Headquarters U.S. Air Force Integrity - Service - Excellence Secure Messaging Maj Amalia M DiVittorio AFMSA/SG6M 7 Apr 2012 Version #1 1 Learning Objectives Communicate the AFMS vision related to secure messaging Define Secure Messaging Discuss the stakeholder’s involvement in the process Summarize Implementation Strategy Integrity - Service - Excellence 2 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 Integrity - Service - Excellence 3 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) Integrity - Service - Excellence 4 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 Integrity - Service - Excellence 5 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 Integrity - Service - Excellence 6 Secure Messaging Login Relay Health is not email. It is a secure Web-based, HIPAA compliant communication tool. Integrity - Service - Excellence 7 Secure Messaging Patient Homepage Appointment Requests Prescription Renewals Lab/Test Results Message Your Provider Online webVisits New Messages Inbox Integrity - Service - Excellence 8 Personal Health Record (PHR) Convenient secure repository for patients’ health information Integrity - Service - Excellence 9 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 Integrity - Service - Excellence 10 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 Integrity - Service - Excellence Benefits to Patients 11 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% Integrity - Service - Excellence 12 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 Integrity - Service - Excellence 13 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. Integrity - Service - Excellence 14 Stakeholders MTF Executive Staff CLINIC STAFF GPM HCI/Disease Mgt/Case Mgt Privacy Office Systems TOPA Pharmacy Integrity - Service - Excellence 15 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 16 Integrity - Service - Excellence 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. Integrity - Service - Excellence 17 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 Integrity - Service - Excellence 18 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 Integrity - Service - Excellence 19 Support Relay Health Contact Number: 1-866-735-2963 Integrity - Service - Excellence 20 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 Integrity - Service - Excellence 21 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 Integrity - Service - Excellence 22 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 Integrity - Service - Excellence 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 Integrity - Service - Excellence 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 Integrity - Service - Excellence 25 Summary For general info: www.sg.af.mil/micare For marketing materials: https://kx.afms.mil/sgcag Integrity - Service - Excellence 26 Summary Questions Integrity - Service - Excellence 27 SM Benefits Integrity - Service - Excellence 28 Air Force Medicine 1% 13% 15% 57% 11% 3% 29 Integrity - Service - Excellence Appointment Requests Test Result Requests Rx Renewal Requests Referral Requests Message to Provider webVisit