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Getting the Message, Securely

January 25, 2012
by John DeGaspari
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New Possibilities and Challenges in the Way Clinicians and Patients Communicate

As healthcare IT leaders are grappling with the many changes taking place under healthcare reform, communications technology continues to charge ahead. And this is to the good, opening up new possibilities in the ways physicians can communicate with each other and with their patients, both inside and outside the hospital IT enterprise. Many of the innovations are tied to healthcare reform as well as broader consumer trends, in the form of, for example, the increasing availability of patient portals in hospitals and the ever-widening array of smartphones that are being embraced by many physicians.

Broad Drivers
Harry Greenspun, M.D., senior advisor for health transformation and technology at the Washington, D.C.-based Deloitte Center for Health Solutions, observes that secure messaging is a broad trend that encompasses consumer and physician preferences, as well as payment issues. “Messaging is used everywhere, in every industry,” he observes. Using the retail industry as an example, he says that consumers are interested in the model where instant messaging is really an adjunct to features such as links and photos that provide a more robust consumer experience.

Harry Greenspun, M.D.

He also notes that secure messaging is really in its nascent stages in healthcare, a situation he attributes to the current payment structure: after all, doctors can’t bill for an IM conversation, he says. That could change as the industry move forward on an accountable care model, where secure messaging can help increase patient satisfaction and reduce costs, he says.

He expects messaging to become more financially viable, especially in communication between physician and patient, but also sees plenty of potential in provider-to-provider communications. “With the move toward accountable care, there is a much bigger requirement for care coordination across providers and across care setting,” he says. The ability to use secure messaging and coordination of care among providers can provide a competitive advantage for those groups, he says.

Jason Taule, corporate information security and privacy officer in the Civil and Health Services Group at the Falls Church, Va.-based CSC, agrees. As consumers, patients want greater responses, more accurate data and more information about their own health, he says. “They want to be more involved in the process.” Secure messaging technology has allowed patients to play a bigger role in the patient-provider relationship, he says.

In his view, the game changer has been the availability of data that can be captured and provided in real time whenever it’s needed. That’s the paradigm in which secure messaging is the enabling technology in appropriate care settings, he says. “Most of us would agree that the emergency room is not where we should be providing primary care. As one possible alternative we can now consider home health solutions, given the availability of medical devices that capture information and report it back.”

Provider Organizations Weigh In
Experiences on the part of providers vary. Advocate Health Care, Oak Brook, Ill., is in the early stages of implementing a patient portal as a way for physicians to communicate with their patients, which went live in January of last year. The organization has been rolling out the portal gradually to its employed physician groups, and currently has 20 physician offices using it and about 50 physicians who are actively enrolled with some of their patients. Only about a dozen of those physicians are heavy users of the portal, according to Mike Delahanty, Advocate’s vice president of applications.

Delehanty says he has observed some reticence on the part of physicians to take advantage of the patient portal, because they suspect that it will take up too much of their time. “In fact, it’s probably more convenient to do it this way, because the physician can leave a secure message and the patient gets it when he wants; they don’t have to play phone tag.” Despite its relatively slow uptake, Delahanty sees potential for the patient portal. One of the hospital’s more immediate goals is to use the portal to schedule appoints and fill out forms. “We believe that making more information available to the patient is good for everybody,” he says.

The University of Rochester Health System, Rochester, N.Y., has embraced secure messaging among physicians and between physician and patient. In our institution, they are very different,” says CIO Jerry Powell. “We are really moving electronic communication through our patient portal,” he says. The hospital uses MyChart as the patient portal solution, which is a component of its electronic medical record (supplied by Epic Corp., Verona, Wis.).

The patient portal has been in use for about a year as part of outpatient Epic deployment in the hospital’s cancer center. Powell estimates that the portal is being used by about 28 percent of the patients there. Overall less than 20 percent of the patients are using it system-wide, although he expects a rapid uptick in the next 12 to 24 months, after it is deployed for all of the hospital’s outpatient services in May.

Powell adds that the main motivation for the hospital to implement the patient portal is better patient care and patient satisfaction from being more involved in their care. “We’ve seen a lot of interest in this area, and we think expectations are going to grow in this area of patient-provider communication,” he says.