NC HEALTHCONNEX CLINICAL PORTAL PRIMARY PROVIDER USER MANUAL

Transcription

1 NC HEALTHCONNEX CLINICAL PORTAL PRIMARY PROVIDER USER MANUAL NORTH CAROLINA HEALTH INFORMATION EXCHANGE AUTHORITY (NC HIEA)

2 2 This user manual was developed in coordination by the North Carolina Health Information Exchange Authority (NC HIEA), Orion Health and SAS Institute to assist NC HealthConnex clinical portal users in navigating the system. See contact information below for the primary points of contact in your organization as well as the NC HIEA business office. Contact Details: Participating Organization: Participant Account Administrator: Participant Account Administrator: NC HIEA Business Office: For questions relating to the user manual, please contact Alice Miller at (919) or via at Visit the website:

3 3 TABLE OF CONTENTS INTRODUCTION... 8 Purpose... 8 Welcome... 8 Privacy Statement... 8 History of NC HIEA... 9 What is the NC HealthConnex Portal?... 9 ROLE OVERVIEW Roles and Responsibilities Overview Role-Based Permissions GETTING ACQUAINTED WITH THE CLINICAL PORTAL INTERFACE What Clinical Portal Does Clinical Portal User Interface Global Menu Logging In to Clinical Portal Logging Out of Clinical Portal Automatic Logout CLINICIAN HOMEPAGE Recent Patients Worklists Received Messages SPECIFY SYSTEM PREFERENCES My Details Panel Additional Screen Configuration Reset/Change Your Password User Details Password Change Resetting a Password Using a Secret Question (Forgot My Password)... 19

4 4 PATIENT SEARCH Sorting Search Results Recent Patients Patient Privacy Opt-Out Patients Patient Record Access Descriptions Break the Seal VIEWING PATIENT INFORMATION Viewing Patient Summary Demographics Allergy List Encounter History Medication History Problem List Procedures Viewing Patient Documents Document Tree Read/Unread Documents Filter and Sort Options View a CCD View an Incoming CCD Generate a CCD Customize a Generated CCD Viewing Results Viewing a Single Result Numeric Results Textual Results Microbiology Radiology Results Viewing Historical Results Version History Collection Details Result Details, Reference Range and Unit of Measurement Viewing Cumulative Results... 49

5 5 Textual Observations Working with Graphs Overview Graph Individual Graphs Timeline Working with Timeline USING WORKLISTS Viewing Worklists Adding Patients to Worklists From a Patient Search From the Context Menu Replacing Patients on a Worklist Removing Patients from Worklists Renaming a Worklist NOTIFICATIONS My Subscriptions USING CLINICAL PORTAL MESSAGING Sending Messages Reading Messages Sent Messages COMMUNICATE SINGLE SIGN ON Instructions for Enabling Single Sign On COMMUNICATE (DIRECT SECURE MESSAGING) WEBMAIL Using the Global Menu Message List Conventions Working With Messages Receive New Messages Receiving Messages from a Proxy (Shared) Mailbox Unread Messages... 75

6 6 Sorting Messages Flag Messages for Follow Up Flagging A Message Compose a Message Use Rich Text to Format My Message and Signature Find A Provider Forward A Message Replying To A Message Sent Messages Sorting Sent Messages Working With Sent Messages Working With Drafts Editing A Draft Sorting Drafts Working With Attachments Adding An Attachment To A Message Download An Attachment Forwarding A Message With An Attachment Delete Messages Deleting Multiple Messages Sorting Deleted Messages Emptying The Trash Folder Find A Message Print Messages Working With Shared Mailboxes Things To Note Authorize Another Person to Manage Your Mailbox Managing Folders System Folders User-Defined Folders Add A Folder Delete a Folder Renaming a Folder Move a Folder Move Messages Between Folders

7 7 Dragging and Dropping Messages Using the Move Message Dialog Moving Multiple Messages Managing your Mailbox Automatically Forward s Enabling Automatic Forwarding Turn on Automatic Replies Use Rules to Manage Messages Deleting a Rule Add a Signature to my Messages Working with Address Book Manage Contacts Sending Messages to a Contact in Address Book Manage Contact Groups Viewing a Contact Group Adding a Contact Group Deleting a Contact Group Updating a Contact Group Sending Messages to a Contact Group Sort and Search Contacts and Contact Groups Searching Contacts and Contact Groups Delivery Receipts in Communicate Webmail Protected Health Information Taking Care Not to Miss Vital Messages TECHNICAL REQUIREMENTS Browsers Mobile Device Requirements HELP DESK INSTRUCTIONS ABOUT OUR PARTNERS DISCLAIMER APPENDIX A...128

