The Day “View, Download, and Transmit” Died

By Jim Tate, EMR Advocate
Meaningful Use Audit Expert
Twitter: @JimTate, eMail:

“Things don’t change until they do.” I think Albert Einstein said that. Maybe it was Cat Stevens, I’m not really sure. We go along in our merry little lives content with the knowledge that the sun will come up tomorrow and summer will follow spring. All the rules that we rely on help us make sense of a chaotic universe. Lifestyle, habits, and workflows are constructed to help us through the maze of life. Business models are created based on the assumption that the future is predictable. Every now and then something occurs that turns the all the apple carts upside down. An asteroid crashes into earth and the dinosaurs die. A plane crashes in 1959 and Buddy Holly, Ritchie Valens, and the heaven-sent Big Bopper perish. Rock and roll dies that day and morphs into pop and soul music. Even the dinosaurs wept.

What does this have to do with Meaningful Use (MU)? Well, one of the major elements of Stage 2 and Stage 3 MU was hit by one of the unexpected events. Proposed rules released last week have effectively gutted the most troublesome of the “patient engagement” requirements. The issue is the sudden collapse of requirements related to “patient engagement”. There had been intense pushback against the measures that required patients to come to a provider’s portal or send a secure message to their provider. This issue affects both eligible hospitals (EHs) and eligible professionals (EPs) in varying degrees. Complex workflows had been developed to bring those patients to the portals. Ambulatory practices were having to be extremely creative to get their patients to send secure messages. Suddenly things changed. Now, instead of trying to mandate “patient engagement” using a top down approach, the Gods of MU have changed policy to create an environment where this can occur organically. I’ll skip all the details for now but just know this will be effective for 2015 and going forward. There will still be measures related to patient engagement but it looks like the requirement that at least 5% of patients come to a portal will be reduced to a ONE PATIENT threshold. I guess this will prove that the portal at least works.

The short term winners are providers who are trying to achieve MU and their patients who were being educated/manipulated into the use of portals and secure messages. It is better to pull patients into engagement with value. They were being pushed, and that never works in the long run. Kudos to the policy makers who read the tea leaves and made the changes. We who are about visit our doctor salute you.

Jim Tate is known as the most experienced authority on the CMS Meaningful Use (MU) audit and appeal process. His unique combination of skills has brought successful outcomes to hospitals at risk of having their CMS EHR incentives recouped. He led the first appeal challenge in the nation for a client hospital that had received a negative audit determination. That appeal was decided in favor of the hospital. He has also been successful in leading the effort to reverse a failed appeal, even after the hospital had received notification of the failure with the statement, “This decision is final and not subject to further appeal”. That “final” decision was reversed in less than a week. If you are a hospital with questions or concerns about the meaningful use audit process, contact him at: