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The agency's notice stated that health education materials delivered by EHRs “are rarely written in a way that is understandable and actionable for patients with basic or below basic health literacy,” which includes about 77 million people. “Persons with limited health literacy face numerous healthcare challenges,” according to the AHRQ notice. “They often have a poor understanding of basic medical vocabulary and healthcare concepts.” 
 
Agency officials expect the rating system to address that challenge by giving clinicians a method to determine the quality of the data their systems provide or that such resources are even available.
 
A draft version of the rating system was applied by researchers at AHRQ to sample education materials on asthma and colonoscopy and indicated some of the material had “low understandability or low actionability.” The agency plans to next use consumer panels to test the accuracy of the rating system.
 
Other related health literature activities planned by AHRQ includes creating a library of patient health education materials, a review of EHR's patient education capabilities and education of EHR vendors and users.

By Rich Daly

“AHRQ developing consumer info rating system,” Modern Healthcare (October 8, 2012)

A study published in the most recent issue of the Annals of Internal Medicine found that 60 to 78 percent of patients who read their visit notes reported that they were more likely to take their medications as prescribed.  And their doctors reported that sharing their notes actually strengthened relationships with patients.

The study included 105 primary care physicians and 13,564 of their patients at Beth Israel Deaconess Medical Center in Massachusetts, Geisinger Health System in Pennsylvania and Harborview Medical Center in Washington, who participated  in a project called OpenNotes, in which patients were given electronic access to their files.

Study authors Tom Delbanco and Jan Walker of Beth Israel said they were surprised and delighted to find that patients who viewed their medical notes were more likely to take their medicines correctly. “Medication adherence is one of the greatest problems in health care,” said Delbanco, “yet flipping this switch seems to activate patients.”

As one patient explained, “having it written down, it’s almost like there’s another person telling you to take your meds.”

Patients also reported “an increased sense of control, greater understanding of their medical issues, improved recall of their plans for care, and better preparation for future visits,” the study authors write.

Despite concerns among participating physicians that sharing their notes would increase their workload, few of them reported longer visits or spent more time answering patients’ questions outside of visits.

One concern is that doctors may change the way they write their notes if their patients can read them. Since the same notes are shared with other doctors, this could have a clinical impact. As an example of a minor change, some doctors reported using “body mass index” in place of “obesity” to avoid offending their patients.

Blunt language, however, seems to have motivated some patients. “In his notes, the doctor called me ‘mildly obese,” one patient commented. “This prompted my immediate enrollment in Weight Watchers and daily exercise. I didn’t think I had gained that much weight. I’m determined to reverse that comment by my next check-up.”

At the end of the experiment, nearly 99 percent of the participating patients wanted continued access to their visit notes. And all three participating hospital sites have decided to broaden patient access to their doctors’ notes.

“Our greatest hope is that this will become a standard of care,” said Walker. “We’re at a good time in history because more and more doctors and hospitals are getting electronic health records and putting up secure patient portals,” allowing many patients easy access to their records.

They add, however, that privacy implications could be enormous: 20 to 45 percent of patients reported that they shared their notes with others, including family and friends. A patient could also choose to post their notes on Facebook or Twitter. “The patient-doctor relationship is confidential,” explained Delbanco, “but whether it’s private is now up to the patient.”

By Jenny Gold

“For Patients, What A Difference A Note Makes,” Kaiser Health News (October 2, 2012)

CHIME called for:

• Temporary process to be a provisional or interim one that builds on current certification strategies and is "harmonized" with the eventual permanent certification process. According to CHIME, certification process should be the responsibility of the vendor, and that the purpose of certification should be to provide healthcare providers and professionals with assurance that the product they are purchasing can help them achieve meaningful use.

• More specificity in language to define what constitutes a self-developed EHR. Current wording in the regulation suggests that any complete EHR or EHR module that's modified by a healthcare provider or a contractor could require certification.

• Changes in certification requirements be made only when they are necessary to meet meaningful use evolution or advance interoperability, not just because a certain amount of time has passed.

• If CMS maintains the "adoption year" approach originally advanced in proposed regulations, providers should not be required to have products certified for capabilities not required in their current adoption year.

• Individual EHR modules be certified to ensure that they can communicate according to adopted standards, and that the interoperability of those modules as used by providers be deemed as certified.

• HIT vendors fully disclose functions for which their products are certified and fully disclose known compatibility issues.

• In the event of a certification body losing its authority to certify products, vendors should have six months to recertify products, and providers should not be penalized for a change in a product's certified status if they are still able to demonstrate the meaningful use of the technology.

"CHIME raises concerns about EHR certification," Healthcare IT News (April 9, 2010).