Dr. Luo is associate clinical professor in the Department of Psychiatry and Biobehavioral Sciences at the University of California in Los Angeles; past president of the American Association for Technology in Psychiatry (AATP) in New York City; and Gores Informatics Advocacy chair at the AATP.

Disclosure: Dr. Luo reports no affiliation with or financial interest in any organization that may pose a conflict of interest.


 

Technology has enabled mental health practitioners to have greater reach to their patients with telemedicine, and electronic prescribing systems have made transcribing errors a faint memory. However, the day-to-day practice of medicine still requires many other elements in the office for communication and documentation such as e-mail, scheduling, transcription, and voicemail. Some practices can afford to hire staff full time, whereas others consider part-time and even off-site assistants for cost savings. With today’s more technologically savvy patients who look up their physicians online and review medical information, it is not a far stretch that these same tech-savvy patients want that same convenience with online scheduling and one stop for messages. This month’s column reviews these virtual assistants which can enhance the clinician’s busy practice and save time.


Online Scheduling

It is highly unlikely that a private practice would use an online calendar such as Google Calendar1 to schedule appointments for the office. Although it is free and has options whereby Gmail users can share their calendars, it clearly lacks privacy features and the ability to set appointments. Many electronic health record systems such as Practice Fusion2 and Valant Electronic Medical Record3 offer appointment scheduling entered by providers and administrative staff in realtime on these Web-based systems, typically at the end of an appointment. However, a true time saver would be if patients could independently reschedule or schedule their appointments directly online without staff intervention. Companies such as SCI Solutions’ Schedule Maximizer,4 Appointment Quest,5 NetAppointment,6 and Appointment-Plus7 offer these services. Patients are able to see available times only and do not see appointment times taken by other patients. They can log in at any time and set up how they want to be reminded, such as via e-mail or phone. In addition, these systems can be set up to collect co-pays and other information in advance of the appointment. Many of these systems can export the schedule into Microsoft Outlook or a spreadsheet for offline backup. Finally, many of these systems also provide analysis, which may help providers determine which patients cancel the most often or who change their appointments frequently.

 

Secure Communication

Many healthcare providers utilize e-mail for communication with patients, usually initiated by the patient who finds it convenient for asking for refills or a change an appointment. The 1998 American Medical Informatics Association Guidelines for the Clinical Use of Electronic Mail with Patients recognized that encryption was not widely available, user friendly, or practical, and therefore did not demand its use.8 Although encryption availability in standard e-mail client software still has not become user friendly or practical, there are alternative solutions to ensure that electronic communication between patients and providers is secure enough to maintain privacy. LuxSci9 and 4SecureMail10 are companies that provides Health Insurance Portability and Accountability Act-compliant e-mail solutions. One method is using a a secured ‘escrow’ account where patients and providers go online via an SSL connection to the company e-mail server providing a secured portal as all messages are left there. Alternatively, both companies also offer secured SMTP (simple mail transfer protocol) relaying services so that providers can use an e-mail client such as Microsoft Outlook or Eudora to send encrypted e-mail. RelayHealth provides a secure communication portal where patients can leave specific messages for providers, such as request/cancel appointment, request a lab/test result, request medication refills, send a note to the doctor/office staff, or request a referral.11 It structures the patient queries via specific messaging templates that have fields such as pharmacy and medication request, so that the prescription can be sent via fax directly in the system on the SureScript network. RelayHealth also offers webVisits, where patients can enter specific queries or consultations on non-urgent topics, which are responded to by providers using a template-based reply system to save time. For offices with a single provider and on a limited budget, TeleHealth Connect provides a free secure communication system for providers with their patients using the basic account.12 TeleHealth Connect has partnered with Microsoft’s HealthVault, a personal health record system, so that all secure messages and attachments are stored in HealthVault. These messages are controlled by the patient, who can delete and discontinue them at any time. Patients always use the TeleHealth Connect system at no cost, whether the healthcare provider is in solo practice or part of an enterprise system.

Although there may be some reluctance on the part of patients to entrust their medical information with a large company such as Microsoft, HealthVault was launched in 2007 and was designed to balance privacy features with management of health information. In particular, the privacy protections in HealthVault reflect the privacy principles of the Coalition for Patient Privacy,13 a non-profit health privacy watchdog organization founded in 2004 by Debora C. Peel, MD. Encouraging patients to set up a free account with HealthVault has benefits for healthcare providers as many Internet-based healthcare applications and medical devices interface with HealthVault and store information there. For example, Quest Diagnostics,14 a large national laboratory testing company, can export patient test results directly from their doctor into their HealthVault account upon authorization. In this way, patients can have a copy of their blood tests after reviewing them in the office with their physician. If the physician is using the National ERx initiative software from Allscripts ePrescribe,15 patients can request to have an electronic record of medications, conditions, and allergy information be placed into their HealthVault account. Similarly, patients can have their pharmacy records from CVS16 and Walgreens17 linked to their HealthVault account for management. Personal health records were primarily touted as a way for patients to keep track of their own health information; however, a secondary benefit is that more accurate health information is organized and now available to any physician, which will save valuable time spent sending for records or contacting pharmacies for medication names, dosages, and frequencies.

