I n t e g r i t y - S e r v i c e - E x c e l l e n c e

Headquarters U.S. Air Force

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Secure Messaging

Maj Amalia M DiVittorioAFMSA/SG6M

7 Apr 2012Version #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

patients to interact in an asynchronous manner for a more efficient

communication exchange to improve healthcare outcomes

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PEOPLE

PROGRESS

POTENTIAL

PCMH Goals

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Secure Messaging AFMS Vision

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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

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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

PATIENT EXPERIENE

QUALITYMEASURES

INFORMATIONMANAGEMENT

&TECHNOLOGY

PATIENT EXPERIENCE

PHYSICIAN-ledTEAM

AIR FORCEMEDICAL HOME

PROACTIVE PREVENTIVE HEALTH CARE

PATIENT

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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

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

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Secure Messaging Patient Homepage

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Appointment Requests

Prescription Renewals

Lab/Test Results

Message Your Provider

Online webVisits

New Messages Inbox

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Personal Health Record (PHR)

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Convenient secure repository for patients’ health information

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Benefits to Medical Group

Staff

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Anticipated Benefits

Secure messaging can help streamline administrative activities in the clinics

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Benefits to Patients

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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.

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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

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

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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

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Nurse notifies patient and

requests follow up visit

Care Team Prescription

Renewal Request

Inbox

Nurse follows current processes

to initiate prescription

renewal

Is the patient renewal eligible?

Yes

No

Patient sends prescription

renewal request via SM

System sends automated

notification to all Family Health Med

Techs

Med Tech opens message and

checks for available refills

End Process

Med Tech informs patient of refill

availability

Are there refills

available?

Yes

No

Med Tech forwards request to Nurse

Nurse opens message and

checks for renewal eligibility

Care Team Rx renewal

request inbox

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FAQ’s

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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

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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

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Relay Health Contact Number:

1-866-735-2963

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Pilot Sites

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Pilot Dates

Joint Base Elmendorf-Richardson Dec 2010

Pentagon Flight Medicine Clinic Jun 2011

Data as of 1 Apr 2012Patients enrolled: 13,786PHR elements shared: 600,000

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Current Status

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AFMS deployment Plan Started Nov 2011 – 26 MTFs by June 2012Wave 1: “GME Sites”

Nov-Feb 2012Wave 2 – East Coast

Jan- Apr 2012Wave 3 – South/MW

Feb- May 2012

Eglin Andrews Columbus

Hurlburt Bolling Keesler

Nellis Charleston Lackland

Offutt Dover MacDill

Travis Hanscom Maxwell

Scott McGuire Patrick

Langley Moody Randolph

Robins Tyndall

Seymour Johnson Wright-Patterson

Shaw

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Current Status

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MHS View

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Army Navy Air Force Joint Task Force

Brand

Tag Army MedicineSecure Messaging Service

“MTF”OnlineNMCSD Online MiCare Army Medicine

Secure Messaging Service

Providers 704 1,043 903 156

MTFs 38 29 28 2

Active Enrolled Patients (As of Jan 2012)

13,000 80,000 15,000 ----*

All Sites Deployed

Target - July 2012

Completed June 2011

Target – August 2013

Target – Feb/March 2012

Highlights CBMH Completed – Dec 2011

eRx Pilot Bethesda

PHR Data Exchange via CDC with COHORT

Ft BelvoirDiLorenzo Tri Service Pentagon Clinic

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Future Roll Out

MHS UMBRELLA Projected to start Tri-Service contract Fall 2012

Strategic plan Finish CONUS USAFE PACAF

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Summary

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For general info:

www.sg.af.mil/micare

For marketing materials:

https://kx.afms.mil/sgcag

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Questions

Summary

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SM Benefits

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Air Force Medicine

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