secure messaging
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I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Headquarters U.S. Air Force
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Secure Messaging
Maj Amalia M DiVittorioAFMSA/SG6M
7 Apr 2012Version #1
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Learning Objectives
Communicate the AFMS vision related to secure messaging
Define Secure Messaging
Discuss the stakeholder’s involvement in the process
Summarize Implementation Strategy
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I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Purpose
SECURE MESSAGING equals the ability for healthcare teams and
patients to interact in an asynchronous manner for a more efficient
communication exchange to improve healthcare outcomes
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PEOPLE
PROGRESS
POTENTIAL
PCMH Goals
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Secure Messaging AFMS Vision
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Air Force Medical Service (AFMS) is dedicated to the health of military families—and have priorities that align with the MHS Quadruple AIM*
AF/SG has directed Secure Messaging in support of PCMH under the eHealth Initiatives Project (e-HIP)
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Secure Messaging AFMS Vision
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PCMH Model Improved clinic access management Improved care coordination Increased population
health management Improved readiness Enhanced patient activation Enhanced patient access Transition to PCMH goal
of Team focused care
PATIENT EXPERIENE
QUALITYMEASURES
INFORMATIONMANAGEMENT
&TECHNOLOGY
PATIENT EXPERIENCE
PHYSICIAN-ledTEAM
AIR FORCEMEDICAL HOME
PROACTIVE PREVENTIVE HEALTH CARE
PATIENT
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Secure Messaging
MiCare – Secure Messaging (SM) is a Web-based service that helps healthcare teams manage their patients’ healthcare by offering secure, efficient electronic communication between teams and patients and exchange of health information. HIPAA compliant communication
system directly linking patients to their healthcare teams
Can be accessed anywhere, anytime Future capability to auto populate
PHR information Capability to allow cross communication
from military to civilian medical networks
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Secure Messaging Login
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Relay Health is not email. It is a secure Web-based, HIPAA compliant communication tool.
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Secure Messaging Patient Homepage
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Appointment Requests
Prescription Renewals
Lab/Test Results
Message Your Provider
Online webVisits
New Messages Inbox
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Personal Health Record (PHR)
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Convenient secure repository for patients’ health information
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Benefits to Medical Group
Staff
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Anticipated Benefits
Secure messaging can help streamline administrative activities in the clinics
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Benefits to Patients
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Anticipated Benefits
Secure messaging enables easy, direct access and communication with your medical providers – eliminating unnecessary trips to the MTF.
By creating and maintaining a PHR, patients can take control of their own health information.
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Anticipated Benefits
Research data gathered by Relay Health:
20% reduction in patient phone calls A single message eliminates 2.6 phone calls Estimated 15% reduction in “patient no-shows” as a result
of appointment reminder messaging Rx renewal authorization time cut by 40% Referral request time decreased by 58%
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Research
Secure Messaging has been in civilian medical community 10 yrs
Secure messaging users office visit rates decreased by 10.3%, while the control group only decreased by 3.7%.
Overall phone messages increased since KP implemented new documentation procedures for telephone contacts during the study period. However, annual documented telephone contact rates for SM users increased by 16.7%, while for the control group the increase was 29.9%.
Fears of being overwhelmed by electronic patient messages proved groundless; message volume increased far more slowly than patient enrollment
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Research
Research is limited but growing everyday
Telephone case volume was 18.2% lower and fell 6.5 times faster than the control group
Patients were overwhelmingly satisfied and providers and staff were generally satisfied; both found the system easy to use
total scheduled telephone visits per member increased nearly nine fold and secure e-mail messaging, which began in late 2005, increased nearly six fold by 2007.
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I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Stakeholders
MTF Executive Staff
CLINIC STAFF
GPM
HCI/Disease Mgt/Case Mgt
Privacy Office
Systems
TOPA
Pharmacy
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Workflow Scenario
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Nurse notifies patient and
requests follow up visit
Care Team Prescription
Renewal Request
Inbox
Nurse follows current processes
to initiate prescription
renewal
Is the patient renewal eligible?
