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POSTS BY TAG | Secure Messaging


Many health care organizations have already deployed secure email software but don't realize that their providers are still sending sensitive patient information to each other via SMS text messages. Text messaging is king, especially in the hospital setting where highly mobile physicians need fast answers about the sickest patients and aren't always in front of a computer.

But secure text messaging solutions aren't all the same. SMS text messaging is very easy to use and everyone already has it installed on their phone, so if you expect a secure replacement to get widespread adoption, the secure texting software actually has to be better than SMS in some way. In this series, I will share some areas of opportunity that we've discovered at pMD while helping our customers deploy our secure text messaging software. If you're in the market for something like this, I hope you find this series informative and that it inspires you to seek the best solution on the market for your needs!

This scenario may sound familiar: you send someone an SMS text message about something important and you're waiting to hear back. Some time later, you realize that you haven't heard back. Maybe the recipient didn't get your message. You decide to open up your text messaging app, but it doesn't say one way or the other. You start to wonder if you should send another text message, or maybe even call the other person. Then something distracts you and you lose the thread. It could be a while before you think to check again, and your phone won't bring the unread message to your attention. The recipient might not have received your message, or might not have noticed when it arrived; either way, the thread of communication stopped there.

Most secure text messaging software on the market actually makes this problem more severe. Unlike SMS text messages, you need a data signal (WiFi or cellular data) in order to get notified about a secure text message that was sent to you. Most hospitals are riddled with dead zones where you can't find out right away that a secure text message was sent to you because there isn't enough data signal for push notifications to reach you. This is dangerous in the hospital setting where providers are sending time-sensitive clinical information and they expect it to work like SMS.

To solve this problem, seek a solution that will automatically follow up on your behalf. Replaying the scenario described above, if the recipient hasn't received or hasn't read your message after a period of time, the software should automatically follow up with an SMS text message reminding them that they have a secure text message from you. Even if they don't have a data signal, they can get this text message reminder - you don't have to remember to text them to see if they got your first message because the system does it for you.

Ideally the software should follow up again, this time with an automated voice call, if the recipient still hasn't read your message in pMD after even more time has passed. Though more intrusive than an SMS, the voice call is appropriate for time-sensitive messages like a stat consult - in other words, situations where you yourself would call the recipient if you didn't get a quick reply... if you remembered to. Automation makes this consistent and saves you the trouble.

If the recipient got distracted or was unreachable and never read your message, at a certain point you want to know that. Most secure and non-secure messaging systems require you to actively keep checking the status of the message to see if it was read. You should look for a system that instead closes the loop by actively letting you know that the recipient hasn't read it yet after more time elapsed. This way you don't have to check the status of the message and you can't forget to check it.

Putting all these reminders together, you should seek a secure text messaging solution that acts like a concierge or assistant for your communication. It should follow up for you, using different types of reminders that don't rely on data and that become increasingly hard to ignore. Finally, if your message still wasn't read, the system should let you know so you can try to reach the person a different way, or find someone else to contact. That way if your message wasn't read, you'll be the first to know.

These follow up actions shouldn't be needed most of the time, but when they kick in, you’ll be relieved to know that your message isn't just sitting out there in limbo. Hospital-based physicians can find great peace of mind in knowing that their messages are not only secure, but also persistent.
We released our secure text messaging product last week and our secure messaging video is finally complete! In this video we exemplify the importance of secure messaging and the consequences associated with underestimating its relevance.

It has been a few months since the pMD team and Belljar first started brainstorming ideas for the video. We had many long discussions as to what we wanted it to look like, what we wanted it to sound like, and even what we wanted it to feel like. There was a lot of blood, sweat, and tears that went into this messaging video, but good tears, not bad ones.

Throughout our creation process, there were plenty of ideas that led to hours of meetings and edits. At one point in our process, we had a lengthy conversation about our character, Dr. Fast Thumbs’, interaction with his patient.