8 8 Functional Roles Matrix INTRODUCTION Purpose The North Carolina Health Information Exchange Authority (NC HIEA) provides a secure and integrated view of a patient s longitudinal health record. Our mission is to link all health care providers across North Carolina to improve health care quality and outcomes. This document is intended as a guide for all users to provide basic clinical portal navigation information for the state-operated health information exchange, now called NC HealthConnex. Welcome Welcome to the North Carolina Health Information Exchange Authority (NC HIEA). Your participation in the health information exchange will enable you and other participating organizations to: Save time and reduce paperwork, Facilitate more informed treatment decision-making, Improve care coordination, and Enable better health outcomes. Privacy Statement Privacy Statement: The NC HIEA takes patient health data privacy and security very seriously. In accordance with HIPAA regulations and state law, the NC HIEA has entered into and will enter into Business Associate Agreements and applicable data sharing agreements with all organizations that will receive personal health information (PHI) from the HIE network now known as NC HealthConnex. The State also has the authority to audit the activity of organizations that receive PHI from NC HealthConnex. Please note that every time you login you are agreeing to the terms signed by your organization which provided you with a unique User ID, including (but not limited to) the following: I will only access patient information for treatment, payment or health care operations purposes as defined by HIPAA or as permitted by the NC HIEA Participation Agreement I understand that all access of patient information is monitored and recorded I will safeguard patient information from inappropriate disclosure I will immediately report any suspected breach of patient information to my supervisor, if applicable, and the NC HIEA I will not share my User ID or password with anyone

9 9 History of the North Carolina Health Information Exchange Authority (NC HIEA) History of Health Information Exchange in North Carolina: Today: Federal funding became available for states to create Health Information Exchanges (HIEs) North Carolina was an early adopter and created the initial NC HIE Control of the North Carolina HIE was transferred to Community Care of North Carolina (CCNC) North Carolina created the North Carolina Health Information Exchange Authority (NC HIEA), housed within the NC Department of Information Technology, to facilitate the creation of a modernized HIE to better serve North Carolina s health care providers and their patients. (NCGS ). North Carolina is committed to developing an exchange that will meet the needs of health care providers and their patients and welcomes stakeholder input Fully funded for two years, with recurring funding every biennium Connection is mandated for providers who receive Medicaid funding: o o Our Partners: February 1, 2018 All Medicaid providers to be connected to the NC HIE June 1, 2018 All other entities that receive State funds for the provision of health services to be connected to the NC HIE SAS Institute Provides technical services and Help Desk Orion Health Provides the health information exchange clinical portal DirectTrust Certifies the NC HealthConnex Direct Secure Messaging component (Communicate Webmail) and enables the provider directory through Orion Health What is the NC HealthConnex Portal? The NC HealthConnex portal provides you access to a secure, standardized electronic system in which providers can share important patient health information. The use of this system promotes the exchange and analysis of personal health information from many disparate systems throughout North Carolina in a consolidated and efficient manner. Providers with the highest level of access are able to view a patient s medical history including allergies, medications, problem lists, procedures, lab results, radiology reports, immunization history, discharge summaries, and other important information from providers across the state that have seen the patient even if those providers are not part of the same practice or health system. NC HealthConnex does not require providers to use an EHR or to purchase special software in order to be able to leverage the NC HealthConnex platform. Direct Secure Messaging through Communicate Webmail is also facilitated through the NC HealthConnex portal, which allows providers to securely exchange patient information via a HIPAA (Health Insurance Portability and Accountability Act) compliant system.

10 10 The NC HIEA is constantly working to expand its service offerings to improve the tangible value to providers from all areas. There are many projects currently under development that will be added to the NC HealthConnex infrastructure as they are completed including, but not limited to, the NC Immunization Registry, the ehealth Exchange, provider directory, and other functionalities. ROLE OVERVIEW Roles and Responsibilities Overview Access to the clinical portal is granted to clinicians and other users that provide patient care in a variety of settings offices, clinics, emergency departments and hospitals. Functions include: Search for patients View clinical information Send messages to other HIE users A full list of clinical user levels is provided in Appendix A Functional Roles Matrix. Role-Based Permissions NC HealthConnex is configured with various clinical views that end users can access. Not all views need to be accessed by all users, and access can be based on sensitivity of information or relevance to the user. User groups and roles are used to control this access. Level Title/Description Examples Level 1 Primary Provider A Primary Provider is a credentialed provider who has a treatment relationship with the patient. Most commonly this is a user whose name would appear in the clinical results as an ordering provider, attending provider, etc. Physician Nurse Practitioner Resident Level 2 Secondary Provider Secondary providers work in conjunction with the primary provider in providing patient care. This person works under a fully licensed provider. Nurse Intern Therapist Pharmacist Level 3 Care Support Care support staff are those that require access to clinical information as part of their normal job duties. These duties may include entering clinical information into the practice EMR, retrieving all clinical data from outside sources, and following up on patient care. Unit Clerk Medical Assistant Level 4 Front Desk Staff

11 11 Level Title/Description Examples Front desk users may need access to the Open Platform for purposes of verifying demographics. These users are not granted access to clinical data. Billing Clerk Medical Assistant II Registration Staff Level 5 Participant Account Administrator Participant Account Administrators are responsible for creating and maintaining Clinical Portal end user accounts for their organization including password management. Participant Account Administrator Healthcare Organization (HCO) Staff Level 6 HIE Administrator & HIE Privacy Officer Participant Account Administrators are responsible for creating, changing and deleting Clinical Portal end user accounts, including password management. They can manage user accounts globally (HIE-wide) or within the organization. They are also responsible for creating and maintaining EMPI Administrator accounts whereas Organization Participant Account Administrators can manage users only within their own organization. HIE Participant Account Administrator Compliance Officer Privacy & Security Officer Privacy Officers are responsible for the monitoring and auditing of clinical portal access as well as manually updating patient consent (opt-in/out) status. They can do it globally (HIE-wide) or within the organization.

