Free-standing PHRs and Stage 2 Meaningful Use

The Emergence of External PHRs

Robert Rowley, MD
Twitter: @RRowleyMD

In the upcoming year, Electronic Health Record companies will be challenged to enhance their products in anticipation of Stage 2 Meaningful Use. Stage 2 is right around the corner, and will begin in 2014 for those who have already started their EHR usage in 2011 or 2012 (for those who start Meaningful Use later, Stage 1 will apply for the first two years, and Stage 2 will kick in on the third year of participation).

For EHR vendors, the process of becoming Stage 2 Certified takes place in 2013, so that “eligible providers” (physicians, etc.) can start using these products in 2014. That means that 2013 will see a flurry of activity among EHR vendors to flesh out their products to be Stage 2 Certified by the end of the year.

Will this be difficult? Many of the Stage 2 requirements are similar to Stage 1 – things like e-prescribing and drug interaction checking; structured problem, medication and allergies lists; and so forth. But one area where there is an increased emphasis is in the realm of patient engagement tools.

Stage 2 has 17 core measures (as opposed to Stage 1, which has 15 core measures), several of which involve patient engagement activities:

Most EHR vendors have tethered PHR portals that accomplish some of these tasks, and might only need modest modification of their product to achieve all of them. Other vendors have a much larger task to build these capabilities into their EHRs during the 2013 Stage 2 Certification period.

Generally, patient-facing PHR portals are a side-activity for EHR vendors. After all, their main focus is on building their core products, which address what physicians and other EPs need in order to function well within their offices. So where does that leave patient-facing health IT?

[Related Article: Patient Engagement in Health IT the New Frontier]

The promise of external consumer-based PHRs
The patient-engagement health IT arena is starting to piece together consumer-based PHR products that are independent of the EHR-based portals that exist today. On the horizon are consumer-facing PHR products that have the ability to connect from the patient side to any EHR, and act like the fully-tethered EHR patient portals that now exist.

Such next-generation products, of course, are focused on consumer experience (rather than physician experience) and can be made into tools that can enjoy the levels of engagement that consumer health Internet sites have – measured in the millions, not thousands, of users.

It is certainly possible to build these kinds of products in ways that facilitate what Meaningful Use Stage 2 will require of EHR vendors, and of clinicians. In particular, the “view, download and transmit” requirement can be nicely addressed by linking to such external PHR products (once they are built).

By mid-2013, when Stage 2 Certification is in full swing, many EHR vendors may find themselves hard-pressed to offer a patient-facing add-on to their core technology that can satisfy some of the new requirements. However, if external PHR products are emerging into the market by that time, then collaboration with EHRs might be a very prudent way to achieve the intent of Stage 2 Meaningful Use (where it involves patient engagement).

The call is at hand for the health IT industry to evolve quickly in the PHR space, as well as the EHR space. By mid-2013, the landscape might look significantly different than it does now.

Robert Rowley is a practicing family physician and healthcare information technology consultant. From its inception through 2012, Dr. Rowley had been Practice Fusion’s Chief Medical Officer, having created the underlying technology in his own practice, and using that as the original foundation of the Practice Fusion web-based EHR. This article was first published on Dr. Rowley’s web site