Practice Makes Perfect: VDT—One of the more challenging provisions of Stage 2

In June 2013, the Medical Group Management Association released the results of a questionnaire that ranked members' most pressing practice-management challenges. In this edition of "Practice Makes Perfect," we'll tackle No. 12 on that list: participating in the CMS' meaningful-use incentive program for electronic health records.

Successfully attesting to Stage 2 meaningful use is likely to prove significantly more difficult for eligible professionals than the initial stage of the program. Practice managers and executives are reporting that one new requirement in particular is causing considerable angst because it typically requires modified workflows, revised staff assignments and significant additional costs for their organizations.

The “view, download and transmit” (VDT) requirement is one of the more challenging of the core criteria of Stage 2, and practice executives must understand the program requirements and effectively implement VDT in order for their eligible professionals to successfully participate and avoid future Medicare payment adjustments.

All eligible professionals attesting to meaningful use in 2014 will need to implement the VDT capabilities for their patients. While eligible professionals in Stage 1 in 2014 will attest to using the revised criteria and must simply indicate that they are able to provide “access,” in Stage 2 they will be required to attest that patients actually use the VDT component.

The requirement's objective is to provide patients with the ability to view online, download and transmit their health information within four business days of the information being available to an eligible professional. The requirement contains two measures: the first measure requires that more than 50% of all unique patients seen by eligible professionals during the EHR reporting period are provided timely (i.e., available to the patient within four business days after the information is available to the eligible professional) online access to their health information; the second measure (Stage 2) requires that more than 5% of all unique patients seen by the eligible professional during the EHR reporting period (or their authorized representatives) can view, download or transmit their health information to a third party.

To meet the measure, eligible professionals must make specific information available to patients online. Along with patient and provider name and contact information, patient information should include a current and past health problems list, a list of procedures, laboratory test results, a current medication list and medication history, and other measures, all available for patients to access.

VDT is one of the few meaningful-use components that requires a minimum number of patients to take any action. Although VDT could prove difficult for many practices to achieve, it will be particularly challenging for those medical specialties that typically do not have ongoing relationships with patients or those eligible professionals whose patient panels tend to be less technologically proficient.

Practice executives should consider employing the following strategies:

• Consider building an opportunity into your workflow for eligible professionals to review the patient's medical record prior to making it available to the patient online.
• Provide all patients with an overview of the benefits of accessing their health information online; easy-to-follow written instructions on how to create a unique and registered user name and password; and assistance with anything else the patient might need to view, download or transmit their information.
• If a practice has a significant number of patients who visit with a spouse, son, daughter or other caregiver, consider targeting a separate VDT message for those individuals.
• Review the options for having one or more computer-access points in the provider waiting room or other common areas, allowing patients to, for example, view their records while they wait to be seen. If the practice offers this service, ensure that sufficient privacy and security precautions have been taken to avoid any unauthorized information disclosures, and prepare administrative staff to answer logistical questions from patients.
• To encourage patients to access the online portal for VDT, talk to vendors about building additional administrative functionality into the portal, such as appointment scheduling and bill payment.

As the meaningful-use program moves into its more advanced stages, the burdens on eligible professionals are increasing. VDT, with its patient-action provision, could prove a major stumbling block to successful participation. However, armed with an effective patient-engagement approach, practice executives can assist their eligible professionals in meeting this requirement and successfully attesting for Stage 2.

Robert TennantSenior policy adviser Medical Group Management AssociationEnglewood, Colo.