For Idaho Clinic, Secure Messaging Means HIPAA Compliance and Better Patient Care

John Cotten

With secure messaging, when the nurse or provider sends out a message, the patient
gets it.”

– John Cotten, IT Director,
Family Medicine Residency of Idaho



HIPAA Mandates Secure Electronic Communication

“Starting in February of this year, the next revision of HIPAA came out – the high-tech policy that required any kind of unsecure electronic communication to be encrypted and secure. In other words, you can’t e-mail your patients,” said John Cotten, IT Director at Family Medicine Residency of Idaho (FMRI). In response to this new federal HIPAA requirement, the clinic decided to adopt secure messaging. This technology would enable health care providers and nurses to send medical information like lab results to patients securely by e-mail.

Family Medicine Residency of Idaho, based in Boise, trains medical school graduates to become family physicians. The clinic associated with FMRI is called the Family Medicine Health Center. It provides a range of health services with an emphasis on affordable care for underserved groups.

Another benefit of secure messaging is streamlined patient communication. “Traditionally in a doctor’s office, when lab results come in for a patient, the nurse will try to call up a patient and let them know what the doctor said. And a lot of times they are playing phone tag. With secure messaging, when the nurse or provider sends out a message, the patient gets it. There is no phone tag and no interpretation of what the provider may have said. It’s pretty black and white – here are your results and here is what we recommend,” said Cotten.

GE Centricity Secure Messaging and Patient Portal

Cotten attended a user conference where he previewed the GE Centricity Secure Messaging and Patient Portal solutions. FMRI already used GE Centricity Electronic Medical Record (EMR) in its clinic. The Secure Messaging and Patient Portal solutions, originally developed and sourced from the vendor Kryptiq, were integrated with Centricity EMR and resold under the GE brand. Therefore it would be easy to drop them into the clinic’s existing IT infrastructure.

Cotten presented this solution to the staff. Dr. Justin Glass, one of the doctors at the clinic, happened to be looking at a grant that would cover an IT healthcare solution like this, so they included it in the application. The grant was approved and they went ahead with the deployment. It was a fairly easy sell to management because of the new HIPAA mandate for secure electronic communication.

The clinic configured the system for robust security to ensure the privacy of a patient’s medical record. When a new patient visits, he or she receives a one-time PIN for the portal. The patient goes online and registers, providing some key information to verify their identity. At this point the patient is set up for secure messaging. When a provider wants to send the patient information, such as the results of a cholesterol screen, the patient will receive an e-mail with a link to the portal. The patient clicks on the link, logs in and views the results and recommendations. If a patient does not log in and view the information within a certain number of days, the system alerts the nurse or provider so they can follow up by other means.

“Of course, with any technology, you can do a lot of things with it. What really drives a technology is the policies and procedures that you put in place at your practice,” said Cotten. Providers can control how and if information is presented through secure messaging. They might allow a patient to see a full test result or choose just to say, “Everything is normal. Check back in six months.” Sometimes presenting too much complex information which is subject to interpretation may be confusing. And for sensitive information, they might forego e-mail altogether and contact the patient in person.

Providers also have the option to allow the patients to respond by e-mail, and some at the clinic take advantage of this feature for back-and-forth communication. It facilitates more responsive patient care. “One of our providers is a huge proponent of the system, and he decided to allow some of the patients to respond to him. In one case, a patient responded to an e-mail and said, ‘I’m having pain in my leg…’ The nurse was able to see that information, track down the provider and see if they had taken care of it. If not, find another provider to take a look at it. So from a patient standpoint, it was great patient care,” he said.

Another benefit is that messages become part of a patient’s electronic medical record. The next provider that works with a patient can see the record and know exactly what was communicated. This provides more detail than summary notes.

Managing Change

As with any new healthcare technology, it is challenging to train and encourage people to use it. “A lot of technologies aren’t going to make their jobs easier right off the bat. At first it seems like one more thing to do,” he said. But in the end secure messaging reduces the amount of time spent with unanswered patient calls and playing phone tag. The clinic’s approach is to educate about the benefits and the ultimate goal of the technology. For instance, Cotten sent a message to the staff about how secure messaging will help nurses and providers focus on the patient that is here and in front them while still getting the message to the patient that they have already seen. In another words, a tool for efficiency and better patient care.

The patients themselves were leery at first about giving their e-mail addresses to the clinic because they did not want to be spammed. Once they realized it was so their provider could communicate with them, they became more enthusiastic. Many people prefer to communicate by e-mail today.

Building on the Patient Portal

The clinic uses Centricity Patient Portal only for secure messaging at this time, though it has the potential to do much more. The software can show a patient’s full medical record, including historical details. So FMRI is currently studying how it might build upon this solution in the future. According to Cotten, while the technical aspects are straightforward, the real work is in understanding the impact on providers, nurses and patients and developing appropriate policies and procedures around the technology. It always comes down to the human impact.


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