructure may still be under development in many parts of the nation. Therefore, health care professionals and hospitals will also have the option of either sending a paper copy of the summary of care record to the next provider or having the patient deliver the summary care record to the next provider themselves. However, a certified EHR system must be used to generate the care summary and record whether it was given directly to the provider or given to the patient to deliver to the provider.

Patient portals

The CMS outlines Medicare and Medicaid incentive program targets for the utilization of patient portals under a new “patient engagement” objective, emphasizing that the goal is not just to use the portal to provide information to patients but to actively involve them as “partners” in their own care.

The agency believes that the electronic communications facilitated by the portals will encourage patients to become more aware of their health, make healthy lifestyle choices, and become actively involved in planning their health care.

The Stage 2 Meaningful Use objectives require practitioners to establish patient portals through which they can:

  • Provide patients with the ability to view online, download, and transmit their health information, and
  • Use secure electronic messaging to communicate with patients on relevant health information.

To qualify for Medicare or Medicaid incentive payments under the Stage 2 criteria, health care practitioners must provide more than 50 percent of the patients seen during the course of an EHR incentive program reporting period with electronic access to their health care information within four days of their office visit.

In addition, 5 percent of patients must actually view, download or transmit their information from the patient portal.
Practitioners must also send a secure message, using their EHR system’s messaging function, to at least 5 percent of the patients seen during an EHR incentive program reporting period.

Federal officials are now working on “patient certification” procedures that will allow patients to securely access their health information through the portals.

Patient common dataset

The federal Office of the National Coordinator for Health Information Exchange’s (ONC) designated common standards for the electronic exchange of information by health care practitioners are listed below. (Required terminology sets are shown in parentheses.)

  • Patient name and demographic information including preferred language (ISO 639-2 alpha-3 Language Codes), sex, race/ethnicity (U.S. Office of Management and Budget Standards for Data on Race and Ethnicity) and date of birth
  • Vital signs including height, weight, blood pressure, and smoking status [Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT)]
  • Encounter diagnosis [SNOMED CT or International Classification of Disease, 10th Edition, Clinical Modifications (ICD-10-CM)]
  • Procedures (SNOMED CT)
  • Medications (U.S. Library of Medicine RxNorm) and medication allergies (RxNorm)
  • Laboratory test results [Logical Observation Identifiers Names and Codes (LOINC)]
  • Immunizations (HL7 Standard Code Set CVX – Vaccines Administered)
  • Functional status including activities of daily living, cognitive and disability status
  • Care plan field including goals and instructions
  • Care team including primary care provider of record
  • Reason for referral and referring provider’s name and office contact information

(Hospitals will be required to provide discharge instructions on electronic summary of care records instead of referral information.)

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