How information flows and is re-used between the portal and EHRs will be a technical challenge for Sharp and everyone else, Spooner says. View/download/transmit capability will require that the EHR receiving the request be able to format the data in addition to storing it, he explains.
The EHR will have to look at a lab result and know it goes in the patient summary and has to be in a format to be received in the requesting EHR system.
A learning curve
At Greater Baltimore Medical Center, an inpatient portal to support patient access to their health information is just part of the overall meaningful use plan. "We're looking to do more with the portal than just meaningful use," says HIM director Day. Functions such as online payment and pre-registration, among others, will offer patients more convenient services and make the portal more valuable.
The medical center already has a patient portal for its more than 40 owned multi-specialty ambulatory practices, but HIM wasn't involved in that project and has a learning curve to learn the basics of portals. Day expects to get advice from practice administrators, and already has reached out to HIM peers in the region with an inpatient portal to get ideas on addressing such issues as providing access not just for adult patients but also minors.
Greater Baltimore hopes to do a full 90-day test reporting period for Stage 2 during the fourth quarter of 2013, then do the formal reporting period at the start of 2014 and attest in early April.
That timetable would have Stage 2 compliance off the hospital's plate six months before the ICD-10 compliance date in October to ease that initiative, but also give the hospital a little wiggle room during the April-June quarter if it needed more time to finish attestation, with still three months to focus on completing ICD-10, Day explains. "Why schedule other projects to coincide with ICD-10 if you can avoid it?"
Exchange options
A patient portal will be a core tool for complying with Stage 2's view/download/transmit and secure messaging requirements at Hays Medical Center serving northwest Kansas, but it won't be the only way to get patients their information electronically.
The hospital presently uses CDs to give patients their information when requested, and is considering providing flash drives to patients who don't have ready Internet access to satisfy the meaningful use measure, says Deloris Farthing, director of health information management.
Hays Medical has been live on a physician portal to serve local physicians since 2008, with up to 40 doctors being heavy users, 20 others "rather consistent," and spotty use among the rest, says Scott Rohleder, I.T. director. A big push to sign up physicians and giving portal access to the picture archiving and communication system helped fuel use.
To meet the various data exchange requirements under Stage 2 and better coordinate care, the hospital also is getting ready to build its own health information exchange, and was in the vendor selection process in late 2012. Rohleder is hoping the HIE option will further drive physician buy-in of data exchange.
The hospital now is piloting a patient portal with a large family medicine clinic, learning what data is actually displayed and where the data flows to. Staff members at the clinic have worried about a portal inundating them with patient requests and the hospital is considering having a centralized service to accept and route messages from the portal or sent by secure messaging.
Hays Medical has a big stake in getting physicians and staff comfortable with exchanging data with each other and patients in a variety of ways, as it employ more than 90 percent of the area's physicians.
More exchange options
In the ambulatory portal pilot, enrollment has proven to be cumbersome as patients need to come to the clinic and have staff enroll them.
That process could be streamlined by also offering self-registration online and via kiosks in the clinics.
Hays Medical's hospital vendor won't be ready to offer an inpatient portal until January 2013, and that worries Rohleder and his peers in other hospitals. They wonder how ready vendors will be for all of the technology changes necessary under Stage 2, and are afraid that they'll be pushing up against deadlines for completing implementations and workflow changes. Hays Medical, for instance, doesn't expect to get coding for updates until spring 2013.
How to handle secure messaging between patients and physicians is still a moving target, Rohleder says. "I don't think we yet have a firm idea of the technology or the process at this point."
Secure messaging software using federally developed Direct Project protocols won't be ready for Hays Medical's inpatient and ambulatory systems until late 2013.
But the technology is available now through the Kansas Health Information Network, so that may be an option.
Vendors Also Face Stage 2 HIE Challenges
Health care providers have plenty of challenges ahead of them to be able to quickly give patients the ability on online view, download and transmit their health information under Stage 2 of the electronic health records meaningful use program, and so do their services and software vendors.
Vendors that offer outsourced release of information services have to expand out of the traditional boundaries of what they do-copy images of records and give them to patients, says David Borden, chief technology officer at MRO Corp., King of Prussia, Pa. Now, they'll have to generate and hold discrete data.
MRO created a patient portal to make electronic copies of records or discharge summaries available to providers who wanted to comply with a menu (optional) measure under Stage 1, Borden notes. In Stage 2, he believes every EHR will have to include a portal, but MRO will continue to offer its portal if clients want them to handle view/download/transmit functions.
