The largest federal investments in health IT and patient electronic access to health information are the Medicare and Medicaid EHR Incentive Programs. These programs provide incentives to hospitals and health care professionals that are able to demonstrate meaningful use of a certified EHR system. Providers must attest that they have met certain measures in order to receive payment, with the required functions increasing in complexity as providers move through the stages of the program. Among the measures in the current programs are two that are specifically designed to capture the extent to which patients are able to electronically access their health information. Unless providers claimed an exclusion from reporting these measures, providers were required to successfully complete them in order to receive incentive payments for program year 2015. The measures are as follows: (1) Ability to electronically access health information. More than 50 percent of a providers’ patients must be provided timely access to view online, download, and transmit to a third party their health information, and (2) Actual electronic access. At least one of a provider’s patients must electronically view, download, or transmit to a third party their information during the 90-day reporting period. Providers participating in these EHR Programs must use certified EHR technology, which is technology that has been determined to conform to standards and certification criteria developed by ONC. These criteria do not specify a particular technical method for providing patients with access to their health information, but do specify parameters for accessing certain types of health information. According to ONC, many providers use some type of patient portal to provide access to these types of health information. A patient portal is a secure online website that gives patients 24-hour access to their personal health information and medical records from anywhere with an Internet connection. Patient portals are purchased by a provider and generally only include health information generated and made available by that individual provider. ONC released the most recent strategic plan for health IT, developed with input from federal and nonfederal stakeholders, in September 2015. This plan guides the actions of multiple federal agencies with regard to health IT. The plan outlines four primary goals, each with its own objectives for using health IT, to improve the health and well-being of individuals and communities. Two of these goals are to transform health care delivery and community health and advance person-centered and self-managed care. In addition to this strategic plan, in 2015 ONC developed, with input from federal and nonfederal stakeholders, a Shared Nationwide Interoperability Roadmap (which we refer to in this report as the Roadmap). The Roadmap proposes specific actions to advance the nation towards an interoperable health IT system that collectively improves health. The Roadmap includes the goals that patients can access their longitudinal electronic health information, contribute to this information, send and receive that information through a variety of technologies, and use that information to manage their health and participate in shared decision making with their health care providers. These Roadmap goals support the HHS strategic plan goals of advancing care and transforming health care delivery and community health. Performance measures assess performance via ongoing monitoring and reporting of program accomplishments, which include progress toward pre-established goals. Our previous work has found that performance measures can serve as an early warning system to management and as a vehicle for improving accountability to the public. We have also published guidance on assessing performance which states that it is important for performance measures to be tied to program goals and for agencies to ensure that their activities support their organizational missions and move them closer to accomplishing their strategic goals. In addition, our guidance to federal agencies on designing evaluations suggests that performance measures should include both process and outcome measures. (See table 1.) Outcome measures are particularly useful in assessing the status of program operations, identifying areas that need improvement, and ensuring accountability for end results. Furthermore, our guidance on assessing performance notes that leading organizations should not only establish performance measures but also use information from these performance measures to continuously improve processes, identify program priorities, and set improvement goals. Data from CMS show that most patients who received their health care from providers participating in the Medicare EHR Program had the ability to electronically access their health information. Information from our survey of providers and interviews with patients and providers show that this access is typically offered through patient portals and the type of information offered varies. In interviews, patients described the benefits and limitations of accessing their health information electronically. CMS data show that providers who participated in the 2015 Medicare EHR Program reported offering most of their patients the ability to electronically access their health information. In 2015, all participating hospitals and nearly all participating health care professionals reported offering electronic access to health information to 88 and 87 percent of their patients respectively, on average. This means that the providers gave the patients they saw or discharged all of the information necessary to electronically view, download, and transmit the patients’ health information, such as a website address, a username and password, and instructions for logging onto the website. Our survey of providers who participated in the 2014 Medicare EHR Program and interviews with providers further illustrate the extent to which providers offered their patients electronic access to their health information. Our survey found that nearly all providers routinely provided new patients with access to this information (92 percent of health care professionals and 91 percent of hospitals). Providers we interviewed also described circumstances in which a patient may not have been offered access. These circumstances included instances such as in emergency care, when offering electronic access may not be appropriate at the point of care, or for behavioral health data, when it might not be in the best interest of the patient to access the information. ONC has published information on the extent to which non-federal acute- care hospitals and office-based physicians provide their patients with access to their health information. ONC reported that in 2015, almost all hospitals (95 percent) offered patients the ability to electronically view their health information, and about 7 out of 10 (69 percent) hospitals provided their patients with the ability to view, download, and transmit their health information electronically. In addition, ONC recently reported that among office-based physicians, 63 percent provided patients with the ability to electronically view their health information. ONC reported in another data brief that in 2014, nearly 4 in 10 Americans were offered electronic access to their medical records. Our survey of providers who participated in the 2014 Medicare EHR Program found that most providers offered electronic access to patients through a patient portal, and our interviews suggest that patients often received access to a different portal for each provider. A patient portal is a secure website that allows patients to access information contained in their provider’s EHR system and is managed by the provider. EHR vendors and providers we interviewed noted that patients generally have to manage separate login information for each provider-specific portal. Many patients we interviewed confirmed this; for example, a number of patients we interviewed said that they had access to more than one portal, each of which contained their health information from a different care setting (e.g., hospital stays, general practitioner, and different specialists). The types of health information that providers made available to patients varied, but our survey of providers indicated that most routinely offer access to most types of patient information. The Medicare EHR Program requires that participants make certain types of information available, such as laboratory test results and current medications. According to our survey, an estimated 94 percent of hospitals and 77 percent of health care professionals routinely offered access to laboratory test results, which are required by the program. (See table 2.) Our survey also showed that fewer providers routinely offered access to certain information that is not required by the program and that they find less helpful for their patients to view. For example, 46 percent of hospitals and 54 percent of health care professionals reported routinely offering access to clinician notes, which are not required by the program. Additionally, our survey showed that fewer providers find it helpful for patients to view clinician notes and radiological images than for patients to view information such as laboratory results and current medications. Representatives from two hospitals we interviewed explained that their hospitals relied on a committee to decide what information to make available to patients through the portal and how soon after it is available to the provider to make it available to the patient. One EHR vendor we spoke with noted that the vendor automatically makes almost all information, including clinician notes, available to patients through the vendor’s patient portal by default, though many vendors allow providers to limit the types of information they routinely make available to patients. Patients we interviewed said that the type of information made available in their portals was incomplete and inconsistent across providers. Though many patients talked about accessing their lab results through their portal, multiple patients said that their results were not always available for them to view. For example, one patient said that sometimes her lab results are posted, and other times they are never made available to her, and she does not have a sense of when the results will be made available. Three patients expressed frustration that their vital signs information such as weight and blood pressure was not available through their portals, particularly since they knew that their providers collected this information during visits. Another patient said that she has observed a lot of variability in what information providers make available through their portals, with some doctors providing access to detailed information such as clinical notes and lab results, and others only making basic information available, such as appointment reminders and vital signs information collected during visits. During our interviews with 33 patients who have accessed their health information electronically, patients described numerous benefits from the ability to electronically access their health information. These benefits included the ability to communicate better with their health care providers, track health information over time, and share information with other providers. Multiple patients described circumstances in which they used information in their portal to improve their interactions with their provider and adhere to provider recommendations. For example, one patient described how he logged into the portal after a visit to review instructions from his provider that he had forgotten. Patients also noted that electronically accessing their health information made them feel empowered or more proactive to manage their health, particularly over time.