Direct Messaging an Emerging Fax Replacement

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Solving the problem of communication among healthcare providers is exactly what Inofile is trying to do. Inofile’s cloud-based Kno2 product can leverage the U.S. federally developed Direct Message protocol to facilitate exchange among providers with disparate platforms. Recently, Inofile, which already has a partnership with Kodak Alaris to integrate scanned documents with Kno2, announced a partnership with healthcare patient portal provider Access My Records (AMR).

Direct Messaging is an outgrowth of the U.S. federal’s government’s Direct Project which was launched in 2010. According to the Direct Project’s Overview, “The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.” Its use is also encouraged through federal government reimbursement programs, which offer incentives to providers to meet various “Meaningful Use” standards.

On the most basic level, Direct Messaging is secure e-mailing for healthcare providers. Unfortunately, like most secure e-mail platforms, it can be difficult to use. “We launched Kno2 in February, specifically targeting it toward healthcare specialists whose EHR systems typically don’t offer direct messaging capabilities,” said Therasa Bell, president and CTO of Inofile. “These include student healthcare clinics, rehabilitation facilities, behavioral health specialists, and long-term care facilities.

“Let’s say, for example, you operate a nursing home and you have three or four hospitals knocking on your door that want to give you a Direct Messaging address and log-in information. It can get complicated when you have multiple addresses and portals you have to deal with to retrieve your messages. However, if your facility is utilizing Kno2, you can counter that by giving the hospitals your own Direct Messaging address to use for sending files to you.

“These addresses are designed to replace fax numbers that are often used to initiate workflows in a healthcare facility. So, your billing department might have one direct messaging address, and whoever receives the lab reports, another. One of the Meaningful Use Stage 2 requirements is that 10% of communications with other providers need to go through Direct Messaging. Kno2 offers a means for accomplishing that.”

Integration with a patient portal
The integration with AMR offers another avenue for meeting Stage 2 requirements. “AMR is a certified Meaningful Use Stage 2 patient portal,” said Leonard Tambasco, CEO of Access My Records. “Our technology is designed to automatically create a patient portal utilizing information from Direct Messaging. We are integrated with several HIEs (Health Information Exchanges), EHRs, and now Inofile.

“Basically, when a provider wants to share a record with a patient, they just need to include our Direct Message address as well as the patient information. Under the covers, we will utilize this to create a secure portal for the patient, who we will send an e-mail letting them know their record is available. Through our partnership with Inofile, if the doctor is sending a record to another provider using Kno2, we can offer them the option of making the record available to the patient through our portal.

“One of the requirements of Meaningful Use Stage 2 is that providers be able to show that 50% of their patients can communicate with them through a portal and that 5% are actively using it. We offer a way for the providers to achieve that at no cost.”

AMR’s revenue model is based on charging a small annual fee to patients for a premium version of the portal. “The premium service enables the patient to pull in records from multiple sources,” said Tambasco. “We did a survey and found that 49% of people would be willing to pay $20 a year to have the ability to manage records from multiple locations in a single portal.

“Having to deal with three or four different doctors’ portals can be very challenging (for the same reasons it’s challenging for providers to deal with multiple Direct Messaging portals). Having a centralized record also gives the patient better capabilities for sharing records. This can be especially useful in areas like long-term or home healthcare for elderly patients who might have children that live out of state and want to see what’s going on.”

“The partnership between Inofile, AMR, and Kodak Alaris gives providers the capability to provide a portal of complete records, including paper records, to their patients, in a very automated fashion,” said Bell.

Market coming together
Inofile’s revenue model is for providers to subscribe to Kno2. “There are two sides to the gambit when implementing a Direct Messaging solution,” said Bell. “The first is the financial incentives that are administered through Medicare and Medicaid reimbursements. The second is that it enables a provider to take the full leap into the technology vs. just doing what is necessary. Instead of becoming a victim of the changes brought on by Meaningful Use, they can benefit by making improvements like replacing their faxes.”
“Faxing definitely creates a lot of anxiety in the healthcare community,” added Jody Miller, director, healthcare solutions, Kodak Alaris. “You have to be sure you have the right fax number and the right person is picking up the record on the other end. Kno2 is a great solution that addresses these concerns through Direct Messaging.”

All parties agree, however, that they do not expect patient portals and Direct Messaging to be adopted overnight. “Though we’ve been around and doing this for awhile [AMR was founded in 2005], the technology is finally catching up to our vision,” said Tambasco. “I expect our portal to become more popular as we integrate tools like those developed by Inofile. We are also working on educating the consumers, doctors, and facilities managers to migrate from faxing by helping them understand that sharing information electronically is the future.”

“Initially, we have identified specific markets that are more primed to needing this type of solution and have a higher demand,” added Miller. “Behavioral health, for example, requires a high level of privacy, but most institutions in that area are still utilizing a lot of faxing.”

“In the end, we will be targeting any healthcare provider that is sending documents to other providers and releasing them to patients through traditional methods,” said Bell. “These include faxing, making photocopies, burning images to CDs—in many cases the providers have no other method for achieving distribution. This solution is really targeted at any providers struggling to release information effectively.”

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