12 12 GETTING ACQUAINTED WITH THE CLINICAL PORTAL INTERFACE What Clinical Portal Does Clinical Portal can be used as a central point from which you can access all of the patient information and functions available in the NC HealthConnex portal. Clinical Portal User Interface Clinical Portal user interface refers to the menus, icons, buttons and other user information on the screen that will help you interact with the application. The following terms are used when referring to the Clinical Portal user interface: Global Menu: The primary menu that displays links to the user account information and the Home and Help options at the top right of the display Portal Menu: The menu that you see when you do not have a specific patient in context; for example, when viewing your Worklists or patient searches. Patient Context Menu: The secondary menu that will display when a specific patient record is in context. Global Menu The Global Menu is always accessible from any screen in Clinical Portal and provides the following functionality: Home: Returns user to the Home Page. Help: Provides context specific help page. This information is generic in nature, and may not be an exact representation of your configuration. UserName + dropdown: Displays users full name, or username depending on user account setup. If the user s full name is not entered in setup, the username only will display. Dropdown reveals User Settings link. Logout: Logs the user out of the Clinical Portal session. Logging In to Clinical Portal This section explains how to log in to Clinical Portal and the various options that you might see on your login screen. To log in to Clinical Portal: Access Clinical Portal by typing the Clinical Portal URL ( into an Internet browser (such as Microsoft Internet Explorer or Mozilla Firefox ). Clinical Portal may already be set up as a link in your list of favorites. Once you have entered the URL, the login screen is displayed The login screen is shown below. A username and password are required to gain access to the application. A temporary password will be assigned upon account creation. Once the user has entered the username and temporary password, the system will prompt the user to change the password.

13 13 Username is not case-sensitive; however, the password IS case-sensitive. Tips for setting passwords: Passwords must be at least 8 characters long Passwords must be strong (upper and lower case, number, special character) Account will be locked out after 3 bad login attempts (counter and account reset after 30 minutes) The Forgot Your Password link allows users who have forgotten their password to gain access to Clinical Portal by answering correctly the secret question they have configured on the My Details screen. The Help Desk or other support staff do not need to be involved when a user requires password assistance by utilizing the Forgot My Password link on the sign-in screen. See My Details section of the User Manual for set-up instructions. Once the user entered account credentials and clicked the Login button, a Disclaimer page will appear. Each user must read the disclaimer and accept the terms, in order to gain access to Clinical Portal. The user must read and select the Accept button within 5 minutes, or the user will be returned to the login page. See screenshot below for Disclaimer content:

14 14 Logging Out of Clinical Portal The logout button is used to exit NC HealthConnex. The logout button is located in the upper right portion of the display, to the left of the Orion Health logo. Figure 1: Logout Button It is important to use the logout button as opposed to clicking on the X button of the browser. The HIE logout button will log the user out of the application and close the session. If the logout function is not used, the session will remain active for the pre-defined period of time before the auto-logout feature is activated. Automatic Logout The inactivity timeout feature in NC HealthConnex ensures robust security by logging out the user if he or she has been inactive for a pre-defined set of time. The inactivity timeout period is currently set to 30 minutes, but may be edited by the user on the My Details screen. The user may set the inactivity logout time to increments lower than the time set by NC HealthConnex Administrator but not higher. Clicking the logout button allows the user to remain active. For more information, see My Details section of the user manual.

15 15 CLINICIAN HOMEPAGE The Clinician Homepage automatically appears when a user logs in to NC HealthConnex. The homepage displays summary information relevant to a user. The layout of each user s homepage is comprised of one or more windowlets. Windowlets partition the display, allowing a user to see more than one view on a single screen. The homepage for Primary Providers is divided into windowlets: Recent Patients My Worklist Received Messages (Coming Soon) The following sections provide an overview of each windowlet. Recent Patients The Recent Patients windowlet is a system-generated list of up to 50 patient records most recently viewed by the user. The list of patients is sorted into the following categories: Today Last seven days Last four weeks Last twelve months For more information, see the Recent Patients section of this document. Worklists The Worklists windowlet displays six worklists available to users. For more information, see the Worklist section of this document. Received Messages Messaging enables the secure sending and receiving of s between users within Clinical Portal. The Received Messages windowlet displays messages that have been sent from another user or the system administrator. For more information, see Using Clinical Portal Messaging section. Messages can only be sent to, and received by, users that have access to Clinical Portal.

