Direct messaging: Radiological communications at the speed of bytes

The ubiquity of mobile computing across society and throughout healthcare has sharply raised expectations around the speed of communications. Where once referring physicians anticipated waits of several days to receive radiology reports, whether by courier, fax or sometimes even snail mail, they now bristle at lag times measured in hours or even minutes. Increasingly, patients want the same for themselves.

Seeking a way to keep up, some have looked to email or proprietary systems connecting radiologists with referrers. But the latter greatly limits flexibility and email is notoriously security-challenged, hard to authenticate and easily overlooked by recipients.

This helps explain the rise of secure Direct Messaging capabilities as key components in RIS and PACS.

Then, too, Meaningful Use (MU) stage 2 compliance now requires some form of Direct Messaging—and rightly so, believes one industry expert.

“To me, cutting out all the middle steps is really the main intent of meaningful use,” says Vijay Ramanathan, president and CEO of RamSoft, the Toronto-based supplier of healthcare IT software and services, citing getting a fax from the fax machine and into the hands of the referrer as a prime example. “The vision of every imaging facility is to create a report, and have it automatically land within the referring physician’s EMR -- is a vision of where healthcare needs to go.”

Now is the time and Direct Messaging is the way, says Ramanathan. However, he points out, the technology isn’t yet all it could be in times of emergent or critical findings because humans aren’t always as attentive to incoming messages as they sometimes need to be.

“Phone calls and text messages are still needed for such situations,” he says. “Hopefully this will be incorporated into future versions of Direct Messaging.” A lack of protocol for that emergency aspect—including with some kind of automated acknowledgment or receipt capability—was an obvious oversight in the initial rollout of stage 2 of the Medicare EHR Incentive Program, he believes.

The five percent solution

Ramanathan says RamSoft has worked hard and innovated carefully to see that its Certified EHR Technology (CEHRT) equips radiology practices with the tools they need to meet Medicare’s five percent compliance threshold.

That’s the percentage of the practice’s total patient caseload that must be shown to be securely receiving health info—whether directly, as through an online patient portal, or via an authorized representative such as the referring physician.

“What we have done is built in the tools out of the box so that an imaging facility can simply enter in the direct address of the referring provider,” Ramanathan explains. “The moment the radiologist signs off on a report, the report gets automatically sent to the referring provider using Direct Messaging.” No more faxed pages to lose, and no more manual entry into the patient’s EMR—that’s where Direct Messaging automatically sends the information.

RamSoft’s RIS/PACS system, PowerServer, also gives referring docs the ability to use Direct Messages to order radiology exams, creating a reliable “closed loop” system. “When you [the radiologist] receive the order electronically, you receive the complete history and relevant background of the patient along with it,” Ramanathan says. “We feel this reduces error, speeds up the process and minimizes the chances for duplicated exams.”

MU nonparticipants benefit too

The Centers for Medicare and Medicaid Service (CMS) spells out its rationale for calling on incentive-eligible healthcare providers to give patients access to their health information within four business days of it being available to the provider.

“Providing patients an electronic copy of their health information helps them and their caregivers be more engaged in their care,” reads a section on “In addition, when patients move or transfer providers, they have the ability to bring their health information with them, providing care coordination and management.”

Ramanathan says PowerServer facilitates direct communications between radiologists and patients by giving the patients their own messaging addresses on, for example, personal health record systems such as Microsoft HealthVault. On such widely available systems, they can see all medical records submitted by providers using CEHRT.

RamSoft is offering its Direct Messaging function not only to its PowerServer RIS/PACS customers but also its PACS customers as well. “Some of our radiologist customers are not eligible for the Meaningful Use program, and others choose to be exempted from Meaningful Use,” he explains. “Just because someone chooses not to participate in Meaningful Use does not mean that they cannot benefit from Direct Messaging. We are offering all of our customers the tools to participate in enhanced communication via Direct Messaging along with everyone else in healthcare.”

PACS-only customers can add the module, which is a standard part of RamSoft’s latest version of PowerServer, 6.0, by signing up for a paid monthly subscription that includes a mailbox and technical support to set it up and maintain it.

Security comes courtesy of RamSoft’s use of transport layer security (TLS), the standard across the Internet. “The nice thing with modern TLS implementations is that the security algorithms are complicated enough that they prevent any easy tampering with the communications,” Ramanathan explains. “Plus, when you incorporate a universal standard, you find it a whole lot easier to receive the latest updates and patches that apply across all industries, not just healthcare.”

Great expectations, fulfilled

Asked his opinion on the possibility that CMS may come out with yet another version of CEHRT this year, Ramanathan doesn’t hedge. “I think it’s a double-edged sword for radiology practices and imaging IT vendors,” he says. “The positive aspect of it is that the standards will keep evolving, making the communications loop tighter and tighter, in line with the core aims of meaningful use. The negative aspect of it is that now, in 2015, healthcare facilities are really still just adopting solutions that comply with the 2014 standard. It’s quite important, in my mind, to give providers at least three years to adopt a standard.”

Harking back to the explosive growth of mobile computing over the past several years, Ramanathan says PowerServer 6.0 contains a component the company is calling RapidResults. It’s essentially a software module that allows physicians to access images and reports on any kind of device, including smartphones and tablets.

“Timeliness and accessibility of information is really the name of the game. In fact it’s the whole idea behind Meaningful Use,” concludes Ramanathan. “This is why we have taken great pains to make sure we’re giving physicians access to the information they need to care for their patients—from any site, using any device and with the speed they have come to expect.