Are you conducting a risky business?

The time has come for secure messaging.

July 4, 2016

“Saving lives or risky pics? ‘Revolution’ in MDs’ smartphone photos raises ethical concerns,” read the headline of an April National Post article. Followed by, “Would you want your most intimate photos saved alongside your doctor’s baby pics? Patients across Canada are increasingly asked for that consent.” Those are attention-grabbing headlines, particularly for physicians.

E-communications have become ubiquitous in our busy lives and while you know that emailing, texting and faxing are not secure channels over which to exchange confidential information, you continue to use it, thinking (hoping) that you’ll never experience a security breach. Despite having set gold standards for yourself and your clinic staff, when undertaken in the context of a maxed-out-busy work environment, e-communications (such as texts and email exchanges) are fraught with the potential to be compromised.

They’re not secure; “… it’s that simple”

“There’s no doubt that as physicians, we need a secure platform to message each other,” says Dr. Scott F. Wilson, member of the Alberta Medical Association (AMA) Secure Messaging Engagement Committee and President, Section of Neurology. “Security is a growing concern and the faxing, texting and emailing of information is not secure; it’s that simple.”

Dr. Wilson’s interest in secure messaging began while he served on the Physician Office System Program Committee. “Our goal was to facilitate the ability to message across platforms through a health information exchange, and I thought it could enhance my job as a specialist, in communicating with family physicians, to provide better care for patients in Alberta,” Dr. Wilson continues.

Fast-forward a decade and with Alberta’s physicians using electronic medical records (EMRs) more than any other province, the emphasis is now on facilitating health information exchanges among health care providers that are not only secure but, “enhance the entire workflow of a physician’s office, from the nurse or medical office assistant directly to the physician,” says Dr. Wilson.

“AMA dr2dr Secure Messaging does that. This platform takes the movement of information to a whole new level with multiple enhancements. Patient demographic information can easily be included with a secure message and medical office staff can track the status of any secure message, whether it’s simple advice regarding patient management or a referral.”

And those EMR systems? Well, AMA dr2dr can be integrated with any EMR system hosted by a vendor open to integration. Currently Healthquest is integrated and Telin users will be happy to know that Mediplan EMR is in the works.

Stand-alone system with a fee code = good business decision

“It can also be used as a stand-alone system for physicians who either don’t have an EMR or don’t have EMR-integration ability,” adds Dr. Wilson.

“And with the new E-Consult fee code (03.01R; accompanied by the earlier fee code; 03.01O), the cost of the system can be completely offset, for both the family physician and the specialist,” continues Dr. Wilson. “From that perspective alone, it’s easy to see that adopting the AMA dr2dr secure messaging system is a good business decision.”

The capabilities of AMA dr2dr and its financial win-win aside, it’s the other features and benefits of secure messaging, and how they set the environment for providing his patients with coordinated, informed care, that stand out as the deal-closers for Dr. Wilson.

Improved coordination of care

“When you look at the secure messaging system’s ability to accommodate the gathering and management of clinical advice, opinions and information; its flexibility and security with respect to attaching patient files; and its ability to serve as an efficient, reliable record of referral and other communications – all of which form the foundation of coordinated patient care – this is the system that can help physicians provide better care for our patients.”

“I think there are some misconceptions about secure messaging,” Dr. Wilson notes. “Physicians may be thinking that they’re going to be saddled with one more thing to log into, and upload files and move patient data to."

He goes on to stress that: "The quick-fix is to engage your office staff, as the reality is that the dr2dr system supports clinic staff, as well. In fact, they can do most of the initiating of a message for the physician, such as adding the attachments or a note. The physician can add any final comments and push ‘send.’ Finally, a copy of the conversation can be printed and added to the patient’s paper record. It’s as easy as that.”

Foundations of change

At the AMA Spring 2014 Representative Forum, with motion RF14S-22, the need for a secure electronic messaging system was recognized as a priority. Gaps in continuity of care, many of which were identified in the Health Quality Council of Alberta’s Continuity of Patient Care Study (December 19, 2013), were a contributing factor in the secure messaging motion, moved by Dr. Wilson.

“We’ve long recognized the need for a secure messaging system that facilitates new modes of coordinated care,” he explains. “It’s also imperative that it complies with current privacy legislation and expectations for standards of care. For the past six months, the Secure Messaging Engagement Committee and the AMA have been working closely with Microquest to ensure that AMA dr2dr does that, and more.”