16 16 SPECIFY SYSTEM PREFERENCES Your My Details screen is the central location for changing many of the ways in which you interact with Clinical Portal. To change your system preferences: From the portal menu, select Common>My Details to display the My Details screen. Alternatively, click the User Setting link under your user name next to the Logout button. The following screen displays:

17 17 My Details Panel The options available on this screen may differ depending on which role(s) you belong. The options include: Field/Option Username Change Password Set Security Question Start Screen Inactivity Logout Important Messages Description Displays the username of the currently logged in user. Click the Change Password link to change your password. You will be prompted to change your password every 90 days, and you may not re-use the last twenty-four (24) passwords. Enables you to change your secret question and answers. This is used for a password reset in the case of a forgotten password. The first time a user accesses the My Details screen, this option is displayed as Set my secret question... Clicking the Set button opens a screen with a drop-down list of secret question options. You must select a question, provide an answer and provide your login password to configure this feature. An active address is also required by the Password Reset feature. This is entered in the Users Group Attributes panel, shown below your user details. Displays the first screen that you see after you log in or when you click the Home link in the Global Menu. Select the screen from the drop-down list of options. If this field is blank, the default Clinician Home Page will be used. Sets the period of inactivity, which must pass before you are automatically logged out of Clinical Portal. Select your preferred time period if this option is available to you. By default, the maximum time period is selected, and you can only select a shorter time period. An Important Message is one that has been tagged as Important by the user who sent it. An exclamation mark next to the number of unread messages in the Global Menu indicates that at least one of the messages you have received has been marked as Important by the sender. The options for this property determines how this alert will be displayed. Show alert until dismissed - display until you manually close the notification. Show alert for <n> seconds - display the notification for the set number of seconds. Do not show alert - do not display the notification. Roles I Perform Lists the access level or role to which you belong. If you believe your access is incorrect, please consult your Participant Account Administrator for review.

18 18 Additional Screen Configuration This screen can be configured to provide several other options, which are likely to differ from user to user. The following fields may be available: Users o - the user's address, which can be changed at any time. address must be present if you are utilizing Communicate Webmail Single Sign-On. address must also be present if you are utilizing Forgot My Password functionality. Clinician Homepage - This determines the contents of three of the panels appearing in your Clinician Home Page. o Worklist to show on My Homepage - Click the Search icon to open a screen from which you can select the worklist to appear on your Clinician Home Page. Click the Clear icon to clear any previously made selection. HIE Users o Facility the facility associated with a user. (Edits by HIE Administrator only) Patient Search & Demographics o My Preferred Patient ID Type - The Patient ID Type identifies the issuing authority for the patient's medical number that you will be using most often when you run one of the Clinical Portal patient searches. Selecting the ID Type on this screen will save you time when using these searches as part of your everyday use of the application. Select your preferred options and click the Update Preferences button. If you do not want to save your changes, click the Discard Changes link. Reset/Change Your Password You can reset your password from the User Details screen. Alternatively, you can reset your password by utilizing Forgot My Password functionality. If you cannot reset your password using either of the methods described below, please contact the Help Desk. User Details Password Change To change a user password: On the User Details screen, click the Change Password link. You are then prompted to enter your old (existing) password, your new password and confirm your new password. You may not use the last twenty-four (24) passwords.

19 19 Resetting a Password Using a Secret Question (Forgot My Password) The Password Reset feature allows users who have forgotten their password to gain access to Clinical Portal by answering correctly the secret question they have previously configured on their My Details screen. This means Help Desk or other support staff do not need to be involved when a user requires a new password. When password reset is enabled, a Forgot your password? question is added to the login page. A user clicking this link is first requested to supply their login ID. When this is submitted, the portal will check that: The submitted user ID is valid. The user has set their secret question. The user has an active account. The user's account is not locked. If any of these constraints are not met, the screen displays the following details: A message stating that assistance will be needed to reset the user's password. A link that returns you to the login screen. If all constraints are met, an containing a link to the Reset password screen is sent to your address. From this screen, you can verify identity, create and confirm a new password, return to the Login page and access Clinical Portal using the new credentials.

20 20 PATIENT SEARCH The Patient Search options in Clinical Portal allow you to search for and locate a patient's medical record. The Demographic Search is used to locate a patient s medical record that has had contact with a participating organization. There are two main methods of searching within this area: Demographics search, and EMR (Local) Identifier search. Note: If searching by EMR (Local) Identifier, do not enter demographic details in the search criteria and vice-versa. The following table describes search criteria: Field EMR (Local) Identifier System Name Name Sex Date of Birth Description Enter the patient's medical record number. If an identifier is specified, its matching System Name must also be specified. System Name (facility) must match the Identifier source. Select the correct System Name from dropdown if the default setting is inaccurate. Enter the patient's Last Name, plus either First Name, Date of Birth, or Sex. Last Name plus one other field is required. Enter the patient s sex. Choose from Male, Female. Enter the patient s date of birth. TIP: If the search results return too many results, add additional search criteria to filter the results and return a refined list of patients. The search algorithm will return results that are a close match, i.e. return results for commonly misspelled names.

