Health care review spotlights valuable new tool

The recent 90-day review of the Military Healthcare System found it “comparable in access, quality and safety to average private-sector health care,” Defense Secretary Chuck Hagel told a press conference last week.

That was disappointing to hear for a medical system that, for decades, has described itself as overall excellent and among the best in the country.

“Overall, MHS performance mirrors what we see in the private sector: a good deal of mediocrity, pockets of excellence and some serious gaps,” wrote Janet M. Corrigan of the Dartmouth Institute for Health Policy and Clinical Practice, one of the outside experts who helped with the review.

The report and appendix run more than 700 pages including 10 pages just to list and define a sea of acronyms associated military health care. But the report also turns a spotlight on a new tool that patients, staff and outside health experts agree is improving access to care and perhaps quality too: a secure messaging system between patients and military physicians.

The report endorses it, urging full implementation and careful monitoring to ensure that it achieves its potential for beneficiaries and in support of the military’s “patient-centered medical home” concept of care.

The concept has transformed the direct care system, starting in 2010, putting at its center beneficiaries enrolled in primary care clinics, assigned to named doctors who are supported by small professional staffs or teams.

And eyeing ways to enhance the relationship of physician and patient, and to widen access, the military by August 2010 took its first step toward secure messaging, selecting a commercial product called RelayHealth.

The Navy was first to test it. Positive results led the Army and Air Force to buy in. By January this year, RelayHealth became operational at Aviano Air Base, Italy, the last of 440 primary care practices provided secure messaging.

Air Force calls it MyCare. Soldiers and their families know it as the Army Secure Messaging System. Navy still calls it RelayHealth. With a new contract due in 2016, one goal will be to rebrand under a single name.

As of June, more than a million beneficiaries enrolled in direct care had registered for secure messaging, up 57 percent from last year. However, only 120,000 a month log in to initiate contact with their physicians.

“We think that is low,” said Regina M. Julian, chief of patient-centered medical home primary care for the Defense Health Agency.

Given the new MHS review endorsement, and positive feedback from both patients and providers, the Army, Navy and Air Force are developing a tri-service promotion campaign for secure messaging, Julian said.

Those trading emails with their doctors appreciate the ease of access, the speed of response and the convenience. Survey data show 97 percent of beneficiaries who use secure messaging are satisfied, and 86 percent say it likely saved them from making clinic appointments or visiting urgent care. So it frees up appointments that other patients can use, Julian said.

Cost avoidance is another benefit. A clinic visit costs the military, on average, $77, she said. If just 9 percent of message users replace clinic visits with email exchanges, the costs avoided would cover the annual $8.5 million cost of the RelayHealth contract.

The larger goal, however, is that lowered demand for face-to-face appointments by some will allow more to get military care or faster care.

“People who have it, and whose doctors use it, love it,” said Joyce Wessel Raezer, executive director of National Military Family Association, when asked to assess the popularity of doctor-patient messaging.

“If they can handle something with the doctor over secure email, such as ‘Your test results are normal’ or ‘I want you to take this medication for a while longer,’ that frees up appointments [and] reduces the hassle.”

But Raezer said availability of secure email across military health care “is still inconsistent.” It can vary between hospitals, clinics or even physicians, she said, “with some doctors just choosing not to play.”

“We have a few holdouts in a couple areas in primary care [and] providers who aren’t necessarily using it as robustly as he or she could,” Julian said. The goal achieved in January was secure messaging installed at all primary care clinics. Some specialty clinics will begin to get it soon. But Julian said she read many comments from beneficiaries made during the review, saying they wished all of their providers used secure messaging.

One irritant for staff is that RelayHealth isn’t integrated with AHLTA, the military’s electronic health record system. “That means they have to cut-and-paste the encounter into AHLTA [to] have a good virtual lifetime record of care,” Julian said. “That caused our people a lot of angst initially.”

Army found a way to automate the cutting and pasting of secure messaging into AHLTA encounter notes. Every service now uses it.

“This is much more efficient than the old way of hand-typing an entire telephone encounter as phone calls come in,” Julian said.

Some doctors also have been concerned that secure emails lengthen their workdays or lower their opportunity to accumulate “relative value units,” a measure of work product. A face-to-face visit typically counts as 2.4 RVUs whereas answering an email might not count for any, Julian said.

