Secure Messaging

1. Secure Messaging Maj Amalia M DiVittorio AFMSA/SG6M 7 Apr 2012 Version #1

2. Learning Objectives Communicate the AFMS vision related to secure messaging Define Secure Messaging Discuss the stakeholder’s involvement in the process Summarize Implementation Strategy

3. Purpose PEOPLE PROGRESS POTENTIAL PCMH Goals 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

4. Secure Messaging AFMS Vision • 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)

5. Secure Messaging AFMS Vision AIR FORCE MEDICAL HOME QUALITY MEASURES PATIENT EXPERIENCE PATIENT EXPERIENE PATIENT INFORMATION MANAGEMENT & TECHNOLOGY PHYSICIAN-led TEAM PROACTIVE PREVENTIVE HEALTH CARE 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

6. 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

7. Secure Messaging Login Relay Health is not email. It is a secure Web-based, HIPAA compliant communication tool.

8. Secure Messaging Patient Homepage Appointment Requests Prescription Renewals Lab/Test Results Message Your Provider Online webVisits New Messages Inbox

9. Personal Health Record (PHR) Convenient secure repository for patients’ health information

10. Anticipated Benefits • Secure messaging can help streamline administrative activities in the clinics • Secure messaging allows for increased productivity and reduced workload (based on prior implementations) • Reduced phone calls, phone tag, and unnecessary patient visit Benefits to Medical Group Staff • Medical staff can have a streamlined response to prescription renewals, lab/rad, and immunization requests • Potential for increased patient care levels and satisfaction • Streamline communications with patients and improve the quality of patient outcomes • Ability to send broadcast secure message to all patients (streamline tasks like alerting high-risk patients of flu shot administration availability)

11. 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. • Consult with healthcare team via a secure messaging tool • Request Prescription Renewals online • Request Appointments online Benefits to Patients • Request and Receive Lab Results online • Access Doctor-approved information links • Request and Receive Immunization Records online

12. 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%

13. 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

14. 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 satisfiedand 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.

15. Stakeholders MTF Executive Staff CLINIC STAFF GPM HCI/Disease Mgt/Case Mgt Privacy Office Systems TOPA Pharmacy

16. Workflow Scenario Are there refills available? Med Tech informs patient of refill availability System sends automated notification to all Family Health Med Techs Patient sends prescription renewal request via SM Med Tech opens message and checks for available refills Yes End Process No Is the patient renewal eligible? Care Team Prescription Renewal Request Inbox Nurse follows current processes to initiate prescription renewal Med Tech forwards request to Nurse Nurse opens message and checks for renewal eligibility Yes No Care Team Rx renewal request inbox Nurse notifies patient and requests follow up visit

17. FAQ’s • 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.

18. FAQ’s • 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

19. 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

20. Support Relay Health Contact Number: 1-866-735-2963

21. Pilot Sites • Data as of 1 Apr 2012 • Patients enrolled: 13,786 • PHR elements shared: 600,000

22. Current Status • AFMS deployment Plan • Started Nov 2011 – 26 MTFs by June 2012

23. Current Status

24. MHS View

25. Future Roll Out • MHS UMBRELLA • Projected to start Tri-Service contract Fall 2012 • Strategic plan • Finish CONUS • USAFE • PACAF

26. Summary For general info: www.sg.af.mil/micare For marketing materials: https://kx.afms.mil/sgcag

27. Summary Questions

28. SM Benefits

29. Air Force Medicine