21 21 The following table describes the fields that are commonly displayed in the search results: Field EMR (Local) IDs (System Name) Name Description EMR (Local) ID and system name (in parenthesis) Patient s first, middle and last names. TIP: Hover over patient name to reveal Address. DOB Sex Patient s date of birth. Patient s sex (if known). Access icon may be present in the leftmost column, depending on user/patient relationship status. Access icons are: Icon Status Description Privacy Sealed Unlocked Patient Record The patient's name is visible and can be selected, but a reason for access is required before the patient can be placed in context and their medical details viewed. You Opened the Privacy Seal for a patient, and can access the patient medical record. The record will remain unlocked until you log out (current session). No Icon Full Access You have access to the patient's medical record without breaking the seal.

22 22 Sorting Search Results The results returned by a search are typically sorted in ascending order by the patient's name. The results can be sorted by any column by clicking its title; click a second time to reverse the sort. When search results have been sorted by any column other than the default, that column name is shown in blue, and a marker is shown next to the column name to indicate if the column is sorted ascending or descending. Recent Patients The Recent Patient list is automatically populated with the names of the patients whose patient record you have recently viewed. The list can hold up to 50 names. If the list already includes 50 patients and another patient is added, the oldest entry (according to the date the patient record was last viewed) will be removed. The list is further categorized by how long ago the record was viewed. Recent Patients Categories: Today Last seven days Last four weeks Last 12 months The Recent Patients list displays: The EMR (Local) identifier The patient's family name in capitals, followed by their first name. The patient's sex and age.

23 23 Patient Privacy The standard patient consent model implemented in NC HealthConnex is opt-out, meaning that patient data is by default opted into the NC HealthConnex unless they explicitly request to opt out. NC HIEA Opt Out Policy: Patients have the right to opt out of having their information shared between providers through the HIE. If a patient chooses to opt out, they are required to complete a form and mail it to the NC HIEA business office. Opting out of the HIE (NC HealthConnex) will not adversely affect patient treatment by any physician and patients cannot be discriminated against if they decide to opt out. Patients may also use the form to rescind a previous opt out if they change their mind. Please note that there is an exception in state law that allows health care providers to access a patient s HIE information during emergencies. However, only a privacy officer in an administrative capacity will have access to this information in the event of an emergency. The primary opt out process is for a HIE Administrator/Privacy Officer (level 6) to manually change a patient's status in the NC HealthConnex Clinical Portal. Opt-Out Patients If a patient has opted out, then for role levels 1 to 4 (clinical users) the search function will not display their record at all. However, for Privacy Officers/HIE Admin level (level 6) the following search results will be available: A subset of the patient's demographic data to identify the patient: name, date of birth, gender, phone number and address details Access to the patient's opt-in/opt-out screen Even if a patient has opted out of the HIE, their clinical data will continue to be recorded in the data repository. The HIE s privacy and consent permissions will hide patient s clinical data from users view.

24 24 Patient Record Access Descriptions The patient record access level that is applied is based on the user s role, whether the patient has optedout, and also whether the patient has been registered at the organization that the provider belongs to, and whether this specific provider has a relationship with the patient. Access to the patient record has several levels: Access Level Description No access Privacy sealed Full access The patient would not be returned in any searches that the user initiates. (Opted Out patient) The patient would be returned in a patient search and the user will be asked to provide a reason for accessing the patient record before breaking the seal. The patient record is returned and is directly accessible without the need to break the seal. Break the Seal To access a patient record, users must have an established relationship (data-driven or facility relationship) in order to view the patient record. If the user does not have a relationship with the patient, temporary access may be granted to view the patient record. To gain temporary access: 1. Search for and select the patient record. 2. From the Access Sealed Patient screen, select a reason from the dropdown list to Break the Seal. 3. After selecting an option (free text comment may be required), select Break the Seal button to open the patient record. Patient record access will remain open until the session has ended at Logout. All instances of Break the Seal are logged and may be audited.

25 25 VIEWING PATIENT INFORMATION Within Clinical Portal, you can access patient information received from participating organizations: Patient Summary - A single, aggregated record that lists the information received for an individual patient within the Clinical Portal. Refer to Viewing Patient Summary for details. Clinical Documents - View documents received from participating organizations. Refer to Viewing Patient Documents for details. Results - Test results in the form of numbers or text. Refer to Viewing Results for details. Patient Timeline - A visual representation of a patient's encounters and documents over time. Refer to Timeline for details. Viewing Patient Summary A Patient Summary is a read-only snapshot of a patient s record. It is the first screen you see when a patient's name is selected from a worklist or the results of a search. The Patient Summary is the first screen displayed for all patient records opened in Clinical Portal. To view a Patient Summary: Search for a patient record using Patient Search, Recent Patients or Worklist method. Select the patient for which you want to view the Patient Summary. The Patient Summary is then displayed, as shown in the following screenshot.

