DocbookMD Streamlines Communication, Care
Practice Management — April 2014
By Crystal Zuzek
Tex Med. 2014;110(4):43-47.
The days of waiting for a page from a radiologist for a patient's x-rays and imaging reports are long gone for Austin family physician James Merryman, DO. Now he relies on Austin Radiological Association (ARA) Connection, a DocbookMD feature that provides him with secure real-time notifications of radiology reports on his smartphone, streamlining his workflow and allowing him to see more patients.
"I had a patient who I suspected had a herniated disc. With DocbookMD's ARA Connection, I was able to share the results of the magnetic resonance imaging [MRI] scan with a neurosurgeon, schedule an appointment for the patient, and have the patient seen in a 48-hour period. In the past, it could have taken up to a week for all that to occur. DocbookMD saves time and effort for busy physicians like me and makes patients happy," he said.
Another of Dr. Merryman's patients started treatment for lung cancer one day after diagnosis with the help of DocbookMD. Dr. Merryman forwarded the patient's chest scan to an oncologist using the ARA Connection function, which he says fosters efficient patient care and gives him added peace of mind.
"I don't have to worry about missing something. I can get the reports directly on my phone and not have to wonder whether scans have been done," Dr. Merryman said.
DocbookMD is a secure, HIPAA-compliant, Texas Medical Association-endorsed communication app that allows physicians and their care teams to share real-time messages and images such as electrocardiograms and x-rays, resulting in more efficient care coordination. Physicians can send text messages and images to one another while meeting HIPAA encryption and security requirements.
The app is available free to TMA and county medical society members. A paid version of the app is also available for hospitals and large groups.
The Texas Medical Liability Trust is a sponsor of DocbookMD, which is available for iPhone and Android phones, as well as for iPad and iPod touch. A web version of the app is coming out this spring.
For more information about DocbookMD, visit the website. Download the DocbookMD mobile app via the TMA website.
To obtain the necessary credentialing data to start using DocbookMD, call your county medical society, or contact the TMA Knowledge Center at (800) 880-7955 or (512) 370-1550 or by email.
One Big, "Appy" Family
The Austin husband-and-wife team of Tim Gueramy, MD, and Tracey Haas, DO, developed the app and launched the flagship application in 2009. Dr. Haas, a family physician, says DocbookMD eliminates the need for unnecessary and often costly repeat office visits when an image of an x-ray or wound, for example, would suffice. The app allows physicians to:
- Prioritize outgoing text messages;
- Confirm receipt of text messages;
- Search a local pharmacy and physician directory for up-to-date contact information; and
- Locate area doctors by name, specialty, and by facility with which they're affiliated.
Drs. Haas and Gueramy say the app's growth and popularity among the medical community thrill them. DocbookMD has more than 8,000 Texas users and more than 15,000 users in 38 additional states. More than 300 county medical societies nationwide — including all Texas county medical societies — offer DocbookMD to their members.
Since the app's inception five years ago, Dr. Haas says DocbookMD has been focused on enhancing the product and meeting users' needs. Over time, for example, Texas physicians asked to be able to use the app to communicate with staff.
DocbookMD responded by adding the CareTeam function last May to allow individual doctors to "add members of their own staff, who can all see one another and send secure messages to one another," Dr. Haas says.
Since opening secure messaging to staff members, she says the volume of text message communications tripled from September to February. Nonphysician CareTeam members have to be invited to join by physician users of DocbookMD and don't have access to the full medical society directory.
"Multiple doctors can share the same CareTeam members, which answers a huge need in hospitals," Dr. Gueramy said, adding that CareTeam sparked development of a new offering for hospitals and large groups known as Docbook Enterprise. At press time, eight hospitals and medical groups in Texas, plus two hospitals in other states, had contracted with DocbookMD to use Enterprise in their facilities among their physicians and staff members.
Dr. Haas says the new feature will help hospitals and physician groups improve patient care, reduce HIPAA violation risk, and prevent costly medical mistakes. Docbook Enterprise has a secure, cloud-based platform that allows physicians and staff to discuss patient care and share data in real time.
"Now, Enterprise clients can give us a directory of their entire medical staff, and we can build care teams for them, or they can build their own care teams as an extension of the hospital directory," Dr. Haas said.
Hospitals and large groups pay a negotiated rate for Docbook Enterprise, which can be used by all physicians and staff affiliated with contracted hospitals and groups, regardless of TMA membership. Only TMA members, however, have access to the full regional physician directory. Physicians who aren't TMA members can view the hospital directory only.
Dr. Gueramy says a partnership between DocbookMD and Medical Service Bureau, Medlink, and MAP Communications enables doctors to receive their answering service messages through the app, which contains encrypted information and notifications. Looking ahead, Dr. Haas says DocbookMD plans to offer a third-party viewer for full radiology images that has been approved by the U.S. Food and Drug Administration.
"Doctors can finally read the actual x-ray, computed tomography scan, or MRI directly from their device. That's the solution we were originally looking for when we first envisioned DocbookMD six years ago," Dr. Haas said.
DocbookMD released version 5.3 earlier this year. It's available free of charge and features improvements to the user interface, most noticeably in the organization and navigation of messages and upgrades for your "Favorites" list. (See "Free DocbookMD Update Available.")
Network at Your Fingertips
Wichita Falls otolaryngologist Jed Grisel, MD, downloaded DocbookMD last year and says it helps him coordinate care for patients. For instance, he and his colleagues at Head & Neck Surgical Associates work with a dermatologist who removes skin cancers from patients. After having the cancer removed, patients return to Dr. Grisel or another physician in the practice to have the affected area reconstructed.
