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How to satisfy patient engagement in Stage 2 Meaningful Use

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- Stage 2 Meaningful Use looms over the heads of the CIOs, CMOs, and ultimately the CEOs of our nation’s largest and smallest hospitals alike. In a few short months, hospitals as well as eligible providers must demonstrate that five percent of unique users are sending secure electronic messages through their patient portal or EHR system. The only problem is that no one really understands how we’re going to achieve this benchmark.

Eric Manley of the Mayo Clinic has stated publically that Mayo’s electronic system will likely only capture two to three percent of their patients at most, falling fall short of the necessary benchmark.  In response to why, Manly stated, “Simply making the services available will not attract users. Unless you engage patients, you will not meet your meaningful use (MU) requirements.” Ah-ha — so it’s patient engagement that is the ticket to meaningful use stardom.

But what exactly is patient engagement?

The California Healthcare foundation defines it as “involving patients in their care.” Venture Beat, a health & tech entrepreneur focused outlet, offers up patient engagement as encompassing “interactions with technology that lead to some ancillary or direct health benefit.” Dan Munro of Forbes suggests it might be a “blockbuster drug,” “snake oil,” or somewhere in between.

Okay, so you get the point. No one knows, or at least agrees on, what it exactly means.  The good news is that it doesn’t really matter as long as we can all somewhat agree that it clearly involves enticing patients to do something that they weren’t doing before they were engaged. When it comes to meaningful use and patient portals, patient engagement simply means getting them to use it, specifically sending a secure electronic message

READ MORE: New NATE Member to Focus on Improving Patient EHR Data Access

READ MORE: CMS Addresses Changes to the EHR Incentive Programs in 2017

READ MORE: CMS Reviews 2016 Meaningful Use Reporting Requirements

How do we get patients to send a secure message?

Here’s the meat of the how patient engagement relates to Stage 2 Meaningful Use. Over the defined reporting period, eligible providers must identify the number of unique patients seen by the provider (or at least recorded a visit in the EHR software.) This is the denominator in the equation. The numerator, in contrast, is the number of patient or patient representatives who send a secure message.

Note: These do not have to be from the same population of patients.

What follows are what I call the tricks of patient engagement. Combine these three points and you have a secure messaging platform that is comfortably in the double digits.

If you see twenty patients per day, one patient of yours must send you a message. Now, Dr. PCP or hospital CIO, you know a number and not a potential percentage of patients that must be using your secure messaging portal. This may sound interchangeable, but tangible numbers are significantly easier to work with when planning meaningful use goals and standards and will help you set targets for push and pull campaigns as outlined in below.

The physician does not need to respond to the message. All we are counting here is incoming messages from patients and their representatives. I am not encouraging you to ignore their messages — that is not only ethically wrong but also dangerous and the easiest way to convince patients and their entire network to never message you again.  Instead, a triaged and controlled messaging portal is essential.

In our experience, nearly two-thirds of our 7,000 daily secure messages intended for providers are regarding billing, office hours, or other back office or mid-level questions. What we learned years ago is this: The first time doctors become inundated with irrelevant or non-medical questions, that will be the first and last time that they will use your messaging platform.

It’s a pull and a push. Pulling messages means practically eliminating or at least sufficiently reducing the activation energy for the patient so that messaging becomes easier than using the next best thing, the telephone. Since I have spoken at length previously on the actual structure of portals for effective patient engagement , I won’t go into details here.

In contrast, the push refers to outgoing connections that encourage the patient to engage, (i.e., automated and personalized messages offering wellness information, health journal entries, feedback, reviews, referrals, opportunities to connect with other patients). We call these “pushes” and they are oftentimes become what prevents a three- to four-percent engagement rate from becoming a seven- to eight-percent rate.

What has been your experience with your patient portal? Has it been effective or a total dud? I am interested to hear your thoughts on the points above as well as hear what your institution has done to conquer these (not-so) monumental tasks!


Zachary Landman, MD, is the Chief Medical Officer for Doctorbase, a leading developer of scalable mobile health solutions, patient portals and patient engagement software. He earned his medical degree from UCSF School of Medicine and as a resident surgeon at Harvard Orthopaedics, he covered Massachusetts General Hospital, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center. He is a frequent author and speaker on the topics of patient engagement, mobile health, and patient portals. 









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