Getting the Message, Securely

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.

David A. Krusch, M.D., the hospital’s CMIO, says the primary focus of the patient portal has been patients with cancer and chronic diseases such as asthma, high blood pressure, and diabetes. “People who are followed for continuity of care purposes tend to be very vigilant about keeping up with results,” he says. He adds that from his personal perspective as a physician, the patient portal has been “tremendous,” because it takes a process that would have been synchronous and makes it asynchronous. “Based on how well it fits into my workflow or my nurse practitioner’s workflow or my partner’s workflow, I can review the information and, if I feel comfortable with it, push it out to the patient. I do that when it works for me, and the patient does it when it works for him,” he says

As far as physician-to-physician communication, Powell says the health system’s 1,000 internal physicians communicate either through the hospital’s EMR or through a secured email system that is separate from the hospital’s wider email network. The secured email is available to providers and other health systems in the wider community.

Powell adds that the hospital system does permit physicians to bring in mobile devices, but requires that the devices be registered with the hospital’s IT department and encrypted. As new technologies and new devices become available, the hospital reviews them to apply existing policies or develop new policies to maintain data security, Krusch adds. Mike McClure, the hospital’s chief information security officer, notes that many of the new devices have inherent features that allow the hospital’s IT department to implement necessary security measures.

Charles E. Christian is CIO of Good Samaritan Hospital in Vincennes, Ind. He describes an ongoing project there—which is still a work-in-progress—known as Unified Communication, which will expedite the process in which caregivers can contact one another. He envisions a notification system that will alert clinicians that a lab report is ready for review, and will provide a way for the recipient to acknowledge that he received the notification, or to forward the notification to another specialist. If there is no response to a message within minutes, it will resend the message to a back-up recipient.

Charles E. Christian

As a fail-safe, someone will be responsible for making sure that the proper notifications take place. “We can’t 100 percent depend on technology, because there are too many places where technology can break down,” he says. He adds that the same communications platform can be used for a variety of purposes, including meeting notifications or disaster notifications.

Clinicians’ View
Timothy Burdick, M.D., is a family medicine physician employed by Fletcher Allen Health Care, Burlington, Vt. As a practicing physician, Burdick says secure messaging has been helpful in improving transitions of care. “The advent of electronic health records that are enterprise-wide has made the issue much less of a problem,” he says. At Fletcher Allen, the messaging to the physicians takes place through PRISM, which is the hospital’s name for the EHR system (supplied by Epic Corp.), which has been live for about three years. Fletcher Allen went live with PRISM on the inpatient side in January 2009, and ambulatory clinics went live over the course of 2010, according to Burdick.