Ophthalmology Patient Portal and Online Communication Editorial

Secure Messaging—Take the Challenge

May 1, 2009

E-communication in Daily Life

I was reminded the other day, while searching for an old email, just how much stuff I routinely do electronically. I found references to many types of recent transactions. I had received or sent emails regarding taxes, my daughter’s tuition and confirmations of recent transactions from several e-commerce sites. The point is that all of this stuff required communication and that it occurred efficiently and painlessly, when it was convenient for me. I didn’t wait on the phone or play phone tag. Contrast this experience to communicating about healthcare issues. My last personal experience consisted of a wasted afternoon by the phone waiting to resolve a simple issue. Communication in this setting was anything but painless. What if every other industry on the planet abandoned e-mail to re-embrace the telephone? Wow, that’s a depressing scenario. Who wants to go back to the telephone for all these tasks? This all

 Paul C. Seel, MD, MBA
 Vice President & Medical
 Director
 Sophrona Solutions

Technology Laggards
E -communication for healthcare has been slowly percolating up through the ranks. Back in 2003, the American Medical Association published a very good set guidelines for email communication with patients (http://www.ama-assn.org/ama/pub/printcat/2386.html). Six years later, adoption remains quite low with a gap between the number of patients who want to communicate with their physician’s offices (80%) and the number of physicians who currently utilize this form of communication (<10%). This utilization gap is even more dramatic when one considers that every other industry has adopted e-communication in one format or another to conduct business.

E-mail vs. Secure Messaging
E-mail, as we routinely use it is not appropriate for communicating healthcare issues, it is illegal and subject to harsh fines under HIPAA. Secure messaging is a specialized e-mail application for healthcare accessed through a patient portal. Like e-mail, secure messaging is asynchronous. Herein lays the major advantage. The message’s writer and recipient don’t need to be engaged simultaneously as they would on the phone or in a conversation allowing patients to communicate off hours when it’s more convenient and office staff to batch similar activities and level their work load. But unlike regular email, secure messaging is fortified with additional features that address concerns unique to the healthcare setting. To address security and privacy issues, secure messaging is password protected, encrypted and embedded with the ability to track every office staff member opening a message. Messages get time stamped when received and opened and the patient’s receipt of a message can be verified. To mitigate liability issues, patients agree to specific guidelines for when secure messaging is appropriate as well as when to expect a reply. Templates can be used to structure the patient’s communications and gather the specific information necessary refill a prescription or to qualify appropriate encounters for billing as e-visits.

Role Based Messaging Key to Overcoming Barriers
It’s possible to offer patients secure messaging on a limited scope through role based messaging. This can overcome some of the change issue barriers. With role based messaging, patients see a menu limited to certain staff roles and topics, e.g. billing office staff available for billing issues with a response by the next business day. Other staff roles and topics may be sequentially added, each with its guidelines for use and response timeline. Eventually all of the staff may be using it.
The last adoption hurdle comes with the use of secure messaging for clinical issues. Those opposing usually latch onto liability concerns, which shouldn’t be a concern provided there are appropriate safeguards regarding security, privacy and guidelines for using in place. In reality, there are far more liability issues using the telephone, it’s just that we’ve been lulled into complacency through familiarity. But even if the physician and clinical staffs lag the rest of the office in adopting secure messaging, the patients will have the benefit of a more efficient means of communicating with the office staff who in turn will reap the benefits inherent with asynchronous communication.
For those who remain skeptics of secure messaging—I offer the following challenge. Go through your old emails as I did and consider the time it would have taken to accomplish all of it by phone. With this perspective, it’s tough to imagine why patients have put up with this for so long. I think it’s time for change.

Paul C. Seel, MD, MBA
Vice President & Medical Director
Sophrona Solutions
Email: pseel@sophrona.com