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Meaningful Use and Measuring Patient Engagement

The Difference Between Stage 1 and Stage 2

In Stage 1 of the Meaningful Use program from the Centers for Medicare and Medicaid Services (CMS), practices were required to provide health information to a percentage of their patients. In Meaningful Use Stage 2, practices are expected to go further, to actively engage in promoting and measuring patient engagement, including: 1) interaction with online patient portals for patients to view, download and transmit their health information; and 2) using secure electronic messaging to communicate with patients.

This is the course CMS has set in the transition from Stage 1 to Stage 2: Stage 1 focused on recording and reporting particular measures while Stage 2 shifts away from those basics to focus on achieving care coordination and measuring patient engagement. The overall goal of Stage 2 Meaningful Use measures is to promote informed and empowered patients in order to improve care.

Meaningful Use Incentives and Penalties

What are the rewards for measuring patient engagement? The incentives for participating in Meaningful Use are considerable: under the Medicare EHR Incentive Program, eligible professionals (EPs) can receive up to a total of $44,000 over five years (for those having completed Stage 1 by the end of 2012). In the Medicaid EHR Incentive Program, EPs can receive up to $63,750 over six years.1

While there is a financial incentive, there are also penalties. If Medicare-eligible professionals do not adopt and successfully demonstrate Meaningful Use of a certified EHR technology (CEHRT) by October 1st, 2014, the EP’s Medicare physician fee schedule for covered professional services will be adjusted by a reduction of 1% each year.

Measuring Patient Engagement with Stage 2

Regardless of a practice’s success with Stage 1, many will find that demonstrating Meaningful Use patient engagement will be the most complex and intensive component of attesting for Stage 2. That’s because Stage 2 requires that patients not only have access to their health information, but that they also have to view, download or transmit it—meaning the patient must actively engage with their health records.

Specifically, there are two Stage 2 objectives that could pose a challenge when it comes to promoting and measuring patient engagement:

  • Under the core objective to provide patients the ability to view online, download and transmit their health information, more than 5 percent of patients must do so. This pertains to any patients seen by the EP or admitted to an inpatient or emergency department of an eligible hospital or CAH.
  • Under the Stage 2 Meaningful Use core objective to communicate with patients on relevant health information via secure electronic messaging, more than 5 percent of patients must send a message to their provider using the electronic messaging function of a Certified EHR Technology. This pertains to unique patients seen by an EP during the EHR Meaningful Use reporting period.

In summary, to demonstrate Meaningful Use and patient engagement that will satisfy Stage 2 requirements, health care organizations need to implement a patient engagement strategy that 1) leverages technology, such as an online patient portal, and 2) promotes the portal so patients know about it, understand its benefits, and use it.

1 Centers for Medicare & Medicaid Services. Meaningful use. Available at:

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