Getting in touch with the physicians of Direct Care Clinic of Northwest Arkansas is easy—they’re only a text or email away.

Secure mobile communication with patients has become a prime source of communication that enables the Rogers, Ark.-based practice to serve patients and offer them personalized care.

The physicians of the practice wouldn’t have it any other way.

“This is the way primary care should be done,” says Dan Weeden, MD, one of the two physicians in the practice. “It’s a good way to do primary care.”

Dan Weeden

Weeden and Joel Frankhauser, MD, have changed the practice’s approach, in part enabled by new information technology systems. It’s changed electronic health records systems, deployed a smartphone app and adopted the secure messaging software to enable better communication.

Direct Care now offers direct primary care to about 700 patients who pay a set amount each month—less than $50—for all treatment and services. That’s a slightly different model than concierge service, under which an individual or family pays an annual fee for care. And it’s a far cry from the traditional fee-for-service model the practice employed before the change, when it treated more than 2,000 patients.

Before the switch, the practice used an EHR from Epic, and followed the traditional path of filing claims with insurers, which paid varying amounts for care. In making the switch, it’s moved to the InLight EHR system from Amazing Charts, which has better enabled the shift to direct primary care, helping it offer the more consistent monthly fee approach.

Weeden says the new approach has opened up communication with patients, who may want an often visit but frequently just want a quick answer to a medical question. This year, the practice sought a secure messaging application that could be integrated into the InLight EHR and found Twistle, which enables patients to use smartphones to send messages to the practice.

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The app brings convenience to the practice and patients, according to Weeden. It reduces the need for office visits and gives patients peace of mind while, at the same time, quickly alerting clinicians to potential problems.

Patients who have the free Twistle app on their phone can send messages to the practice that go into nurse and physician computers as well as their smartphones. (The cost of the app is folded into the contract for the practice’s EHR.) A mother, for example, may message the practice about a child’s rash and include a picture of skin, and a physician or nurse can quickly assess the photo to decide whether the child should come in for care or be treated at home. Messages are archived, but also can be placed in a patient’s electronic health record at the discretion of a clinician.

Direct Care selected Twistle secure messaging because it is HIPAA compliant, but Weeden worries that some other doctors using the direct primary care model do not follow HIPAA “and it is imperative that they do so,” he says.

Clinicians at Direct Care also use Twistle to follow up with patients, such as asking if patient who are awaiting procedures stopped take certain medications as directed, or asking them if redness around an incision is worsening. While the app brings physicians is an easy way for patients to communicate with physicians, it doesn’t replace a tried-and-true way to reach a doctor that many patients still use, Weeden notes: “If they need to talk, they call.”

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