26 26 If there is any restriction on the information stored for the patient you have selected, you will see a screen explaining that the information is restricted or you may be asked to provide a reason for viewing the patient record. The information presented in the Patient Summary is read-only and is dependent on your user level to access the system. Refer to Clinical Portal User Interface for details on how to use the navigation icons on the Patient Summary screen. The following panels display in the Patient Summary: Demographics Allergy List Encounter History Medication History Problem List Procedures Demographics The Demographics panel lists the patient's personal and contact details. If the patient is deceased, this is indicated by the presence of the Deceased icon alongside his or her name. Individual demographic panels contain the following information: Other Identifiers - alternative identifiers associated with a patient's medical record. Demographics - the patient's sex, date of birth, home address and contact phone number. If the patient is deceased, their date of death will also be listed. Emergency Contact - the name, relationship and contact details for the individual whom the patient has nominated in the case of an emergency. Primary Care Provider - the name, clinic and contact details of the patient's doctor (PCP).

27 27 Allergy List The Allergy List panel lists the patient's recorded allergies. Details - the type of allergy or alert. Reaction - the patient's response following contact with the allergenic substance or event. Severity - the severity of the patient's reaction to the allergenic substance or event. Onset Time the recorded date of onset for the patient s allergy. Encounter History The Encounter History panel lists the patient's previous contacts with the hospital. Admission - the date the patient was admitted. Discharge - the date the patient was discharged. Admit Reason Admit Reason noted for the patient. Discharge Diagnosis - the clinician's diagnosis of the patient's condition that triggered the contact. Visit Type - whether the patient was inpatient or outpatient or ER patient. Specialty - the specialty under which the patient received treatment. Facility - the ward or other clinical area the patient was admitted to during the encounter.

28 28 Clinician - the name of the clinician responsible for the patient's care and treatment during the encounter. Attenders Attending physician. NOTE: Some fields may be blank, as data is not always sent/received from the source system. In the case of outpatient events, for example, the source may not send Discharge date or Discharge Diagnosis information.

29 29 Medication History The Medication History panel lists the history of the medications prescribed for the patient. NOTE: Some fields may be blank, as data is not always sent/received from the source system. In the case of medication received, for example, the source may not send information for all data fields. The Medication History results will contain the following columns: Field Description Medication The name of the prescribed medication Dose The prescribed dose Sig Route The instructions written by the pharmacist on the medication s label to assist the patient taking the medication The route by which the medication was administered Start The date the patient started taking the medication Stop The date the patient stopped taking the medication Prescribed By The name of the clinician who prescribed the medication Status The status of the medication prescribed, whether Active, Inactive, Future, Ordered or Unknown Inactive: Medications with past Stop dates Future: Medications with future Start dates Ordered: Medication that has been order, put not filled Unknown: When the current date is within the partial date range Active: All others

30 30 From the Patient Summary, click the Maximize icon next to Medication History label to display Current Medications panel and the Search Medication panel. The Current Medications panel displays medications the patient is currently taking. The Search Medications panel allows a user to search for medications the patient had been prescribed. To search for medications, complete one or more of the following criteria: Medication - Enter the name of the prescribed medication. Medication name is not case sensitive and does not need to be provided in full. Status - Select the status of the medication prescribed. Active, Inactive or Future or leave blank. Start Date - Enter the date range the patient started taking the medication. Click the Calendar icon next to the textbox to select a date or enter the date into the textbox. There are three search options: o To search for medications the patient started taking between date ranges, enter an older and a newer date into the two Start Date fields. o To search for medications the patient started taking on or after a certain date, enter a date into the first Start Date field. o To search for medications the patient started taking on or before a certain date, enter a date into the second Start Date field. Stop Date - Enter the date range the patient stopped taking the medication. Click the Calendar icon next to the textbox to select a date or enter the date into the text box.

31 31 Problem List A Problem List is a historical compilation of the physical and diagnostic concerns, procedures, psychosocial and cultural issues that may affect the care of the patient. It provides clinicians with a 'summary' view of a patient s problems to determine the best course of intervention and treatment. Problem Type Treating Provider Status Onset Time Resolution Severity

32 32 Procedures The Procedures panel displays a list of procedures performed for the patient. The Procedures data includes: Procedure Code Procedure Description Date Procedure Provider Source Viewing Patient Documents Clinical Portal can display patient documents from participating organizations such as results, discharge summaries, medications, and so on. Documents for the selected patient are shown in the Document Tree. To view the document details, select the document to display it in the main viewing panel. Document Tree The Document Tree displays a list of documents for the selected patient, as shown in the following screenshot:

33 33 The number to the right of each item in the Document Tree indicates how many documents of that type there are for the selected patient. To expand the sections within the Document Tree, click the Expand icon click the Collapse icon.. To collapse sections, Read/Unread Documents The Document Tree will also indicate the number of unread documents as shown in the following screenshot. Unread documents will be displayed in bold text in the Document Tree until they have been read. They will then display in normal text. If you have previously read a document and it is displayed in bold in the Document Tree, this is an indication that the document has been updated since you last read it and you should read it again.

34 34 Filter and Sort Options You can filter and sort documents in the Document Tree, as described in the following table. Icon Purpose Displays a panel where you can search for documents you want to see, as shown in the following screenshot: Note: Pen (sign off) and Important document filters are inactive. Displays a panel where you can specify what you want shown and how you want that information to be grouped and sorted, as shown in the following screenshot: Show - filter the documents based on the date the document was created or received from the external system. Group By - select how documents are grouped, whether by Category, Date, Service, or Author. Sort By - select what field the documents are sorted by. Displays the documents using the default settings. Any search filters you have previously specified are ignored.

