Meaningful Use’s 5% Conundrum

There is something deeply disturbing about the existence of big fat dossiers of personal information, meticulously collected over a lifetime, and stored under lock and key in dark places you are not allowed to enter. There is something degrading and dehumanizing when those secret files, which contain the most intimate details about you, your children and your loved ones, are only accessible to entities empowered to make life and death decisions for you and for those you care about most. The good news is that when those dossiers are your medical records, our government acted decisively to ensure that every American has a right to not just view the collected information, but also to demand and obtain a copy of the records. Every medical facility, from the largest and most powerful conglomerate, to the humblest rural doctor, is required by law to fork over copies of your medical records whenever you ask for them. Few people ever asked for their medical records, and of those who did ask, many experienced difficulties and delays. 

Today, medical records are electronic (at least the newer portions), and the very first stage of the Meaningful Use program included a mandatory (core) requirement that medical facilities should provide at least 50% of patients with an electronic copy of their health information “upon request”, and an optional (menu) requirement that at least 10% of patients should have timely electronic access to their health information. 

By the time Meaningful Use stage 2 rolled out, those two requirements were bundled into one comprehensive core measure requiring that at least 50% of patients should have timely electronic access to their health information so they can look at it, download it or even send it somewhere else, if they so desire.

Unfortunately, providing access to medical records didn’t seem like a good stopping point, so Meaningful Use stage 2 added a mandatory requirement that 5% of patients actually access those records and view, download, or transmit them to another party. Meaningful Use is providing cash payments to physicians who comply, so effectively doctors were getting paid to make their patients log into a portal.

There are very good reasons to wish that patients know about patient portals and put them to good use. For example a study at Kaiser Permanente showed improved medication adherence for diabetic patients who used patient portals to request renewals for their meds. That’s certainly a good thing, although nobody checked to see if the more adherent patients also perused their medical records while ordering new meds. 

It may be beneficial to separate people’s desire to conduct electronic transactions with their doctors, as we do in all other aspects of life, from our need to examine medical records, or to download copies of the same. If you are still not sure this assessment is correct, a survey conducted by the Brookings Institution had the largely unintended consequence of settling the debate. Brookings surveyors found that “68% of the respondents are not willing to pay anything for having access to their medical data”, and that “the average valuation of the medical data ranges between $5 and $7.20.” 

If I asked you whether you would want a pulsating shower head, you would probably say yes (why not), but until you put a price on that head, I won’t know if you really want it, or if you just agree to pick it up if you found it on the sidewalk, and probably never use it. Now we know.

Another study in JAMA indicates that doctors to the poor and underserved, who are already penalized for not having healthy and well educated patients, would be disproportionately penalized under this 5% mandatory model. 

There is something deeply disturbing about a small group of industry insiders, attempting to impose their views of how we should behave, because they know what’s good for us.

Whereas a democratic government has the duty to pay contractors for building and deploying tools to facilitate the exercise of legal rights by the people, it should not have the power to bribe said contractors for delivering certain quotas of “compliant” citizens, at the behest of interest groups. A free society cannot allow this to happen and remain free, and this is a lesson we should learn today.

Margalit Gur-Arie is an author, entrepreneur and a partner at BizMed. A version of this article originally appeared on The Health Care Blog.