1. Attachment 2
AMA dr2dr Secure Messaging Presentation to the Red Deer Information Sessions
May 26, 2016

2. What is secure messaging?
Attachment 2
What is secure messaging?
Simply put, secure messaging (SM) is a solution that enables the exchange of information in a secure fashion  
It is a web-based secure server approach to protect sensitive data that is sent beyond corporate / clinic / office borders
It complies with industry regulations, such as HIA, FOIP, PIPEDA, PIPA, etc. 

3. Why do we need secure messaging?
Attachment 2
Why do we need secure messaging?
Physicians are limited in their ability to electronically communicate patient information with each other in a secure fashion
OIPC, CPSA, CMPA and Alberta Health have voiced significant concerns over insecure e-communication between providers via facsimile, and text messaging
Need to address continuity of care gaps, including those identified in the HQCA report of Dec 19, 2013
Desire to facilitate new modes of coordinated care, enabled by e-communication that is compliant with current privacy legislation and standard of care expectations

4. are secure messaging and secure e-mail the same thing?
Attachment 2
are secure messaging and secure the same thing?
No, secure messaging is not the same as secure
Secure messaging has several important advantages:
No data resides outside of the central server so there is no ability to hack into the information during transport
Confidential and authenticated exchanges can be started immediately. There is no need to install special software or security access devices (e.g. key fobs or fingerprint readers)
It provides a high degree of ‘non-repudiation’, which is proof of the integrity and origin of data as well as highly assured authentication of the identity of the user

5. Attachment 2
Why is the AMA involved?
Need for a simple tool for all physicians to use that complies with required privacy / security practices
Driven by motion passed at the Spring Representatives Forum confirming the value of the AMA engaging in this venture   
Belief that a secure messaging solution will deliver unique value for physicians and their patients
Alignment with AMA business plan goals:
Physicians are supported by an integrated health information system
Physicians have solutions for secure exchange of health information to support improved access and quality of care

6. What are the goals for secure messaging?
Attachment 2
What are the goals for secure messaging?
To provide secure, seamless, timely sharing of medical information between health care providers
To reduce wait times for access to specialists and requests for consultation
To maximize the coordination and continuity of care for Albertans

7. What is the AMA’s secure messaging solution?
Attachment 2
What is the AMA’s secure messaging solution?
The AMA’s secure messaging solution builds on the dr2dr application developed by Microquest (MQ)
AMA is working in partnership with MQ to jointly guide updates and improvements to the application to ensure the initial product adds the most value to Alberta physicians
The long term plan is to include other providers (e.g., pharmacists, NPs) and ultimately patients in the secure messaging solution

8. Reduces Risk Secure Why should I use it? Collaboration
Attachment 2
Why should I use it?
Protects the physician from privacy risks associated with the exchange of the patient’s private medical information
Eliminates telephone tag and disrupted workflow that can occur during follow-up
Provides a central secure mode of electronic communication for physicians and their staff for use in their professional activities
Facilitates management of opinions around the coordination of patient care
Provides a material record of referral communications
Improves collaboration between physicians, and reduces “off the record” patient care communication
Reduces Risk
Protects Privacy
Collaboration
Improved Workflow
Secure

9. Teamwork New e-Codes Useful Address Book Secure
Attachment 2
Why else should I use it?
Provides the basis for a common directory of physicians, including their location, services provided, referral information and clinic contacts
No spam. The secure messaging system is designed to provide a single secure “professional account” for physicians and staff
Costs will be offset by the ability for referring and referred-to physicians to submit the new e-consult fee codes
Shrinks clinic overhead associated with managing faxing and faxing costs
Teamwork
New e-Codes
Reduced Faxing
Coordinated Care
No telephone tag
Useful Address Book
Secure
No Spam

10. Attachment 2
HOW WILL IT BE USED?
Secure messaging can be used for many clinical purposes, but there are three primary functions
Rapid exchange of clinical information
Requesting clinical advice quickly and efficiently
Facilitating electronic consultation and referral
Axe the fax! (and phone)

11. How will it make my life better?
Know when someone's away or not accepting patients
Away notifications are visible before you send a message
No more faxes sitting on the machine for weeks while an office is closed, resulting in staff frustration and significant patient delays
Know your referral has been received and reviewed
All events are timestamped and tracked, including read receipts
No more checking on a previously faxed request only to find out it was not received; and no need for receiving clinics to fax back receipt notifications– a tedious and time consuming process
Know you will get an answer
Request advice and respond to questions when its convenient for you
No more telephone tag while everyone is busy during the day

12. What about privacy and security?
Attachment 2
What about privacy and security?
Protecting privacy and safeguarding clinical information is a cornerstone of the AMA solution and one of the highest priorities
Other than the message generator and authorized receiver(s), no one has access to the messages
Audit details are available, which means that all users and occasions for use will be logged by date and time
System security will be verified through a third-party security audit
Physicians and other users will be authenticated during the onboarding process
Logging into the application will require two-factor authentication (Google Authenticator, SMS code, etc.)