There were R-rated variations of the interaction showing the patient in a vulnerable position that made any woman and most men who saw it cringe. We decided that we needed to tone it a down and were presented with a new version. But with the new G-rated version, we barely saw the patient, and there wasn’t much context as to the “sensitive patient information” that was being shared by Dr. Fast Thumbs. After another discussion, we finalized the scene somewhere between a PG and PG-13 rating, showing the patient head on, but above the patient's knees.

Whether it was the style of background music or the actions of our characters, we broke down each others’ ideas and created a cohesive and comprehensive story that explains what secure messaging means for health care practices. Not everyone may understand the significance of secure messaging, but to people in the medical field, they either know how serious it is, or they will after watching our segment. By sending unencrypted messages, you open yourself up to the possibilities of fines, lawsuits, and even jail time.

We hope that our secure text messaging video helps the medical world understand why encryption and HIPAA compliance is important. Without further ado, enjoy the video!


We’re all excited to move past this frigid, never-ending winter and greet the warmer weather of spring. For me, this season means doing some spring cleaning, and this past weekend, my wife and I spent time on the yard that we have neglected over the past several months. I tend to procrastinate doing the initial work, but I always enjoy seeing the positive transformation of what the yard looks like after our cleaning.

Likewise, it's a also good time to do some spring cleaning around your practice, hospital, or organization. Every year it seems to be the same story: find additional ways to improve revenue and cut costs. In my last post, I discussed questions that you should be asking when evaluating new technology and charge capture software for your organization. Below, I've outlined three areas for your spring cleaning checklist:

1. What is Your Charge Lag for Hospital Billing? The length of time from the date of service to when your billers submit claims can often be days and even months, and some hospital charges may not make it to the office at all. This is an area that proves to be challenging because physicians are extremely busy and moving from one location to the next while being asked to keep up with pieces of paper, index cards, or excel spreadsheets that are the lifeline of the practice's revenue. Reducing your charge lag can be the difference of getting paid faster and earning interest on your revenue. And with some payer deadlines, it can be the difference of getting paid at all.

2. What is Your ICD-10 Plan and Strategy? We all received some extra breathing room on this massive change in health care due to the recent legislation that delayed the implementation of ICD-10 until 2015. However, the well-run organizations and practices that I've spoken with are planning on using the extra time to successfully implement their plans, educate physicians and staff, and move forward with leveraging the extra time to practice their ICD-10 roll-out. This strategy has allowed them to not be caught off guard and rushed, which was a recurring theme with many of the practices I spoke with earlier this year.

3. Are your Physicians and Staff Really HIPAA Compliant? I would conservatively say that eight out of 10 practices and organizations that I speak with recognize that their physicians and staff are sending SMS / text messages that include a form of PHI that could result in a HIPAA compliance violation. Many look the other way or laugh this off stating they cannot get their physicians to stop; however, it's scary to think about what information may be sent through non-secure channels when I think about myself as the patient. The reality to every physician owner, CFO, and compliance officer is that you could be fined up to $50,000 for one HIPAA violation. There is certainly nothing funny about that. Implementing secure, easy-to-use software can assist in eliminating HIPAA violations and instances of non-compliance.

As you study these three areas of your practice, you should be able to uncover opportunities that can have an immediate positive impact and that will put you in a strong position heading into 2015.

In my next post, I'll be sharing ideas of how charge capture can be part of your strategy to improve charge lag, ICD-10 planning, and HIPAA compliance.

Actor John Getz.

Narration can make or break a video. There are many narrative voices to choose from, but it's a matter of finding the perfect one to fit your videos' theme and tone. With our secure messaging video script in hand, we set out to find the perfect voice. We asked ourselves a few questions: Did we want the voice of God? Did we want it cutesy and fun? Did we want it playful and magnificent? No, none of the above seemed to fit - we needed something else.