Yes
No
Patient sends prescription
renewal request via SM
System sends automated
notification to all Family Health Med
Techs
Med Tech opens message and
checks for available refills
End Process
Med Tech informs patient of refill
availability
Are there refills
available?
Yes
No
Med Tech forwards request to Nurse
Nurse opens message and
checks for renewal eligibility
Care Team Rx renewal
request inbox
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FAQ’s
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1. How is information getting to AHLTA? Air Force policy is any electronic SM encounters requiring patient triage, home care advice, any medical decision-making, and communication of clinical results shall be uploaded and posted into AHLTA T-CON. Each T-CON must be reviewed, acknowledged, and electronically signed by the referring provider in accordance with established business practices.
2. How is this different than email?The website is secure. Patients using the service will have to authorize and consent to using the system and allow a copy of their medical information to be placed in the system. By registering, they agree to this. The company has been inspected and meets the security constraints of the USAF network. It is completely auditable and information can’t be deleted.
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FAQ’s
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3. What happens when someone is on leave, TDY, PCS? The secure messages from patients are sent to specific TEAM structured boxes. This is in line with the PCMH model that the team takes care of the medical care of the patient. The MTF needs to decide and agree to who/how these boxes are covered IAW current business practices and utilizing the most appropriate skill level.
4. What about privacy with minors?From a technical perspective, personal health information will not pass to the SM server when the minor’s DOB reaches 12 yrs old. Policywise, the same policies followed currently with telephone communication and minor privacy will be followed when using SM
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Culture Change
1. Understanding the process Similar to online banking and shopping, online medical interaction
is becoming more predominant in our society Learning the SM system will take time and effort
2. Learning workflow Involve yourself in the workflows identified by leadership Give feedback as it is being developed at your site
3. Developing patient expectations Just as in any interaction with patients, we as healthcare providers
are responsible to manage patient expectations Change precipitates stress and can be managed by developing
appropriate protocols and workflows
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Support
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Relay Health Contact Number:
1-866-735-2963
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Pilot Sites
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Pilot Dates
Joint Base Elmendorf-Richardson Dec 2010
Pentagon Flight Medicine Clinic Jun 2011
Data as of 1 Apr 2012Patients enrolled: 13,786PHR elements shared: 600,000
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Current Status
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AFMS deployment Plan Started Nov 2011 – 26 MTFs by June 2012Wave 1: “GME Sites”
Nov-Feb 2012Wave 2 – East Coast
Jan- Apr 2012Wave 3 – South/MW
Feb- May 2012
Eglin Andrews Columbus
Hurlburt Bolling Keesler
Nellis Charleston Lackland
Offutt Dover MacDill
Travis Hanscom Maxwell
Scott McGuire Patrick
Langley Moody Randolph
Robins Tyndall
Seymour Johnson Wright-Patterson
Shaw
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Current Status
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MHS View
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Army Navy Air Force Joint Task Force
Brand
Tag Army MedicineSecure Messaging Service
“MTF”OnlineNMCSD Online MiCare Army Medicine
Secure Messaging Service
Providers 704 1,043 903 156
MTFs 38 29 28 2
Active Enrolled Patients (As of Jan 2012)
13,000 80,000 15,000 ----*
All Sites Deployed
Target - July 2012
Completed June 2011
Target – August 2013
Target – Feb/March 2012
Highlights CBMH Completed – Dec 2011
eRx Pilot Bethesda
PHR Data Exchange via CDC with COHORT
Ft BelvoirDiLorenzo Tri Service Pentagon Clinic
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Future Roll Out
MHS UMBRELLA Projected to start Tri-Service contract Fall 2012
Strategic plan Finish CONUS USAFE PACAF
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Summary
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For general info:
www.sg.af.mil/micare
For marketing materials:
https://kx.afms.mil/sgcag
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Questions
Summary
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SM Benefits
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Air Force Medicine
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