35 35 View a CCD View an Incoming CCD This section details how to view an incoming CCD from another healthcare provider. To view an Incoming CCD: Search for and select the patient for which you want to view the CCD. In the left pane, select Incoming CCD > [Document Title]. A list of CCDs displays, which could include Summarization of Episode Note, Transfer of Care Referral, etc. Select the CCD you want to view. The full CCD, which would have been received from an external system, is displayed, as shown in the following screenshot: To view a CCD that has been generated using the information received by and stored in NC HIE, refer to Generate a CCD for details.

36 36 Generate a CCD The Patient Snapshot - or CCD (dynamically generated by Clinical Portal), gathers key patient information including Results, Details, Alerts, Allergies and Adverse Reactions, Problems, Medications, Results, and Providers of Care Encounters, into a CCD-compliant format that you can view, download, print or customize. A generated CCD (or Patient Snapshot ) is not the same as an external CCD received from another organization. Unlike generated CCDs, external CCDs cannot be saved, printed or customized. To generate a CCD: In the left pane, select Dynamic Documents > Patient Snapshot. The patient snapshot is generated and displayed, as shown in the following screenshot:

37 37 To do something other than view the patient snapshot, complete the appropriate action: To To save a copy of the CCD in XML format To view or save the CCD in PDF format To view the CCD (Patient Snapshot) using the Clinical Document Architecture (CDA) style sheet To customize a CCD (Patient Snapshot) Select Click the Download button. Click the Print button. Click the View CDA button. CDA styled document will be generated in a separate window. PDF and other functionality available from the standard CCD view will not be available. Click the Customize button. Customize a Generated CCD To customize a patient's CCD: Search for and select a patient. In the left pane, select Dynamic Documents > Patient Snapshot. The patient s CCD displays Click the Customize link, as shown in the screenshot below. The Customize Continuity of Care Document screen displays.

38 38 Use the drop-down lists to customize which sections you want to display, and change the time period to be displayed, as shown in the following screenshot: Click the Customize button to regenerate the CCD with the changes you have made. The CCD changes affect only the selected patient. As soon as you navigate away from the CCD, or the Patient Snapshot is reloaded, the changes will be erased.

39 39 Viewing Results Results let you view your patient's laboratory, pathology and radiology results through Clinical Portal. In this section you will find information on the following Results view formats: Viewing a Single Result Viewing Historical Results Viewing Cumulative Results Working with Graphs Viewing a Single Result To view a single result, expand the relevant heading by clicking on it and select an individual result. Results can be displayed in the following formats (and example screenshots):

40 40 Numeric Results A numeric report contains numeric results in a table format and can also include textual observations, as shown in the following screenshot: For each instance of test collection, the test results and values are shown in the table with the following display formatting: Format/Content Black * Red ** Red Description Normal result: the actual value is within the reference range. Red font with one asterisk. Abnormal; the results are outside the normal range and are of clinical concern. Red font with two asterisks. Critically Abnormal; the results are well outside the normal range and are of great clinical concern. - Dash: the test result is not available. a, b, c... Displayed in front of the actual value to indicate that its unit or reference range differs across a set of results. If any of the units are null, they are considered to match any other units that are present. Units are case sensitive; for example, mmol/l and MMOL/L would cause to be displayed. Displayed in front of the actual value to refer to comments associated with the test result.

41 41 Individual results, which have an associated comment, are identified by a letter superscript and the associated comment will display underneath the table. When a numeric result has a textual observation, the full text will display across the Result and Ref.Range (Units) columns. If a reference range is provided, the textual observation will only display in the Result column. Textual Results A textual report contains textual observations, as shown in the following screenshot:

42 42 Microbiology A microbiology report contains microbiological observations, as shown in the following screenshot:

43 43 Radiology Results A radiology report contains textual observations, as shown in the following screenshot:

44 44 Viewing Historical Results The latest version of the result will always display when you select a result to view. The Show Version (and Show Version History for Numeric results) links in the Report History section are available if there is more than one version of the result. You can select and view earlier versions of the result including comments by selecting these links. This is applicable for all types of results. To see all instances of when the result was accessed, along with the name of the user and which views were used, select the Expand icon to the right of the Access History section. Select one of the Show Version links in the Report History section to open a historical version of the report. You can use the Older Version, Newer Version and Latest Version links in the banner to navigate between versions of the report as shown in the following example screenshot:

45 45 Version History Version History displays the test results over time in a tabular form for easy comparison between the currently selected version of results (highlighted in blue) and any earlier or later versions of the same report. It displays the types of test, reported dates and versions of the report as shown in the following example screenshot: By default, results will be displayed from the oldest (left) to the newest report (right). Any values that differ from the previous version will be highlighted with a purple border. You can view additional information by hovering your mouse over the different sections of the screen, i.e. individual numeric value or date/time header.

