Secure Direct Messaging capabilities have become must-have components for many if not most users of RIS and PACS. While Meaningful Use’s requirements around the technology have spurred much of the adoption, Direct Messaging has grown in popularity by its own merits.

In a conversation with imagingBiz last winter, Vijay Ramanathan, president and CEO of RamSoft, the Toronto-based supplier of healthcare IT software and services, described the development. “The vision of every imaging facility is to create a report and have it automatically land within the referring physician’s EMR,” he said. Cutting out the middle steps—faxes, manual EMR entries and so on—“is really the main intent of Meaningful Use,” he said, adding that such efficiency is “where healthcare needs to go.”

This summer, we interviewed Luke Bideaux, RamSoft clinical applications manager, for updates and insights in light of the company’s recent release of PowerServer 6.0 and its ongoing work with Direct Messaging. Here are excerpts from the conversation.

Q: Could you begin with a quick recap of the basics of Direct Messaging technology?

Bideaux: Sure. With Direct Messaging, physicians can discuss and exchange patient information with one another in a secure manner. For example, if a referring physician has questions on a study a patient had, they can easily send a message from their EHR/EMR to the radiologist directly into the radiologist’s RIS/PACS. The referring provider also can send additional patient information with Consolidated-Clinical Document Architecture (C-CDA) and vice versa with just a click of a button. All of the data is encrypted.

Q: How have communications needs changed for radiologists and what are the factors driving that change?

Bideaux: A new generation of tech-savvy healthcare professionals is driving the need for more efficient communication tools. Now, more than ever, radiologists must be connected. Referring physicians demand more from their radiologists these days, besides just the radiology report. Dodging penalties and acquiring incentive payments have increased adoption of CEHRT from the referring physicians over the past few years.

Numerous Meaningful Use objectives, such as those related to computerized physician order entry (CPOE) and image access, are driving a more connected healthcare environment, and now, in Stage 2, radiology is involved more than ever. This requires radiologists to get on board with the necessary technology or risk getting thrown to the wayside by their referring community.

Q: Dodging, getting thrown—that’s vivid language. Have you encountered resistance?

Bideaux: Well, there is a hardship exemption for radiologists to avoid doing Meaningful Use. So one option is to simply do nothing and attempt to do business as usual rather than invest in an upgrade or a new EHR. So, we do see a lot of, “Why should I pour money into something extra when things are fine the way they are?”

When you look at what’s incentivizing radiologists to adopt Direct Messaging, pleasing their referring community is the main driving force.  Radiologists and referring physicians who are already doing Meaningful Use should have Direct Messaging already built into their EHRs, and those who are not participating in Meaningful Use are adding Direct Messaging onto their existing systems as an add-on.  When referring physicians come to their radiology providers and begin demanding Direct Messaging, there’s typically not much resistance on behalf of those radiologists to get on board. 

Referring physicians are demanding Direct Messaging for both the inherent workflow efficiencies as well as meeting their own Meaningful Use requirements.  CPOE and Image Access are two objectives that referring physicians need the help of their radiology providers to achieve. Radiology providers who are able to receive radiology orders via CPOE and provide access to images via the referring physician’s EHR will help those referring physicians not only meet those requirements; they also will be the ones continuing to get referrals rather than the non-adopters who will be on the outside looking in.

Q: What are some of the communications problems among radiologists that RamSoft’s 2014 CEHRT, PowerServer 6.0, addresses?

Bideaux: It has addressed the issue of not having enough clinical data to provide the most accurate diagnosis possible for the patient. It helps eliminate delays in patient treatments by having everything needed at the provider’s fingertips. It saves time by eliminating duplicate data entry, so there is no need to continuously re-enter patient information from system to system.

The RamSoft team was very enthusiastic in developing these tools for the 2014 Meaningful Use requirements because this work improves our product and the quality of patient care for our clients.

Q: Could you talk a bit about what went into the development process?

