Headquarters U.S. Air Force
Integrity - Service - Excellence
Secure Messaging
Maj Amalia M DiVittorio
AFMSA/SG6M
7 Apr 2012
Version #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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Purpose
SECURE MESSAGING equals the ability for healthcare teams and
PEOPLE
patients to interact in an asynchronous manner for a more efficient
PROGRESS
communication exchange to improve healthcare outcomes
POTENTIAL
PCMH Goals
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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)
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Secure Messaging AFMS Vision
AIR FORCE
MEDICAL HOME
QUALITY
MEASURES
PATIENT
PATIENT
EXPERIENCE
EXPERIENE
PATIENT
PHYSICIAN-led
TEAM
INFORMATION
MANAGEMENT
&
TECHNOLOGY
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
PROACTIVE PREVENTIVE HEALTH CARE
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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
Relay Health is not email. It is a secure Web-based,
HIPAA compliant communication tool.
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Secure Messaging Patient
Homepage
Appointment Requests
Prescription Renewals
Lab/Test Results
Message Your Provider
Online webVisits
New Messages Inbox
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Personal Health Record (PHR)
Convenient secure repository for patients’ health information
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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

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)
Benefits to
Medical Group
Staff
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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.

Consult with healthcare team via a secure messaging tool

Request Prescription Renewals online

Request Appointments online

Request and Receive Lab Results online

Access Doctor-approved information links

Request and Receive Immunization Records online
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Benefits to
Patients
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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
civilian
Secure Messaging has been in
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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Stakeholders

MTF Executive Staff

CLINIC STAFF

GPM

HCI/Disease Mgt/Case Mgt

Privacy Office

Systems

TOPA

Pharmacy
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Workflow Scenario
System sends
automated
notification to all
Family Health Med
Techs
Med Tech opens
message and
checks for available
refills
Med Tech forwards
request to Nurse
Nurse opens
message and
checks for renewal
eligibility
Are there
refills
available?
Yes
Med Tech informs
patient of refill
availability
End
Process
No
Patient sends
prescription
renewal request via
SM
Nurse follows
current
processes
Yes
to initiate
prescription
renewal
No
Care Team
Prescription
Renewal
Request
Inbox
Is the
patient
renewal
eligible?
Care Team Rx
renewal
request inbox
Nurse notifies
patient and
requests follow up
visit
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FAQ’s
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
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
Relay Health
Contact Number:
1-866-735-2963
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Pilot Sites
1%
Data as of 1 Apr 2012
Patients
PHR
6%
enrolled: 13,786
21%
elements shared: 600,000
14%
47%
Pilot
Dates
Joint Base
Elmendorf-Richardson
Dec 2010
9%
2%
Appointment Requests
Pentagon Flight
Medicine Clinic
Jun 2011
Rx Refill Requests
Lab Results Request
Referrals
Note to Doc
Note to Office
Patient Initiated webVisits
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Current Status

AFMS deployment Plan
 Started Nov 2011 – 26 MTFs by June 2012
Wave 1: “GME Sites”
Nov-Feb 2012
Wave 2 – East Coast
Jan- Apr 2012
Wave 3 – South/MW
Feb- May 2012
Eglin
Andrews
Columbus
Hurlburt
Bolling
Keesler
Nellis
Charleston
Lackland
Offutt
Dover
MacDill
Travis
Hanscom
Maxwell
McGuire
Patrick
Moody
Randolph
Robins
Tyndall
Seymour Johnson
Wright-Patterson
Scott
Langley
Shaw
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Current Status
Air Force Utilization Statistics
Through March, 2012
16,000
1200
1100
14,000
12,000
900
800
10,000
700
8,000
600
500
6,000
400
4,000
300
200
2,000
100
0
0
Total Patients
Monthly Message Volume
23
Monthly New Patients
Registered Providers
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Registered Providers
Patients/Message Volume
1000
MHS View
Army
Navy
Army Medicine
“MTF”Online
Air Force
Joint Task
Force
MiCare
Army Medicine
Brand
Tag
Secure Messaging
Service
NMCSD Online
Secure Messaging Service
Providers
704
1,043
903
156
MTFs
38
29
28
2
13,000
80,000
15,000
----*
Target - July
2012
Completed June
2011
Target – August
2013
Target –
Feb/March 2012
Active Enrolled
Patients
(As of Jan 2012)
All Sites
Deployed
Highlights
CBMH
Completed –
Dec 2011
eRx Pilot
Bethesda
PHR Data
Exchange via
CDC with
COHORT
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Ft Belvoir
DiLorenzo
Tri Service
Pentagon Clinic24
Future Roll Out

MHS UMBRELLA
 Projected to start Tri-Service contract Fall 2012

Strategic plan



Finish CONUS
USAFE
PACAF
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Summary
For general info:
www.sg.af.mil/micare
For marketing materials:
https://kx.afms.mil/sgcag
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Summary
Questions
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SM Benefits
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Air Force Medicine
1%
13%
15%
57%
11%
3%
29
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Appointment
Requests
Test Result
Requests
Rx Renewal
Requests
Referral
Requests
Message to
Provider
webVisit