Care Coordination Through Secure Messaging

To improve community diabetes care, a group of primary care physicians (PCPs) and optometrists in Hutchinson, Kan. is using secure clinical messaging to coordinate eye care. This use case is seen by many as a natural springboard for further health information exchange activities throughout the state.

This diabetes project, promoted by the Kansas Health Information Network (KHIN), a statewide HIE initiative, started in July 2011 with a pilot group of 35 providers and uses a clinical messaging solution from the Nashville, Tenn.-based Informatics Corporation of America. “We started it because frankly we needed a way for our providers to securely share clinical information with non-affiliated providers so they could meet the core measure for attesting for their meaningful use incentive payment,” says Laura McCrary, executive director, KHIN.

The problem providers in Hutchinson were facing was two-fold: optometrists were not seeing their diabetic patients regularly enough, and PCPs were not getting back eye exam results after the patients’ optometry visits. “One of the problems [providers] had identified was that for patients in their community that had diabetes, they were not able to monitor their eye care at the level they were hoping to,” says McCrary.

Earlier, when optometrists needed to send information in color, they had to send it via courier and incur the associated costs. Now, using the clinical messaging solution, providers are able to send a secure HIPAA-compliant message with any clinical documentation attached via the Internet—no additional software necessary. McCrary says the system is as user-friendly as other enterprise email solutions, and also maintains an audit trail, so providers can verify that their messages were sent and received. The provider can then save the message and any attached clinical documentation to the patient’s chart and depending on the provider’s EHR, integrate it within the patient’s record.

McCrary says Hutchinson providers faced challenges discontinuing their previous fax workflow; some practices were faxing as many as 4,000 pieces of paper a day. “It’s hard to change your workflow and redesign the workflow process,” says McCrary.
 
After the success of the diabetes pilot, KHIN started in August on-boarding other providers who wanted to use the solution. Currently, close to 400 providers, 63 of whom are optometrists, use the secure clinical messaging system across the state, and KHIN is trying to get more physicians signed up. KHIN’s strategy has been to engage hospitals with the solution and then bring in the affiliated physicians. KHIN is now transitioning two Wichita hospitals to use the solution. “It’s one of those things where you need to hit the tipping point to have most of the physicians using the secure clinical messaging, so there’s value and so you don’t have to go back and forth between the secure clinical messaging and the fax machine,” says McCrary. She predicts that in six months the majority of Kansas physicians will be using this messaging system.

Other Secure Messaging Use Cases
McCrary sees many use cases for secure clinical messaging beyond diabetes care. “I think there are some real significant benefits both to the practice, but also to some of our state agencies that need some of this,” McCrary says. The Kansas Department of Labor, for one, requests a lot of documentation from PCPs on patient injuries to verify workers’ compensation claims. A third-party organization is used to rescan faxed documentation from providers and could easily be replaced with secure messaging, she adds.

Another relevant use case for secure messaging involves patient care transitions once he or she is discharged from the hospital. The home healthcare team could be sent the patient’s discharge summary via secure messaging once the patient released, so they can better care for the patient. “That has a lot of applicability in reducing avoidable hospital readmissions and being able to improve the quality of care for the patient and at the same time reducing cost to the system,” McCrary says.

McCrary sees clinical messaging as one step closer for providers to be able to contribute data into KHIN through its provider portal. “We see this as a transitional way for physicians and eligible providers in Kansas to begin sharing data in a way that is comfortable and helps them move at their own pace and has very low barriers to doing it,” she says. “We see it as an opportunity to dip their toe in the water and begin securely sharing information point to point.”