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EMRs’ big gaping hole of secure messaging

Today’s post begins a series inspired by my recent participation in a breakfast panel in Washington, DC, Doctors and Patients Bridging the Digital Divide. There were a lot of useful ideas discussed during this panel, and so I decided to capture and share some with you.

One of the biggest holes in electronic medical records currently seems to be a lack of secure messaging systems built into the software.  Although maybe not universally true, this still represents a huge problem that also represents a great opportunity for gains in technology that will enhance the doctor-patient relationship and move digital healthcare forward into the future.

Currently, my electronic medical record vendor does not supply this feature as part of its software package.  However, as part of the Meaningful Use Stage 2 requirements by the federal government, the use of a certified EMR system that supports this function will be required.  A HIPAA-compliant secure messaging system will be needed as a part of every electronic medical record going forward.

Currently, if I wanted to use secure messaging to communicate with my patients, I would have to purchase a separate third-party vendor’s online software to communicate in a HIPAA-compliant fashion.  This involves an additional service agreement between the third-party and me, as well as monthly fees they can be expensive.  This would grant me the right to not only communicate with patients but also to bill third-party insurance companies for providing such electronic health services.  However, what may people do not appreciate is the small reimbursement allowance for such services, which is quite minimal.  Thus, regardless of the demand by patients, it’s currently more financially lucrative simply to see another patient in the office for a follow-up visit rather than answer a message electronically.  If an electronic medical record vendor builds secure patient messaging into their platform, when there is already a contractual arrangement between the doctor and EMR vendor, then a third-party cost would potentially become unnecessary.  The prospect of using a built-in, HIPAA-compliant, secure messaging system suddenly becomes much more attractive and potentially fiscally responsible.

Unfortunately, many EMR systems are in still developing stages at which they do not yet have built-in secure messaging features in their PHR or personal health record modules.

But what a wonderful and potentially powerful area for future development in order to further promote patients to become more engaged in playing a more active role in their own health care.  The ability of a patient to reach their doctor through the Internet is certainly an attractive feature if done right and seems potentially better than a patient spending five minutes on hold listening to elevator music only to finally speak to a front desk staff member who will only be able to forward a message, which may or may not be forwarded accurately.

September 12, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at

Breakfast Panel: Doctors and Patients Bridging the Digital Divide

Greetings readers!  This week I’m excited to say that I have been invited to participate as part of a breakfast panel for National Health IT Week at the W Hotel in Washington, DC.  The title of the panel will be Doctors and Patients Bridging the Digital Divide and it will be taking place on Tuesday morning, Sept 11, at 8:30 – 10:00 AM.  This breakfast panel is being sponsored by Practice Fusion, and registration is in the form of donations to the Society for Participatory Medicine.  From their website, the main topics for discussion are:

What doctors can do to maximize the potential of technology to improve care,

What workflows and techniques providers can implement to enhance their relationships with patients,

How providers can inspire patients to take an active role in their health management through health IT, and

Which policies and industry innovations can facilitate better patient-provider relationships and value-based care.

An old mentor of mine once gave me wise advice. “Whatever you do, make it count twice.” In other words, if, for example you are preparing a talk, the opportunity may arise later to turn this into a paper/manuscript that you can submit to a journal. Perhaps you can even give a version of the talk as recycled talk at another conference for slightly different purpose. In other words, be efficient!  Turn a dollar into two… or even more.

Therefore, I’d like to share with you some of the ideas that are coming to me as I proceed towards the panel on Tuesday.

What can doctors do to maximize the potential of technology to improve care?  Well, first off, we can simply use it.  Far too many doctors are still using paper records.  My advice would be to get off of paper records and forge ahead into the New World of electronic records, which is quickly becoming not such a new world anymore. This is becoming more and more the standard and will continue to do so in the future. Secondly, I would highly encourage any medical provider out there to use a web-based system as opposed to an older, in-office server-based system. This allows more opportunity to use the technology outside of the office, particularly on mobile devices. Thus, there’s more opportunity for portability and accessibility. I can’t tell you how many times I have been at home or out of town on the weekend or in another country for a few day, and this technology becomes invaluable in allowing me to continue to provide healthcare to my many patients. This can come in the form of prescription refills and communications to patients by messaging my staff to give them a call back. If my patient portal allowed it, which it currently does not, I could even securely message my patients regarding any issues they may be currently having.

Regarding workflows and techniques providers can implement to enhance relationships with patients, I advise turning the computer monitor during office visits to show patiences test results, especially images, more clearly. This will give them the opportunity to ask questions and see firsthand things that might inspire them to be more interested in asking questions. Hence, the visit becomes more of a two-way interaction rather than simply the doctor preaching from on high the recommendations. At the end of patient visits, I currently offer to enroll them in our personalized health record, PHR, so that they can have access to their test results, upcoming appointment information, and diagnoses. This is a far cry from granting them complete access to all the records, but it is a useful start. Patients absolutely love it and have given me a lot of positive feedback. At future visits, patients are then more likely to request me to turn on access to the latest test results, indicating that they are aware that they have personalized access to their health information.

How can providers inspire patients to take an active role in their health management through health IT? As providers, I think it is imperative that we encourage the mainstream media to develop better marketing strategies. Patients need to value and want this in the first place before it can happen. In the meantime, providers can use electronic medical records with a personal health record component. This will grant patients the opportunity and access to become more interested in their healthcare and get inspired with new ideas for such. We providers should advertise openly to patients that a personal health record is available in our offices. Only through knowledge can power come. Finally, we as providers can discuss opportunities for the use of health IT to manage chronic health issues like high blood pressure and diabetes with patients. Providers admittedly need better knowledge in this area, especially since barriers include the massive volume of health IT apps already out on the market. There’s dizzying display of options which often inspire the providers to just simply turn off the computer and go do something else. I also think we need more public advocates among the provider community, people who truly view this as their mission in life, which most providers arguably do not. They are not trained to have such a mission and they are already very busy with providing good health care to the many patients who need it. Thus, identifying key providers in local communities who have a true passion for developing future use and promotion of health information technology is essential in order to inspire other doctors to jump on the bandwagon.

As far as the “policy and industry innovations that can facilitate better patient-provider relationships and value-based care”, I might have to defer that one to my colleagues who are specially trained in how these things typically develop and mature.  In that vein, I’ll be very interested in what my fellow panelists have to say.  Hope to see you at the conference!

September 10, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at