13. Attachment 2
Where is this going?
It’s inevitable that Alberta will eventually move away from faxing to secure messaging.
The AMA would like this to happen sooner rather than later.
To this end, we are encouraging physicians to AXE THE FAX!
Commit to turning off the fax machine for consultation and referral purposes in the next 12 months.

14. How will this work in my clinic?
Attachment 2
How will this work in my clinic?
Doctor to Doctor Messaging
Assistants manage clinic account and include physicians as required.
Dr. Benton, Optima Clinic
Dr. Park, Apex Clinic
Medical Assistant, Optima Clinic
Clinic to Clinic Messaging
Medical Assistants, Apex Clinic
Dr. Park
Dr. Gray
Apex Clinic

15. How will this work in my clinic?
Attachment 2
How will this work in my clinic?
Staff to Staff Messaging
Apex Clinic
Staff
Apex Clinic
Staff
Requires contact permission from other user before you can message (similar to Facebook or Linked-In).
Kim, Optima Clinic
User to User Messaging
John, Apex Clinic

16. How might an e-Consult Request (Advice REQUEST) work in dr2dr?
Receives a notification, logs into dr2dr and reviews the response
Prints conversation as PDF, attaches to EMR patient record and flags for 03.01R billing
Logs into dr2dr and starts a conversation
Enters the name of the Specialist along with the advice request
You will be notified if the specialist is away
You will know when the message is read
Conversation Documented & Billing Facilitated
Advice
Request
Receives a notification from dr2dr with a link to the conversation
Logs into dr2dr and reviews the request
Prepares a relevant response in dr2dr
Sends the response and prints conversation as PDF
Attaches PDF to EMR patient record and flags for 03.01O billing

17. How might a referral Request work in dr2dr?
Enters patient symptoms and physical findings into EMR or paper record
Notifies staff of need to send a referral request
Receives update notification from staff
Reviews referral response from Specialist in EMR or paper record
You will be notified if the clinic is closed
You will know when the message is read
Referral
Request
Referral
Documented
Receives request from physician
Prepares PDF of relevant patient information from EMR or scans from paper record
Logs into dr2dr and starts a conversation
Enters the name of the Specialist clinic and the referral information
Attaches PDF or scanned documents
Can enter patient information as well
Receives response from Specialist clinic in dr2dr and exports PDF
Attaches PDF to EMR patient record or prints
Updates physician on status

18. How might a referral RESPONSE work in dr2dr?
Meets with patient and documents findings and care plan in EMR
Flags for staff to follow-up with referring clinic
Referral
Response
Referral Completed
Receives referral request in dr2dr on the clinic account
Sends response and prints conversation as PDF
Attaches PDF to EMR patient record and schedules appointment
Receives follow-up request from physician
Exports PDF of findings and care plan from EMR
Opens referral conversation in dr2dr, writes note to clinic and attaches PDF
You will be notified if the clinic is closed
You will know when the message is read

19. Software Demonstration
Attachment 2
Software Demonstration

20. Does the solution integrate with EMRs?
Attachment 2
Does the solution integrate with EMRs?
If you have a Healthquest EMR from Microquest, the solution is integrated. Other EMRs, not at the moment.
In the short-term, a proprietary Application Program Interface (API) is available to integrate with other EMRs, should the vendors agree
In the long-term, the AMA is working on a standards-based strategy to federate secure messaging solutions across the different vendors

21. What is this going to cost?
Attachment 2
What is this going to cost?
Subscription-based model
Monthly or yearly subscription
Charged to credit card
All-inclusive, per-physician price
$34.99 per month (that’s less than a Globe and Mail subscription)
Includes
Unlimited staff accounts
Unlimited messaging
Unlimited access
Unlimited upgrades

22. What are the e-consult fee codes?
Requesting Physician (new April 1, 2016)
03.01R - Physician to Physician secure E-Consultation, requesting physician (may not be claimed for transfer of care alone): $32.43
Receiving Physician (already in place)
03.01O - Physician to Physician E-Consultation, consultant: $76.27
May only be claimed when both the referring and  consulting physician exchange communication using a secure / messaging system.

23. What is the timeline for implementing secure messaging?
Attachment 2
What is the timeline for implementing secure messaging?
The timeline is as follows:
May 2016 – Jun 2016
Completion of pilots
Limited production rollout (LPR)
Jul 4, 2016
Full provincial rollout of the AMA dr2dr solution
3 month free trial period
AMA assistance with PIA amendment

24. How can I sign up?
If you are interested in piloting dr2dr or participating in the LPR:
Send an to
Tips for participating in a pilot:
Think about who in your clinic will use dr2dr – the most successful pilots involve both physicians and staff.
Think about who your clinic communicates with – they need to join as well, and we need your help getting them to participate.

25. Questions? Thank You http://www.dr2dr.ca
Attachment 2
Questions? Thank You
Contact us: or
Or send an to: