A key provision in 2009's economic stimulus legislation propelled health information technology (IT) into national health care policy debates. Aimed at encouraging widespread implementation of electronic health records (EHRs), the provision requires Medicare and Medicaid to start paying cash incentives in 2011 to hospitals and practices who use EHRs meaningfully.
Federal officials proposed criteria for "meaningful use" late in 2009. Associate Investigator James Ralston, MD, MPH—GHRI's leading health IT researcher—immediately noticed something missing: the patient.
"The criteria include several traditional measures of clinical quality and a few measures of patient and family engagement," he says. "But those measures are modest and come only from automated data. How can we determine if EHRs are used meaningfully unless we measure patient experience?"
Primed with six years of survey data on patient use of and satisfaction with the EHR and other online services at Group Health, Dr. Ralston and co-authors, including Matt Handley, MD, Group Health's associate director of quality and informatics, published an article in the April 2010 Health Affairs urging policymakers to include measures of patient experience in meaningful use criteria.
Group Health began engaging patients through an EHR and other online services in 2003. By the end of 2009, 58 percent of adult patients had registered for online services—a proportion still rising—and most were highly satisfied, especially with services they used most: exchanging secure e-mail with providers, requesting medication refills, and viewing test results and after-visit summaries.
These data helped advance Group Health's organization-wide rollout of the patient-centered medical home by highlighting opportunities to effectively engage patients in more comprehensive care outside typical office visits. They also caught the attention of the U.S. Department of Health and Human Services, which called on Dr. Ralston to testify at a meeting of their Health IT Policy Committee Meaningful Use Workgroup.
His testimony highlighted the importance of measuring patient experience—and emphasized that patients should never be required to go online to reach health care services.
"Because of concerns about disparities in access to care, especially the 'technology gap,'" he explains, "patients must be able to communicate with providers in the way they need or prefer, whether in person, by phone, or through secure e-mail."
True to this ideal, Dr. Ralston is also exploring mobile-phone applications as a way to improve care across diverse populations. From his vantage, the essential underlying issue is quality.
"It's not about measuring the use of technology," he concludes. "It's about evaluating the patient experience of care more broadly. Patients' experiences are part of quality of care. Period."