With the help of Belljar, we found our inspiration in classic, 1950s, instructional videos. The tone of the narrator is friendly, and the videos teach a lesson to the viewer, much like we are doing in our secure messaging video. Now that we had our tone, we needed to find the talent. Fortunately, we had the perfect person in mind.

Introducing, actor John Getz. Belljar used his talent in our pMD charge capture welcome video and we felt that he would remain the perfect candidate for our new secure messaging video. Our team at Belljar sat down with John in a Los Angeles sound studio, ready to capture the narration. On the pMD side, we got patched in via phone to our San Francisco office and had the opportunity to listen to the live recording. It was possibly one of the most fun events I have taken part in. There were constant jokes and anecdotes being thrown around the studio, and getting to hear John read our script and make it come to life was unbelievable; we are grateful to have had the opportunity to work with John, he is a truly amazing talent.

Included below is the final voice-over of the secure messaging video. Close your eyes and give a listen, you'll be glad you did.

One of the best parts about making a video is letting your creativity roam free. We worked with our amazing partners at Belljar to come up with the perfect script and accompanying graphics for our video.

If you have read our previous posts, you already know about secure messaging and why it’s important, so let me tell you about our story. Our video starts with a closeup of Dr. Mustachio. He’s working with a patient, performing an exam, and sending a message to a colleague using pMD Messaging. Shortly after, we cut to Dr. Fast Thumbs. Dr. Fast Thumbs is a physician, just like Dr. Mustachio, except he doesn’t use pMD Messaging. Instead, he uses unencrypted text messaging, and doesn’t realize the consequences associated with it.

Dr. Fast Thumb’s message gets intercepted, leaving his patient’s information in the wrong hands. HIPAA does not approve of his carelessness and he is forced to pay hefty fines and even serve up to 10 years in prison.

I want to highlight a few moments in creating our boards and script in order to give you a glimpse into our creative process. When we started thinking about how our video would work, our friends at Belljar mocked-up a few slides in order to get the look and feel just right. The slides are hand drawn in order to quickly and efficiently get an idea of how we were going to visually tell our story. I have included a few slides and pieces of the script below:


“Dr. Mustachio uses pMD Messaging to send and receive sensitive patient information in real time.”


“This is Dr. Fast Thumbs’ patient. She has a highly personal health matter she would prefer to keep private.”


“Unencrypted texts can have major consequences, Dr. Fast Thumbs.”

I hope you enjoyed this glimpse into our secure messaging video. In next week’s post, we’ll let you have a listen to our script, read by myself and Adam Kenney.

How is it that we name things? Whether it be a new product or even a child, what goes into the process of naming it? When we started thinking about our new messaging application at pMD, we went through a rigorous naming expedition, constantly brainstorming, coming up with the most crazy as well as some of the most simple ideas. Our names ranged from Soteria, the Roman goddess of safety, all the way to Bleep. In total, we came up with over 120+ names, some of them thoughtful and ambitious, others droopy and just a little too spontaneous.

I picked out some of my favorites for your reading pleasure:

- Bleep
- Can't Text This
- Odin
- Howdy
- SuperTube
- Safety Pigeon
- Soteria
- Lock & Key
- Bona Note
- Bleat
- Cryptext
- Flow
- Happy Text
- Avocado

At the end of the day, we knew we wanted to keep the name simple, precise, and to the point. Unfortunately, none of the above names seemed to fit those criteria, but that didn't mean we'd stop trying.

At pMD, our users consist of mostly doctors. Interestingly, that doesn't mean that the people shopping around for pMD are always doctors, they could be practice administrators, staff, and sometimes even family. We wanted to make sure that our name meant something to anyone who came across it and that also lent itself to our brand and already popular pMD charge capture application. So, we kept it simple and precise, naming our secure messaging application, pMD Messaging. In doing so, we kept the pMD brand, the name recognition and understandability, and our sanity for another day until the likes of Safety Pigeon take over.
As a patient, you should be able to assume that your private health information is safe and guarded from the outside world. Unfortunately, this may not be the case. Unknowingly, many physicians are using unsecured, unencrypted methods of messaging that leave your personal matters a little less private. These methods include, but are not limited to, text messaging, and even email.

