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The Evolution of Communication in Healthcare

Posted on May 12, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Erik Kangas, Founder of LuxSci.

Thanks to technological breakthroughs, communication in healthcare has evolved by leaps and bounds from the old days of paper filing systems, faxes, and phone calls. Although those methods are still widely used, there are faster ways to keep patients in touch with their medical practitioners, doctors, and nurses. Yet with a multitude of benefits come new risks: data breaches, unencrypted messages, and willful neglect that could bring about serious penalties from HIPAA. In order to fully take advantage of all that technology has to offer, the healthcare industry needs to know proper usage policies and to enforce adherence to HIPAA regulations. We might not be in the age of pagers anymore, but that just means that more precautions practitioners need to embrace the newly evolving world of healthcare communication.

Let’s take a look at how these methods of communication have changed over the years and what it all means for the security of ePHI.

Anyone involved in the healthcare sector has surely encountered a pager at some point in time. Healthcare is one of the last industries to use this aging technology, but messaging systems that are easier and faster to respond are slowly replacing them. With so many smartphones and devices that can instantly let you know whether there’s an emergency, there’s less reason to carry around a separate bulky pager.

An article at HealthITSecurity has this to say about pagers: “Communicating internally via pagers could still have some benefits, but there are now secure messaging capabilities that can assist with routine health issues, address patient questions or concerns, help monitor patient conditions, while also ensuring that patients can properly manage their own conditions.” In other words, with technology that’s so much quicker and more efficient, it might be worth finally letting go of the beeper in your pocket and switching to something that can do everything a pager can and more.

Pagers may not be as efficient as current tech, but certain organizations still believe they serve a purpose, especially critical messaging.

Email has become increasingly important in healthcare, increasing the scope of everyone’s efforts toward protecting patient privacy. Explained in this whitepaper about HIPAA and email, this security applies not only to personal information, but all Protected Health Information (PHI) –including a patient’s administrative, financial, and clinical information. Any health information related to an identifiable individual that is transmitted or maintained via email, or another medium, falls under HIPAA’s definition of PHI. That’s a huge amount of information that needs safeguarding if you want to continue using email to transmit healthcare data.

Ensuring that data remains encrypted on laptops, desktop computers, and all other devices is key to staying HIPAA compliant. While encryption can be costly to implement, it’s worth it to keep patients’ PHI (and other data) secure – and without it, an organization risks paying monumentally more in fines, in the case of a data security breach.

Given that data breaches frequently and increasingly occur in the healthcare sector, organizations need to ensure the continued safety of their patients’ data for both financial and personal reasons.

It’s also a wise idea to sign up with a security company that can handle the HIPAA compliancy of your inbound and outbound emails, as well as the security of your network as a whole. However, it’s still up to you to train your staff, review your HIPAA security policies, and keep a copy of the HIPAA Business Association Agreement that you signed with the security company.

Text Messages
Texting is pervasive as a method of healthcare communication, including using text messages to confirm appointments or deliver lab results to anxious patients. There are also plenty of texts exchanged between doctors and nurses in hospital environments, with many messages containing some form of patient information. All these transmissions fall under HIPAA regulations, and it’s very easy to unintentionally text patient data that could be intercepted, sent unencrypted, or stored in an external location like the cloud.

Sending health information via text is a clear HIPAA violation – even with seemingly harmless messages, like appointment reminders. The only case in which texting health information may not violate HIPAA is when the text is sent to a patient who has preemptively signed the proper consent form. Without patient consent and proper documentation, an organization can be fined up to $50,000 per text message, if the messages are found to be in violation of HIPAA’s rules. That’s a massive penalty for any organization.

As with email, it’s important to make sure that you encrypt and decrypt text messages properly, whether through common carriers, specialized apps for decryption, or customized programs that allow users to send and receive HIPAA-compliant messages without the worry of breaking regulation. You can send text messages securely, but it requires training and a financial cost to ensure the information stays safe and only the intended recipient reads it.

The Future of Compliant Messaging
“It’s not enough to decide it’s time to ‘jump on the bandwagon’ or secure messaging,” says HealthITSecurity. “Healthcare organizations need to realize that this communication is part of an evolutionary process, and it’s necessary to implement a system that can easily integrate with the facilities’ current capabilities.” Organizations need to recognize they can’t do compliance in various messaging systems piecemeal or from one staff member to another, they need to make it a blanket effort that ensures everyone is onboard. And while it may create a more convenient system, the legal ramifications of any slipups can more than outweigh the cost of encryption programs or specialized apps.

As long as there are security protocols in place, we’ll continue to see a growing role for secure messaging technology in healthcare.

Communication in healthcare was and is always about making services easier and more convenient for both medical staff and patients alike. With the constantly evolving nature of technology, more organizations can expand their services and share information faster than ever before. As long as HIPAA regulations and cybersecurity are in place, the healthcare sector ought to continually evaluate what new high-tech solutions work for them—and what old traditions could still have a place.