 

Central Communication

Many physicians carry a pager, check messages on an office voicemail system, receive fax requests for medication refills, and use e-mail for communication. All theses systems are enough to make anyone feel like they need several heads like the hyrda beast to keep up with these systems. A variety of products help tame the information overload in different ways. Google Voice18 provides one phone number to manage all the clinician’s phones. This number is linked to the clinician’s account, not a physical location or a particular device. Voicemail can be heard by dialing in or on the computer while online. Voicemail can even be transcribed and sent either via e-mail or text messages. The Google Voice number can be used to route phone calls to any phone number such as a mobile phone or office phone. One very handy feature is the ability to use a Google Voice number as the caller ID, which preserves the privacy of the mobile device. Innoport19 offers hosted unified communication solutions, which provides similar features as Google Voice, but it includes a hosted PBX that provides directory assistance, customizable greetings, and Internet fax to e-mail as well as e-mail to fax. YouMail20 provides access to voice mail either on phone, online, or via e-mail attachment. It also provides voicemail filtering to avoid telemarketing as well as smart greetings to distinguish between family, friends, and patients. Jott21 offers similar services for voicemail, but also allows voice dictation to send notes and to-dos, set reminders and appointments, send e-mail and text messages, and post to blogs, all with a phone call. These time-saving solutions all work by keeping it simple to respond to different mechanisms of received messages.

 

Conclusion

Although the technologies described above at first seem obvious and mundane, the minutes of time saving and decreased hassle all add up. Unfortunately, one system does not provide everything needed for the office practice, akin to how finding the perfect electronic health record system today is very much an exercise in frustration. There are times when a jack-of-all-trades or unified solution is better than numerous expert or customized system solutions; however, many of these virtual assistants do add up to save clinicians time and frustration. Why not employ one of them now?  PP

 

References

1.    Google Calendar. Available at: http://calendar.google.com. Accessed March 4, 2010.
2.    Practice Fusion. Available at: www.practicefusion.com. Accessed March 4, 2010.
3.    Valant EMR. Available at: www.valentmed.com. Accessed March 4, 2010.
4.    SCI Solutions. Available at: www.scisolutions.com/solutions/schedule-maximizer.asp. Accessed March 4, 2010.
5.    Appointment Quest. Available at: www.appointmentquest.com. Accessed March 4, 2010.
6.    NetAppointment. Available at: www.netappointment.com. Accessed March 4, 2010.
7.    Appointment-Plus. Available at: www.appointment-plus.com. Accessed March 4, 2010.
8.     Kane B, Sands DZ. Guidelines for the clinical use of electronic mail with patients. The AMIA Internet Working Group, Task Force on Guidelines for the Use of Clinic-Patient Electronic Mail. J Am Med Inform Assoc. 1998;5(1):104-111.
9.    LuxSci. Available at: www.luxsci.com. Accessed March 5, 2010.
10.    4SecureMail. Available at: www.4securemail.com. Accessed March 5, 2010.
11.    RelayHealth. Available at: www.relayhealth.com. Accessed March 5, 2010.
12.    TeleHealth Connect. Available at: www.telehealthconnect.com. Accessed March 7, 2010.
13.    Patient Privacy Rights Foundation. Available at: http://patientprivacyrights.org. Accessed March 7, 2010.
14.     Quest Diagnostics Partnership. Available at: www.healthvault.com/websites/QuestDiagnostics-MyCare360.html. Accessed March 7, 2010.
15.     Allscripts ePrescribe Partnership. Available at: www.healthvault.com/websites/allscripts-AllscriptsePrescribe.html. Accessed March 7, 2010.
16.     CVS Partnership. Available at: www.healthvault.com/websites/CVSPharmacy-CVSPharmacy.html. Accessed March 7, 2010.
17.     Walgreen Partnership. Available at: www.healthvault.com/websites/Walgreens-Walgreens.html. Accessed March 7, 2010.
18.    Google Voice. Available at: voice.google.com. Accessed March 9, 2010.
19.    Innoport. Available at: www.innoport.com. Accessed March 9, 2010.
20.    YouMail. Available at: www.youmail.com. Accessed March 9, 2010.
21.    Jott. Available at: www.jott.com. Accessed March 9, 2010.

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