By Michelle Butzgy/ParaglideFebruary 1, 2013
FORT BRAGG, N.C. - What if you were able to talk to your primary care provider without making an appointment and waiting at the clinic, possibly for hours?
More than 9,000 Womack Army Medical Center patients are already doing this and more through the Army Medicine Secure Messaging Service. Secure messaging through a partnership with RelayHealth, a connectivity and health information technology company, lets patients log onto a secure website where they can set up appointments, renew prescriptions, get lab results and even have an 'e-visit' with their provider, said Mary Coburn, WAMC Department of Family Medicine senior nurse manager.
"It's not through their email. They have a separate sign-on to this (web) site which makes it HIPAA (Heath Insurance Portability and Accountability Act of 1996.)
The HIPAA requires establishment of national standards for electronic health care transactions while addressing security and privacy of health data. The act was meant to encourage widespread use of electronic health care data in the United States to improve the efficiency and effectiveness of the nation's healthcare system.
The Fayetteville and Hope Mills community primary care clinics were the first to use AMSMS in April 2011, with 40 percent of the clinics' patients using AMSMS. Other clinics were to be on board by September 2012, added Laura Mota, WAMC DFM health system specialist.
"What I saw was that patients, providers and staff really like it because you can message back and forth with your provider and request appointments. The provider can also do what is called an 'e-visit.' If I (sent a message to the provider) saying 'I'm coughing and have a sore throat. What should I do?', they can actually send you back a series of questions like they would ask you if you were in the office. When you answer those, they can often make a diagnosis. You could potentially be treated without having to have a face-to-face visit," said Coburn.
AMSMS also gives providers the ability to send health care education materials tailored to different types of patients.
For example, diabetics who are having difficulty injecting their insulin shots can message their provider who in turn sends back links to websites and videos on how to properly take insulin. All information sent by the provider has been approved through the Army Medical Command, said Coburn.
Mota experienced first hand how well the system worked when she realized she was going to run out of two medications while she was on leave during Christmas. "I had enough for two weeks but I was going to run out in the middle (of my leave.) At 10 o'clock at night, I was on my computer sending a message to my provider. By 10 o'clock the next morning, I had an answer back from the nurse telling me they put in a 30-day prescription for me. (The message also included) all of the blood work I needed to have done, all the instructions, everything right there," she said.
"When I looked at this, I was so impressed. Most people work so it's very difficult to get a hold of somebody by phone. By using this (service), it was just like that -- I could print out instructions to know when my appointment was, what kind of things I needed to do for my bloodwork. It was very thorough and convenient," Mota added.
All communication through AMSMS gets moved into the patient's medical records, added Coburn.
"That's one complaint we have with patients, playing phone tag and trying to reach somebody because everybody works," said Mota.
This allows convenience for the staff as well.
"Instead of having four calls lined up, the nurse can answer each query in a timely manner and patients can access messages at any time," said Coburn.
To register for AMSMS, patients must first come in for an appointment at their clinic's front desk. The participant will receive a form to fill out when they check in. All identification such as military ID cards, addresses and telephone numbers are first verified before an invitation is sent to the patient through the AMSMS portal.
"It's another step but I think it's appropriate just because they're verifying that person is who they say they are," said Mota.
Once a clinic has 20 percent of their patients enrolled in AMSMS, providers will have time built into their day so they can enroll patients and talk about the service.
Some providers will even sign up patients during a routine visit, Coburn said.
Both Mota and Coburn said they can see improvements in the system.
"There's a savings in resources and time. We call these asynchronous visits, a visit that doesn't require face-to-face. It's not as expensive as bringing a patient in. For health insurance companies in the private sector, they're reimbursing for this because it does save money," said Coburn.
"We get RVU (relative value units) credits for those communications. This is how we look at visits and workload in outpatient use," she said.
"If the registered nurse can handle most of this on a call instead of the provider, that's letting people in who really need to be seen by the provider," added Mota.
Mota stressed that AMSMS is not a substitute for urgent care but for use in routine care only. The Army gives providers up to 72 hours to respond to the patient through AMSMS, however WAMC's goal is to answer within 24 hours, said Coburn.
"It's not meant to be a response in two hours," she added.
To sign up for AMSMS, contact your primary care clinic. To learn more about how AMSMS works, visit www.youtube.com/watch?v=UaZTnPgBS8gc8affa1ec70666922f2268ecc4cf35fb40e39afd75cda22604ab066506b2570ae886c9f2285a8a67b325e729216bc530c17bcfb12306dda9945920aebc51a4c5list=PL94A30CCC4268C10B