Freed Associates

How Doctors Can Engage Patients and Meet Stage 2 Meaningful Use Guidelines

By Robin Figueroa

When we, at Freed Associates, talk with medical professionals about Meaningful Use (MU) objective requirements, we’re used to seeing their eyes roll back in their heads. The most frequent reaction is, “So what? This is just another program that makes us click boxes in an electronic health record (EHR) so someone (other than us) can receive money. This means nothing to us or to patient care. Meaningful Use (MU) is not meaningful to us or our patients.”

Adapting to new technology is hard for everyone. It’s even harder for physicians who have long relied on face-to-face appointments and communication to deliver responsive health care. While shifting to digital interaction may be challenging, our experience with clients who have initiated online engagement has been positive. Patients are becoming more involved in the active management of their own care—one of the key goals of the Stage 2 Meaningful Use requirements.

We believe that the Meaningful Use requirements will give patients improved access to appropriate, relevant and valuable health information and the medical professionals who treat them. In order to comply and make Meaningful Use meaningful, providers need to understand the requirements and develop the tools to facilitate engagement naturally — to the point it becomes second nature to communicate virtually.

What Stage 2 MU requires from providers

Stage 2 MU requires that patients are provided access to view their health record online within 4 days of a visit with their provider. Additionally, in 2014, the Secure Messaging measure requires that more than 5% of unique patients securely message the providers they see during a 90-day reporting period. This provides a valuable opportunity for opening lines of communication while complying with the Health Insurance Portability and Accountability Act (HIPAA) regulations.

Within a secure patient portal, patients can send messages to their care providers to do things like get medical advice, confirm treatment instructions, request a refill on a prescription, or request an appointment. The goal is to give patients more flexibility in when, where, and how they receive the initial and follow-up care they require.

How providers can encourage a secure

messaging dialogue

To set the stage for future electronic communications, providers can ask their patients during an initial appointment if follow-up care can be conducted virtually. They can then ask patients to register on their patient portals before they leave the office or when they get home.

Fortunately, providers don’t have to wait for patients to initiate a message. They can meet the 5% threshold if a patient responds to a message from the provider, as long as the message contains relevant health information specific to the patient.

The key to engaging patients meaningfully is to create communication that is personalized and conversational. Humans respond to other humans who sound like they genuinely care. Your message should be short — three sentences long — and ask a leading question that makes it hard for the patient not to respond:

  • First sentence: Let the patient know you are thinking of him/her.
  • Second sentence: Request the patient take a moment to email you back and let you know how he or she is feeling (better or not better).
  • Third sentence: A reminder that you or an associate are always available to answer questions about the condition or treatment.
  • Salutation with provider’s name: Patients will more likely respond if the note is signed by the physician rather than an office staff member.

Some EHRs are capable of sending automated messages after the visit and it is important that those messages don’t sound “canned.” If they do, patients may not take the time to respond. If you do send automated follow-up messages, you may request that several providers in your group write their own versions and rotate the messages monthly or quarterly so patients never receive the same message twice.

One of our clients used this technique in their urgent care facilities and was pleasantly surprised that their patients responded with thank you notes for their email, in addition to details of their recovery. Patient satisfaction numbers improved and the client enjoyed a 20% increase in its compliance with the secure messaging requirement in just one quarter.

“The experience of our after-visit-messaging has reinforced the notion that patients appreciate follow-up from the physician they saw in our clinic,” said Dr. Deborah Greer, Medical Director of the John Muir Medical Group’s Urgent Care Services. “Their positive email responses signaled to physicians that patients want to know that someone cares enough to take the time to check up on them. This form of communication only solidifies a positive doctor-patient relationship.”

Giving Credit for Collaboration

Multiple providers can take advantage of a single message sent by any of their physician group’s patients, as long as each provider has seen the same patient during the 90-day EHR reporting period. The one caveat is that the providers need to share the same Certified Electronic Health Record Technology (CEHRT).

Allowing collaboration is not only good news to those trying to meet the MU Secure Messaging measure; it’s also good for health care.

The following example demonstrates how two providers, who use the same CEHRT, can meet the Secure Messaging measure and maintain superior communication to help ensure the patient gets the care he or she needs.

  • A patient complains of a persistent cough and goes to an urgent care provider and receives a prescription for cough medicine. During the visit, the physician or medical assistant helps the patient sign-up for the patient portal.
  • 3 days later, the EHR sends an automated message through the patient portal to the patient asking how they are feeling.
  • The patient responds that the coughing has not subsided. The urgent care provider responds back to the patient and recommends he see a pulmonologist for further evaluation.
  • The patient does see the pulmonologist, who has access to the same EHR and all the urgent care provider’s notes and messages with the patient.

By the new CMS Meaningful Use Secure Messaging requirements, even though the patient only messaged the urgent care physician, both providers will get credit in the numerator for the Secure Messaging measure.

Next Steps for Providers

Ultimately, Meaningful Use Stage 2 has the power to improve provider-to-patient as well as provider-to-provider communication. While the opportunity to share patient messages will significantly help many organizations meet the Secure Messaging objective, providers should encourage their patients to electronically communicate with them. Through patient portals and secure messaging, valuable health information and data will be shared in real time and patients will have the information and access to care providers they need to comply with prescribed treatments and medications. As our country faces a growing aging population and baby boomers continue to age, this new level of communication and attention will be especially helpful in improving the delivery of care and treatment compliance.

By implementing CEHRT and complying with the new regulations, physicians and nurses can make this new program meaningful and improve the quality, communication and safety of patient care.

The following reading provides good information about MU Stage 2:

Stage 2 Overview Tipsheet

Meaningful Use Core and Menu Measures

Stage 2 Information


Robin Figueroa is a management consultant with Freed Associates. She has significant experience in both inpatient and ambulatory settings leading EHR implementations, workflow optimization efforts, and clinical documentation improvement initiatives. Her 25 years of healthcare experience spans several EHR vendors, including Epic, and she is currently serving as the Program Manager for a successful, enterprise-wide Meaningful Use program at a leading not-for-profit healthcare facility. Prior to her position with Freed, Robin was an IT Manager of Applications and Projects in a major hospital setting.