"Using DocbookMD, the dermatologist can send me an image of the defect on the patient's skin prior to the surgery I'll be performing. It really helps to have that picture in advance because I can begin planning how I'll reconstruct the defect. I'm ready to go the next day, and care is coordinated in a HIPAA-compliant way," said Dr. Grisel, a member of the TMA Leadership College class of 2014.
Dr. Gueramy says DocbookMD takes security and HIPAA compliance seriously. The DocbookMD website lists four major HIPAA security criteria mobile apps must meet:
- There must be a termination procedure that allows rapid removal of protected health information (PHI) from the device or rapid termination of access to PHI. DocbookMD can remotely shut down access to the app and any data containing PHI when a physician reports the device lost or stolen.
- Access to the device containing PHI must be limited. DocbookMD encourages physicians to keep their devices safe and to password-protect their phones and tablets.
- PHI must be encrypted based on the highest encryption standards available. Secure encryption must be continually tested. The DocbookMD website says DocbookMD uses 256-bit encryption for all PHI on the device, server, and during transmission.
- Devices that contain PHI must have backup and recovery procedures. DocbookMD has backup procedures and a disaster recovery plan if a device or PHI is lost or compromised. Servers also have these systems and emergency recovery procedures.
All DocbookMD physician users must sign a HIPAA business agreement, which specifies the company's data protection policy and the responsibilities of all parties to ensure confidentiality of patient information. As HIPAA-covered entities, users of the app must abide by HIPAA and Health Information Technology for Economic and Clinical Health Act rules, including privacy and security rules.
Knowing that the app safeguards patients' PHI is reassuring to Dr. Grisel and the physicians in his group, made up of four surgeons and about 25 staff members. Head & Neck Surgical Associates is the only practice in Wichita Falls that provides all aspects of head and neck surgery. Dr. Grisel says serving a large geographic area comes with challenges.
"One of the issues that is unique to Wichita Falls is that it has a large elderly population concentrated in rural areas. The town is home to 100,000 people, but our group serves 300,000 people who make up the small surrounding communities," he said.
DocbookMD allows Dr. Grisel and his partners to communicate quickly and securely, thereby improving patient care, he says.
"The app has been extremely helpful for us. It will be even more helpful as we get more physicians working in small, rural areas on board," he said.
He encourages physicians practicing in rural Texas communities to download DocbookMD.
"The app gives rural physicians direct, immediate access to their colleagues in other parts of the state. Physicians can communicate efficiently and securely without having to wait for a phone call. DocbookMD provides a support network at your fingertips that is beneficial to physicians and their patients," Dr. Grisel said.
Dr. Merryman also encourages physicians across the state to download and use DocbookMD in their practices.
"The more people who use it, the more robust the network becomes, making the app more powerful," he said.
At press time, Dr. Merryman was setting up the CareTeam function.
"CareTeam will help my office communicate and share labs and images securely and efficiently with nurses and other staff members," he said.
Facilitating Care Closer to Home
Dr. Grisel hopes to expand his use of DocbookMD moving forward. The app may be integrated into a care coordination project for cochlear implant patients Dr. Grisel is working on with College Station otolaryngologist Andrew De Jong, MD, and a California physician. Before Head & Neck Surgical Associates began offering cochlear implants, North Texas patients had to travel to Oklahoma City or Dallas for the procedure.
"Some of our elderly rural patients were reluctant to travel so far because they'd have to make several trips for follow-up care in addition to the surgery," Dr. Grisel said.
Over time, Dr. Grisel says he has realized that providing cochlear implant patients with the best care requires coordination among the surgeon, an audiologist, and a speech therapist.
"I'm working with my partners to set up a small nonprofit organization that will allow this type of care to be more easily provided in community settings, closer to home," he said.
He and his physician business partners are creating an online database for virtual care teams. Multiple health professionals can participate in care for cochlear implant patients and access the online database system, which will contain secure patient information.
Dr. Grisel is a member of the Walters Physician Incubator, an Austin-based venture established by Drs. Gueramy and Haas that helps physician entrepreneurs. (Read "Doctorpreneurs," in the September issue of Texas Medicine, pages 47-50.)
Dr. Grisel says the incubator connected him to attorneys who have helped him with forming the nonprofit organization and ensuring the database is HIPAA compliant.
"We hope to launch the database this summer. Once that occurs, we're talking about integrating DocbookMD into the database as the communication platform. The physicians, audiologists, and other health professionals who use it will be able to efficiently and securely communicate with one another on the details of each patient's care," he said.
Crystal Zuzek can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email.
Free DocbookMD Update Available
Version 5.3 of the Texas Medical Association's endorsed, secure communication app DocbookMD is now available free in the Apple App Store and on Google Play. Version 5.3 now stores your "Favorites" in the DocbookMD cloud, synced with any device you log into and persistent when uninstalling or upgrading the app.
In many situations, texting is the fastest and most efficient way to send information, and reports show that texting among physicians is widespread and that physicians are texting clinical information. Physicians who text each other clinical information risk exposing themselves to HIPAA privacy and security violations, but DocbookMD's HIPAA-secure framework mitigates that risk.
DocbookMD is a free benefit of your TMA membership that you can start taking advantage of immediately. County and state medical societies across the country offer DocbookMD as a free benefit, and more than 23,000 physicians in 39 states are using the app.
To begin using DocbookMD, download the app to your smartphone or tablet, and follow the registration instructions. For more information or help registering, contact the TMA Knowledge Center by email or by calling (800) 880-7955. Be sure to view online video tutorials on how to use DocbookMD.
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