With its web-based, secure server, the AMA dr2dr system protects sensitive data or information that is sent beyond the corporate/clinic/device borders and complies with industry regulations and standards for the secure transmittal of confidential patient data, as stipulated by: the Health Information Act (HIA); the Freedom of Information and Protection of Privacy Act; the Personal Information Protection and Electronic Documents Act; the Personal Information Protection Act; the Office of the Information and Privacy Commissioner of Alberta; the College of Physicians & Surgeons of Alberta and Alberta Health.

Understanding secure messaging: Helping you care for your patients while respecting their privacy

In the name of seeking advice, opinions and ideas from their peer physicians and other health care providers, many physicians are ramping up their use of personal mobile phones (cameras and texting) as well as new online mobile applications and tools, such as Instagram and Figure 1. While convenient and effective in their own right, security can be sacrificed in the name of expediency; at the sobering cost of the patient’s right to privacy.

Misunderstandings of the security aspects (or lack thereof) of mobile technology are rampant, evidenced by a Calgary-based study (conducted by plastic surgeons in Alberta) recently published in the journal Plastic Surgery, in which 75% of the 147 surgeon respondents said “getting simple verbal consent for photos was good enough.”

As Ingrid M. Ruys, privacy advisor to the AMA observes, “Verbal consent is not sufficient. Mobile applications, including photos, need to have patient consent, recommended to be obtained in writing when the patient first visits a physician or during an appointment. If a physician obtains verbal consent, it must be recorded with date, time and reason (e.g., emergent broken arm) in the patient file, and should the patient contest that, it’s open for challenge.”

In other words, verbal consent doesn’t cut it, at all.
Ms Ruys notes that obtaining verbal consent contravenes Section 23 of the HIA, which states that use of a “recording device or camera” must obtain written consent … “All forms that obtain patient information (of which pictures are deemed to be) require consent,” she continues. “Consent is obtained in writing, as outlined in all Privacy Impact Assessments.”

“Protecting privacy and safeguarding clinical information are at the core of AMA dr2dr,” says Dr. Wilson. “It complies with all related industry regulations and standards; the log-in process requires two-factor authentication; all exchanges and attachments are centrally stored and contained within the dr2dr.ca website; in-transit data is 256-bit SSL-encrypted and at-rest data is also encrypted.”

Axe the Fax

“Plus,” he adds, “dr2dr is just easy to use. I recently had a family physician from southern Alberta message me regarding an MRI result in the context of headaches. I was quickly able to answer the question about the MRI findings and suggest a further care plan for the patient; all done in minutes, without going near the fax machine. Best of all, with dr2dr, the family physician could see instantly, after sending his message, that I had received it. No standing around the fax machine, wondering if the fax transmitted, to me, and did I receive it … there’s so much efficiency and clarity, with dr2dr.”

The demise of the fax machine isn’t a matter of if but when, and it can’t happen soon enough for Dr. Wilson. “The potential of secure messaging to improve the workflow in our offices, in our practices, with the frustrations and inadequacies of faxing in the past … that’s my goal.”

The other essential ingredient to improving office workflow with secure messaging is for AMA dr2dr to become the primary means of e-communications between physicians, clinic staff and other health care professionals. “The more users that are on the system, the better,” Dr. Wilson emphasizes. “As the network grows, it will become exponentially more beneficial to all users.”

All onboard!

All good things do take some time (and patience). AMA dr2dr is no exception. Integrating the system into your practice, engaging your staff and trialling the system are investments in your business that will pay off tenfold.

Start now, by signing up for a pilot or early access! The full-system launch takes place on July 4, after which there will be a three-month Free Trial Period (the subscription rate after the free trial will be $34.99 per month, covering a physician and all clinic staff reporting to the physician).

Sign up for a pilot at: www.dr2dr.ca

Technical support

With any new technology, technical support is paramount and the AMA and Microquest technical support teams are already hard-at-work, supporting the 12 system trials currently underway. They have a comprehensive knowledge of the EMR landscape in Alberta and can advise you about the best solutions for your office. With or without an EMR, AMA dr2dr is your secure solution for sending and receiving messages, consult requests and referrals.