So a tri-service advisory board on primary care has approved a new workday template that will build into physician daily schedules 80 minutes of virtual appointment periods to answer email. But the number of patients empaneled to each primary care physician also is to increase in light of secure messaging. They soon could have responsibility for 1,100 enrollees apiece versus current patient panels that top out at about 950.

During town hall meetings at seven military bases during the MHS review, which were arranged to get some direct feedback from beneficiaries and providers, secure messaging was roundly praised by those able to use it.

Julian recalled her own recent meeting with military and veterans advocacy groups where she briefed on secure messaging. “Two gentlemen who self-identified as being well over age of 65,” she said, pulled out smartphones to show her messages from their primary care managers.

“Both of them said secure messaging was the best thing they had experienced in 40-plus years of military medical care,” Julian said.

To comment, send e-mail to milupdate@aol.com or write to Military Update, P.O. Box 231111, Centreville, VA, 20120-1111

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Local News

Employees and patrons of the Everett Mall signed a timeline mural that traces the history of the 51-year-old indoor mall that was once considered the premier place to go shopping in the city. Thursday, March 20, 2025 (Aaron Kennedy / The Herald)
Mall mural offers nostalgic trip into the past

Past and present Everett Mall employees joined customers Thursday to view an artistic timeline of the once popular shopping mecca.

Edmonds Mayor Mike Rosen gives his State of the City address on Thursday, March 20 in Edmonds, Washington. (Will Geschke / The Herald)
Edmonds mayor talks budget at 2025 State of the City

Mayor Mike Rosen discussed the city’s deficit and highlights from his first year in office.

Daron Johnson, who runs Snohomish County Scanner, stands next to his scanner setup on Tuesday, April 1 in Everett, Washington. (Will Geschke / The Herald)
Snohomish County law enforcement to encrypt police airwaves

The plan for civilian police scanners to go dark pushed a host to shut down his popular breaking news feed.

Richie Gabriel, 1, jumps off the bottom of the slide as Matthew Gabriel looks down at him from the play structure at Hummingbird Hill Park on Monday, March 31, 2025 in Edmonds, Washington. (Olivia Vanni / The Herald)
Edmonds residents show up for Hummingbird Hill Park, Frances Anderson Center

After a two-and-a-half hour public comment session, the council tabled its votes for the two comprehensive plan amendments.

Students Haddie Shorb, 9, left, and brother Elden Shorb, 11, right, lead the ground breaking at Jackson Elementary School on Tuesday, April 1, 2025 in Everett, Washington. (Olivia Vanni / The Herald)
Everett district breaks ground on Jackson Elementary replacement

The $54 million project will completely replace the aging elementary school. Students are set to move in by the 2026-27 school year.

Logo for news use featuring Snohomish County, Washington. 220118
Another positive measles case identified in Snohomish County

The case was identified in an infant who likely contracted measles while traveling, the county health department said.

A Tesla drives along 41st Street on Wednesday, March 26, 2025 in Everett, Washington. (Olivia Vanni / The Herald)
Washington faces uncertain future of Clean Air Act regulations

The Trump administration’s attempt to roll back numerous vehicle pollution standards has left states wondering what’s next.

A person walks through the lot at Kia of Everett shopping for a car on Tuesday, April 1, 2025 in Everett, Washington. (Olivia Vanni / The Herald)
‘The tariffs made me do it’: Customers move fast on cars

At one Everett dealership, customers move fast on cars ahead of Wednesday’s expected announcement on tariffs.

Public’s help needed to find missing Arlington man

The 21-year-old left the house Sunday night without his shoes, cell phone or a jacket, and was reported missing the following morning.

Will Geschke / The Herald
The Marysville Tulalip Campus on the Tulalip Reservation, where Legacy High School is located.
Marysville board votes to keep Legacy High at current location

The move rolls back a decision the school board made in January to move the alternative high school at the start of next school year.

The former Marysville City Hall building along State Avenue on Tuesday, April 30, 2024 in Marysville, Washington. (Olivia Vanni / The Herald)
City of Marysville, school board amend property exchange

The city will relocate its public works facility to the district’s current headquarters, which will move to the former City Hall.

Snohomish County Elections employees Alice Salcido, left and Joseph Rzeckowski, right, pull full bins of ballots from the Snohomish County Campus ballot drop box on Monday, Nov. 4, 2024 in Everett, Washington. (Olivia Vanni / The Herald)
County to mail ballots for Edmonds, Brier elections

Registered voters should receive their ballots by April 9 for the April 22 special election.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.