Bideaux: We dedicated certain resources from our development department to, first of all, understand the ONC’s requirements for vendors to satisfy all of the criteria. Naturally, developers are very familiar with the idea of following certain specifications to the "t" and writing the software to meet the specifications. That enabled us to acquire our 2014 certification for stage 1 and stage 2.

From a clinical perspective, we dedicated certain resources from our clinical applications department to go out and work with our client base. A lot of us here have technologist backgrounds or PACS administrator backgrounds, and we drew from that experience to modify the specifications, so that we not only meet the requirements, but also develop these modules in a way that is going to make a useful impact in a clinical environment. The tools need to be easy to use and intuitive in order to really improve the efficiency of operations for the clients who use our software.

Q: Beyond MU compliance, how will Direct Messaging between radiologists and referrers be enhanced with the new release?

Bideaux: From a clinical perspective, radiologists and referring physicians will enjoy more complete, efficient and accessible patient information. Direct Messaging also works on our zero-download RapidResults application, so providers will be able to send messages to each other from literally anywhere, on virtually any device.

Q: Would you describe a real-world scenario of this in action?   

Bideaux: Let’s say you are a primary care doctor, and you’re moving around in a hospital or a clinic environment. Either way, you are mobile. You have a smartphone or tablet, and you’re with a patient reviewing his images and reports. You want, right there on the spot, to message your radiology provider regarding the study. With RapidResults, you can do all of that from your mobile device. It’s all written in HTML5, so it’s just as simple as logging on, and you’re instantly connected.

Q: There have been a lot of high-profile security breaches this year. How have you addressed security concerns?

Bideaux: RamSoft utilizes a Direct Issuing Certificate Authority that supports the Secure/Multipurpose Internet Mail Extensions (S/MIME) message signatures and message encryption for the purpose of achieving privacy, authentication, message integrity and non-repudiation. Users should feel confident knowing that the content of every direct message sent is secure and fully HIPAA-compliant.

Q: How important are radiologist communications to RamSoft RIS/PACS/EHR software development?

Bideaux: Improving the radiologist experience has always been at the core of RamSoft’s development efforts, and facilitating seamless communication tools has been at the forefront of our software for years. In recent years, we have seen an increase in the demand for referring physicians to work out of their own EHRs to access radiology reports, images and other radiology-related information.

We are convinced that this trend will only increase as health systems get larger, dependence on large EHRs increases and the demand for radiology providers to connect with the referrer’s EHR skyrockets.

Q: Are there any other aspects of the technology that you’d like to mention?

Bideaux: Yes, it’s important to know that we can convert received radiology orders into RIS appointments with an electronic referral as an attachment. We can also automatically distribute radiology reports via Direct Messaging to the referring physician’s EHR.

Q: We have seen radiology as a profession attempt to become more visible to the patient. Is this something you keep in mind as you develop and refine your products and services?

Bideaux: Yes, and with the foundation that we have now, we do have the capability to expand our patient-level communication. We also offer, with our software and our Meaningful Use module, electronic patient records by means of Microsoft HealthVault. Patients can go there and review all of their health information, including their radiology reports. That is all securely handled as well.

Direct messaging is not the transfer method for that information, but everything we do has improving patient care in mind. That’s always the ultimate goal. To be able to improve the quality of patient care, we have to focus on the things that are going to make our clinicians more effective and more efficient. Communication is always right there at the top in terms of measuring effectiveness, not just in healthcare but in every industry.

What we’re doing is taking a big step in the right direction for communication. We’re bringing all of this disparate health information together and providing a lot better accessibility and completeness to the records that each clinician is able to access.

For providers, trying to do all of that by yourself in a little box, especially in these days of holding the line on costs, is really not feasible. The government is definitely making it harder and harder to operate as a standalone silo. There are incentives to collaborate and penalties for not doing so. Things are either going to get better or worse, depending on which side of the fence you’re on. We want to make sure that our clients are on the right side of that fence.