Why Accepting Patient Email is a Practical Requirement of the Affordable Care Act

Posted on July 31, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Zachary Landman, M.D., Chief Medical Officer for DoctorBase.
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With the infusion of 30 million patients into the U.S. healthcare system in the coming years, the physician shortage is only going to worsen. In Massachusetts, which has had a similar healthcare legislation enacted since 2006, improvements in healthcare coverage and access are highly associated with physician shortages. Prior to the implementation of the health law in Massachusetts, internal medicine and family practice physicians were in deemed to be in “adequate” supply. Almost immediately following the legislation and in nearly every year since, however, the specialties have listed as “critical.”  While the percent of covered patients in the system has reached upwards of 95%, the result has been that physicians are increasingly difficult to visit. Appointment wait times have soared into weeks and months for some specialties and there has been frustration from both patients and providers regarding access.
MMA workforce 2006 and on
An even direr scenario is expected to play out on a national scale when 55 million people currently without insurance enter the healthcare market through subsidized exchanges. Economists predict that the current shortage of physicians will balloon to 63,000 by 2015 and escalate to 130,600 by 2025, due to both increasing demand and dwindling supply. To add salt the wound, a 2012 Physicians Foundation survey demonstrated that nearly half of the 830,000 doctors in the U.S. are over 50 meaning that as the number of patients swell, the supply of physicians will conversely retract.

Clearly, the way healthcare is provided will need to fundamentally change in order to accommodate the three main tenants of the Patient Protection and Affordable Care Act: Access, Quality, and Cost. One potential way is to simply force physicians and healthcare providers to see more patients in the current set of time or work longer or more frequently to maintain their level of reimbursement. Physician time, however, especially for chronically ill and complex patients has become a relatively “inelastic product.”

Physicians already experience significant rates of burnout, are feeling overworked, and have increased the frequency of patient visits to between and 6 and 9 minutes per encounter. Some studies suggest that trying to reduce this amount of time further may actually cause an increase in costs due to inadequate care, counseling, and increased frequency of complications. I would therefore argue that we have reached a point at which physicians cannot increase the volume and frequency of patient care without a fundamental alteration to the paradigm of healthcare.

Secure email may just be the answer. Securely messaging patients can provide a way to fundamentally alter the type and scope of care provided remotely leading to a maintenance or even reduction in the amount of patient care conducted in the office. The fundamental “if” in this scenario, however, is that it must save physician time. For example, physicians have known the value of hand hygiene in patient care for nearly two centuries, but only recently has widespread adoption been shown in an inpatient setting. What led to the main change? Time.  It takes considerable time to cleanse hands thoroughly between each visit. Only when the practice became a time-neutral or time saving event were physicians keen to alter practice behavior. With the inclusion of quick, visible, and easy to use dispensers outside each patient room, these two principles finally coincided.

It’s the same with email. Many physicians worry that by accepting patient messages, their already inelastic time will continually be stretched, forcing them to work longer and harder for a non-reimbursed activity.  After studying more than 11,000 physicians over three years, I have found that the effective use of secure messaging saves physicians on average 45 minutes per day.

Three hours and forty-five minutes per week. That’s a lot of time. And here’s where it comes from.

#1 – Triage. Physician messages should be directed to a practice manager or physician extender who triages the messages and forwards to the appropriate individual. In our case, we found that nearly two-thirds of “physician” messages could actually be handled by office staff. These messages were typically related to hours, availability, insurance coverage, consultant phone numbers, or other back office functions. Our surgeons found that by including a nurse practitioner or physician assistant could also further reduce the number of “MD-level” messages.

For example, minor concerns regarding wound or incision appearance, follow-up timing, suture removal, or questions from visiting nurses were all routinely and commonly handled by the midlevel provider. The exact nature of each question was handled in accordance with physician comfort and expectations. Ultimately, the number and quality of the messages that were directed to physicians were important, timely, and appropriate which led to fewer ED visits, sameday appointments, and phone calls.

#2 – Mobile. Physicians who are able to read, review, and send messages from their mobile device were able to find a considerable amount of “lost” time in their day. Physicians are constantly on-the-move: between patients, rounding, to the hospital and back, to lunch and back, on the elevator, etc. We found that these “micro-minutes” in each day added considerable effectiveness to mobile messaging. As discussed in #1, physician messages were already screened to be important and relevant and so a timely response is indicated. Physicians were able to answer these questions on-the-fly, leading to further confidence in the system on behalf of the patients and fewer voicemails or messages to return at the end of each day.

#3 – Voicemail. Voice messages are the bane of nearly every provider’s life. They are difficult to understand, slow, and take considerable time to review, record, and answer. Through points #1 and #2, the volume and frequency of voicemails decline considerably. The top competitor to patient portals and secure messaging is the phone. It’s universally understood, easy to use, and an immediate response is obtained. Only when patients have an easy to use portal that they can easily access anywhere (and from any device), send a secure message with confidence that it will be reviewed by the provider in a timely manner, and rewarded with a response will patients choose a new system. That’s exactly what our experience has been and there’s absolutely no reason that this cannot be replicated on a national scale.

Whether secure patient email (and ultimately our healthcare legislation) is a failure or a success relates to the patient and provider experiences and our ability to create a harmonious interplay of accessibility, ease of use, and time.

Zachary Landman, M.D. is the Chief Medical Officer for DoctorBase, a San Francisco mobile health technology company considered to be the leader in mobile cloud-based health messaging services that serves more than ten thousand providers and nearly five million patients. Landman is a former resident surgeon at Harvard Orthopaedics and graduate of University California San Francisco School of Medicine. During his career at the intersection of healthcare, technology, and industry, he has developed interactive online musculoskeletal anatomy modules for medical students, created industry sponsored resident journal clubs, and published numerous peer reviewed articles on imaging and outcomes in spine and orthopaedic surgery. Currently, he is leading the development of DoctorBase’s pioneering patient engagement and automated messaging suite, BlueData.