As Jen mentioned in our last post, apart from your data floating around, your doctor could be fined thousands, or even millions of dollars for sending unsecured information! Imagine you are at the hospital with a broken arm. You have just sat down to look at your x-ray and your doctor decides that he wants to send it to your primary care physician. So, the doctor takes out his phone, takes a picture of the x-ray, and sends it over. That could cost your doctor upwards of $50,000 for one text! There has to be a better way to do this, and there is.

At pMD, we have found a way to solve this problem. We have created pMD Messaging, a secure, encrypted, HIPAA compliant messaging platform that physicians and patients can rely on. Other than its ease of use, one of the many features that makes our secure messaging so special is its integration into our charge capture solution (learn more). Having messaging directly incorporated into the software limits the amount of app switching and allows for quick access to patient records. Instead of two separate applications, you can find the patient and compose your message in the same instance. This is especially important for specialists whose time is very precious when it comes to patients. Specialists need to send and receive information about their patients very quickly, making an app that incorporates both messaging and charge capture the perfect match. Better yet, you can message physicians outside of your practice too!

To explain the importance of secure messaging, we are in the process of creating a video featuring our very own Doctor Mustachio and a new character named Doctor Fast Thumbs. In making this video, we are looking to show a serious situation with a humorous tone. Engaging an audience can be a very difficult task, especially with a topic that can be bland and boring. Over the next few weeks, we'll be posting updates on our progress and giving you a glimpse into the world of animated, video creation, and what it means to use secure messaging.
There are so many great mobile applications available for physicians now, ranging from mobile charge capture to mobile EHR, that smartphones have become very tightly integrated into medical practices. Data hackers may not be interested in which new diet you and your friend are currently attempting to conquer, but smartphone communication can get complicated when the subject matter is work-related and includes sensitive patient health information. It shouldn’t be a surprise that traditional SMS text messaging is not a secure way to exchange confidential information, and HIPAA enforcers do not take kindly to it.

This is one of the complex issues facing physicians, who are trying to find better ways to share patient information within their practice as quickly as possible, while also keeping protected health information, or PHI, secure. As physicians do their rounds at the hospital, they are in constant communication with others around them. This is not only true for physicians within a group who may be spread out among multiple hospitals, but also for specialists that they may work with who deal with the most critical patients where instant communication is essential.

Text messaging can greatly improve workflow inefficiencies and creates a much more effective form of communication than say, pagers or other sluggish systems. But when physicians use nonsecure text messages to send electronic PHI, it not only puts patient data at risk but can lead to exorbitant fines and legal penalties. These fines can be upward of $50,000 for a single violation of the new HIPAA regulations concerning e-PHI as part of the omnibus final rule. Despite this financial penalty, many healthcare providers continue to use texting in their medical practices because it is both quick and convenient. When the wellbeing of the patient is top priority and time is of the essence, legal compliance can often fall by the wayside. But there is a solution so that physicians can put their patients first while avoiding costly penalties and also improving communication within their practice.

Secure Messaging + Mobile Charge Capture


Secure messaging applications are excellent communication platforms that allow healthcare providers and staff alike to exchange e-PHI securely and quickly, and it’s icing on the cake if your charge capture app also has this component. In light of recent government security scandals, secure messaging applications are growing in popularity. The number of secure messaging applications on the market is rapidly increasing, varying in form and function. Some of the notable features among these apps can include group messaging, delivery/read notifications, user authentication, and a supplemental messaging web portal.

If you’re already using a mobile charge capture application, then why add yet another application to your already extensive app inventory? Your charge capture application should have a secure messaging functionality built in. This allows your information to be contained in one centralized hub where you can easily navigate within the app to message quickly and securely.