The Medicare EHR Program  requires that participants make certain types of information available,  such as laboratory test results and current medications. For  example patient-purchased personal health records (PHR) can enable patients  to aggregate electronic information from disparate sources into a  single record. Few Patients of Providers Participating in the Medicare EHR Program Electronically Accessed Their Health Information, and Providers Reported Taking Steps to Encourage Access

		Less than One-third of Patients Electronically Accessed Their Health Information, and Patients Reported Such Access Generally Occurs Before or After Seeing a Provider

Providers participating in the Medicare EHR Program in 2015 reported  that relatively few patients electronically accessed their health information  when it was made available to them. 1.) 2.) 3.) According to patients we interviewed, patients who electronically access  their health information typically do so before or after a health care  encounter. HHS Has Taken Steps to Increase Patients’ Electronic Access to Health Information but Lacks Outcome Measures to Determine the Effectiveness of These Efforts

		HHS Programs and Other Efforts Aim to Further Patients’ Ability to Access Health Information Electronically, Including Longitudinal Health Information

HHS officials said that two agencies, CMS and ONC, have programs or  other efforts aimed at increasing the ability of patients to electronically  access their health information, including the ability to access longitudinal  health information and aggregate it in a single location. While ONC’s data analyses and  commissioned evaluation provide information concerning patient access  to electronic health information and patient engagement, these efforts do  not measure the impact of the Medicare EHR Program on patients’ ability  to access their health information electronically. Without  outcome-focused performance measures, HHS cannot determine  whether, or to what extent, each of its efforts are contributing to the  department’s overall goals, or if these efforts need to be modified in any  way. HHS’s investment in these efforts has been significant— since 2009 HHS has spent over $35 billion on the development and  adoption of health information technology. While HHS’s investment in  health information technology is significant, HHS lacks the ability to  determine whether, or to what extent, CMS’s and ONC’s efforts are  helping HHS achieve its goals. With regard to our first recommendation, which calls for HHS to develop  performance measures to assess the outcomes of key efforts related to  patients’ electronic access to longitudinal health information, HHS noted  that ONC is committed to assessing the effects of health IT adoption and  use. Methodology for Analysis of Medicare EHR Program Data

We analyzed data from the Centers for Medicare & Medicaid Services  (CMS) as supplemented with other government data to (1) determine the  number of providers—that is, hospitals and health care professionals  (e.g., physicians)—that participated in the 2015 Medicare EHR Program;  (2) determine the number of program participants who reported each of  two measures related to patient electronic access to health information;  (3) determine the extent to which program participants are offering  patients, and patients are using, the ability to electronically access their  health information; and (4) examine the characteristics of providers that  were associated with higher or lower percentages of patients who actually  accessed their available health information. Appendix II: ONC Efforts to Further Patients’ Ability to Access Longitudinal Electronic Health Information

	Office of the National Coordinator for Health Information Technology (ONC) Effort Blue Button Pledge Program

Voluntary pledge where organizations, such as providers and hospitals, commit to advance efforts  to increase patient access to and use of their health data.
Why GAO Did This Study

HHS's goal is that all Americans will be able to electronically access their longitudinal health information, that is, their health information over time. HHS's efforts to achieve this goal include the Medicare EHR Program and other efforts to encourage providers to make patient health information available and for patients to access such information.
GAO was asked to review the state of patients' electronic access to their health information. This report (1) describes the electronic access to health information available to patients, and patients' views of this access, (2) describes the extent to which patients electronically access their health information, and actions providers reported taking to encourage such access, and (3) evaluates HHS's efforts to advance patients' ability to electronically access their health information. GAO analyzed data from HHS and other sources; reviewed applicable strategic planning documents; surveyed a generalizable sample of providers that participated in the Medicare EHR program; and interviewed HHS officials and a nongeneralizable sample of patients, providers, and health information technology product developers.

What GAO Found

Since 2009, the Department of Health and Human Services (HHS) has invested over $35 billion in health information technology, including efforts to enhance patient access to and use of electronic health information. One of the largest programs is the Centers for Medicare & Medicaid Services' (CMS) Medicare Electronic Health Record Incentive Program (Medicare EHR Program), which, among other things, encourages providers to make electronic health information available to patients. Program data for 2015 show that health care providers that participated in the program (3,218 hospitals and 194,200 health care professionals such as physicians) offered most of their patients the ability to electronically access health information. Patients generally described this access as beneficial, but noted limitations such as the inability to aggregate their longitudinal health information from multiple sources into a single record.
Data from the 2015 Medicare EHR Program show that relatively few patients electronically access their health information when offered the ability to do so. Patients GAO interviewed described primarily accessing health information before or after a health care encounter, such as reviewing the results of a laboratory test or sharing information with another provider.
While HHS has multiple efforts to enhance patients' ability to access their electronic health information, it lacks information on the effectiveness of these efforts. The Office of the National Coordinator for Health Information Technology (ONC) within HHS collaborates with CMS to assess CMS's Medicare EHR Program as well as its own efforts to enhance patient access to and use of electronic health information. However, ONC has not developed outcome measures for these efforts consistent with leading principles for measuring performance. Without such measures, HHS lacks critical information necessary to determine whether each of its efforts are contributing to the department's overall goals, or if these efforts need to be modified in any way.

What GAO Recommends

GAO recommends that HHS 1) develop performance measures to assess outcomes of key efforts related to patients' electronic access to longitudinal health information, and 2) use the information from these measures to help achieve program goals. HHS concurred with the recommendations.