Secure Messaging - Understanding Patient Engagement

It is important to understand the requirements and exclusions of the Secure Messaging measure. The objective of course is to encourage electronic communications between a patient (equates to patient or the patient’s representative) and a provider regarding the patient’s health information. That communication can be initiated by either the patient or the provider with a response from the patient. The key being the patient has to engage.

Before I discuss ways to meet the measure, let’s review the exclusion. On the CMS website, eligible provider specification document it states, “Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period.”

You can determine broadband availability here. Then click on “Rank your geography”, “Rank within a State”, “County”, Select you State and click on “Generate the List”. The counties in your State will be listed in order of % with access speeds of >3Mbps. There was one in North Carolina that fell below 50%. I found this interesting : ) and certainly not the easiest data to find!

Ok, now that we have that out of the way, let’s talk about the messaging part. Messages must use the certified EHR technology (CEHRT). Typically this is a portal solution. It may be the portal your complete CEHRT used for certification or it could be a different portal that is certified as a modular component. Depending on the solution, percentages can be obtained as follows:

  • Complete CEHRT solution: the provider’s % will be generated out of the reporting solution for the 2014 complete CEHRT.
  • Modular product: generate the messaging report out of the modular component and then compare that list to the denominator generated from the complete CEHRT to get the accurate % for attestation. Don’t forget the put this solution in the cart when you generate your Certification ID on the ONC website.

The actual message exchange between the provider and patient should be about relevant health information, for example, refill requests, request for instructions about a particular condition or treatment, etc. and not the local golf tournament. Either the patient can generate the message to the provider OR the provider could generate the message and the patient could respond. Once this occurs, any provider in the practice who has seen the patient during the EHR reporting period should receive credit in the numerator. This is referred to as a halo effect.

Other ways to achieve this measure would include:

  • Educating the patient on how to send a message to a provider while they are in the office.
  •  Asking for a patient to respond to a clinical reminder message sent to the portal.
  • Asking patients to verify they have reviewed their lab results and do not have additional questions or to include questions in their response.

Whether or not the provider responds to the message is not part of the calculation since it may be more appropriate to respond by another means.