mHealth has 'implied, but vital' function in Stage 2 final rule


Hard to imagine, but true: Among the nearly 700 pages of the newly released guidelines for Stage 2 meaningful use and its accompanying final rule for EHR standards and certification, the word "mobile" appears only seven times.

[See also: Final rules for Stage 2 meaningful use released]

Still, experts maintain that mHealth will play a significant role in the latest stage of the Centers for Medicare & Medicaid (CMS)'s electronic health record incentive program, which places the spotlight on coordination of care and paves the way for improved outcomes.

Brian Ahier, a health evangelist for the Mid-Columbia Medical Center in The Dalles, Ore., questioned in a recent blog why mHealth wasn't given more attention. Ahier said he spoke to Pam Matthews, RN, MBA, the senior director of regional affairs for HIMSS, who said, "We had made comments in several places where mobile could be considered in terms of being a benefit for patient engagement and data exchange, yet in the final rule they remained silent on mobile. HIMSS supports the development of guidelines to achieve transitions of care through patient-centered mobile interfaces. We encourage consideration of including mobile health technology in future stages of meaningful use."

In summation, the CMS guidelines for Stage 2 call on providers to determine whether personally identifiable health data is secure while at rest, with the goal of pushing providers to encrypt data when it's made available on mobile devices. In addition, the new guidelines compel physicians to be able to electronically send medication orders for at least 60 percent of their patients (double the percentage set forth in Stage 1), and indicates that 30 percent of radiology and laboratory orders be sent electronically as well. By boosting the requirements for computerized physician order entry, CMS is compelling physicians to use mobile devices when they can.

The Office of the Nation Coordinator (ONC)'s companion rule on EHR certification, meanwhile, calls on providers and vendors to include mobile capabilities to accessing EHRs, and indicates it won't require a separate certification step for that process if the mobile app offers the same capabilities as the original version. The ONC goes on further to say that all EHR products must meet HIPAA guidelines and ensure that encryption is included with mobile technology that is used to store electronic health information on "end-user devices."

Robert Jarrin, senior director of government affairs for Qualcomm, which is a member of the HIMSS Advisory Council, sees plenty of opportunities for mHealth to make an impact.

"For example, the Stage 2 rules give patients the ability to view online, download and transmit their health information within four business days of the information being available to the eligible provider. Allowing patients to access their health information in a timely manner so they can make informed decisions about care and further share that information with other care providers or caregivers opens patient engagement unlike ever before," he said.

"This access to health information can be provided by any means of electronic transmission according to any transport standard," he added. "This is an enormous opportunity for certified EHRs and EHR systems to harness the power and ubiquity of mobile broadband connectivity to make health information available via smartphones, laptops, tablet PCs, pads and mobile medical devices such as Qualcomm Life’s 2net Hub and Platform."

"It’s also encouraging to read that CMS considered wireless broadband thresholds when deciding exclusions for certain aspects of the requirements," Jarrin said. "This demonstrates that mobile broadband is front and center and bodes well for mobile technologies and healthcare delivery in Stage 3.

Imaging results and associated information are also required to be a menu set requirement to improve quality, safety and efficiency and reduce health disparities. This imaging information can now be accessible through certified EHR technology. Certified EHR developers should seek to incorporate, promote and proliferate mobile radiology imaging applications that are highly regarded by doctors and hospitals."

Charlene Underwood, senior director of government and industry affairs for Siemens and a past board chairperson for HIMSS, said the influence of mHealth in Stage 2 is more implied than stated, but just as vital. Meaningful use requirements are pushing physicians to connect with other sources of information as well as with the patient to create a more-rounded care plan.

"Physicians are going to have to interact with systems to capture more data," she said. "We're going to have to find really good ways of getting them to do that. The challenge is to be incredibly sensitive to the demands that makes on their workflows."

Underwood said the provider community is also going to have to come to grips with the fact that patients want more access to and control over their healthcare data. There's "incredible push-back from the industry on the requirement that the patient be engaged with the system," she said.

[See also: Final rules for Stage 2 meaningful use released.]

"There's an incredible opportunity for innovation here," she pointed out. "It's going to be a push-and-pull process…but [the end result] is a shared care plan."

In the end, she said, providers are going to have to share their data – and their responsibilities – with their patients. By creating portals and using mHealth tools, she said, they'll be able to develop better communications and care plans.

"Here are the consumers – give them the tools," she said.

Leigh Burchell, vice president of government affairs for Allscripts – which recently raised its stakes in the mobile health environment by integrating telemedicine vendor American Well into its EMR and practice management platform – said stage 2 is following a path that the company laid out roughly five years ago with Allscripts Remote.
"The reality is that the market is telling us that they want mobile access to our applications and they want intuitive usability when they do so, [and]…the government is chiming in here and providing general industry guidance," she said.

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