46 46 The Version History table displays the following: The Test row represents the status of the report version, Interim or Final. The Reported row displays the reported date for the sample. For each instance of test collection, the test results and values are shown in the table with the following display formatting: Format/Content Black * Red ** Red Description Normal result: the actual value is within the reference range. Red font with one asterisk. Abnormal; the results are outside the normal range and are of clinical concern. Red font with two asterisks. Critically Abnormal; the results are well outside the normal range and are of great clinical concern. - Dash: the test result is not available. a, b, c... Displayed in front of the actual value to indicate that its unit or reference range differs across a set of results. If any of the units are null, they are considered to match any other units that are present. Units are case sensitive; for example, mmol/l and MMOL/L would cause to be displayed. Displayed in front of the actual value to refer to comments associated with the test result.

47 47 Collection Details You can view more collection details by hovering your mouse over the Reported date. By default, the following details are displayed when you hover (your mouse cursor) over the Reported date, including any observations that were made in association with the report: The dates collected, received and reported Status of the result The source and order number Comments associated with the report identified by a superscript number, if any

48 48 Result Details, Reference Range and Unit of Measurement By default, the following result value details are displayed when you hover (your mouse cursor) over the test value: Actual result value Description of abnormality, if any Date collected Reference range and unit of measurement Source system Comment(s), if any You can access the particular version of the report (in the single-result view) by selecting the Reported date link for that particular version.

49 49 Viewing Cumulative Results Displaying reports in the Cumulative view helps in quickly identifying any trends or patterns that may be present for a series of test results. The Cumulative report is available only for tests with numeric results. To display the report in the Cumulative view, select the View Cumulative Results link from the Single Result view. The screen contains a table of test results over time, allowing easy comparison between the currently selected set of results (with a blue background) and any earlier or later results of the same test. By default, results will be displayed from the oldest (left) to the newest report (right). The table contains rows that represent the type of test and columns that represent different reports, as shown in the following screenshot:

50 50 The Cumulative view contains a table with the following header and body rows: Table Header Rows Row Number Description The number assigned to the report in chronological order based on collection date. If the report is not final, the relevant cell is highlighted in dark orange and the status code of the report is displayed. The cell highlight for a report that is not final will display over the blue highlight that indicates the report in focus. This row also contains a checkbox, which allows you to select all the tests to show on a graph. Collected Source The collection date for the sample. This header allows you to show more collection details, as well as display the individual report in the single-result view. The source of the result.

51 51 Textual Observations Textual observations will also display in the Cumulative view if they are present in a numeric report. Observation text that is too long for the table cell will be partially visible, and you can hover over the text to read the full observation as shown in the following screenshot: Working with Graphs This option is only available for tests with Numeric values. Graphs plot individual results, which have been selected from a Cumulative view. To view multiple numeric results in a graph: In the Document Tree, select one of the results you want to be included in the graph. The selected result is displayed. Click the View Cumulative Results link. Select the results you want to be included in the graph. If you are using Internet Explorer or an ipad, you can only select 10 results to display in the graph. If you select more than 10 results, the Graph button will be disabled, and you will receive an error message. Click the Graph button. The graphed view is displayed.

52 52 To view results: Search for and select the patient you want to view the results From the Patient Summary, expand a category in the Document Tree Select the result to want to view The first graph is an Overview with all the test results. Beneath that are individual graphs for the selected tests. By default, the Overview graph displays the periods covered by the columns in the Cumulative view. All graphs are scaled to show the highest value of all the test values. Overview Graph The Overview graph shows the different test results over time on a single graph, where each line represents a particular test. The legend for the line colors is displayed below the graph. The Source panel displays a separate button for each information source with an indication of how many data points on the graph came from that source. By default, the graph displays the results from all sources. To exclude the results provided by one or more sources, click the corresponding button on the Sources panel. Click the button again to show the data points from that source. The Overview graph allows you to zoom into a specific period to be displayed on the individual graphs. You can use your mouse to highlight a specific area or period on the Overview graph. This action automatically changes the zoom level for the individual graphs below. The individual graphs are automatically refreshed to reflect the period specified on the Overview graph.

53 53 Zoom quick links are links to pre-configured zoom levels. To use the zoom quick links, click the All or Default link below the Overview graph. All - Zooms all individual graphs to show all test results. There is no selection indicator (pale blue overlay) in the Overview graph. Default - Zooms all individual graphs to show the test results selected. The Overview graph shows the selection indicator (pale blue overlay) over the area of these results. Individual Graphs Each graph represents a test involved in the result. The graph title displays the name of the test and its corresponding reference unit. The graph shows a data point for each result value. The pink shaded areas in individual graphs represent areas outside the corresponding reference range. If any point in the graph has a differing reference range or unit, the symbol is displayed next to the title of the graph. To display more information for a specific data point, hover your mouse pointer over the data point. To return to the previous screen, click the <test name> Cumulative link from the breadcrumb trail above the Overview graph.

54 54 Timeline The Timeline gives you an overall perspective of a patient's medical history using a visual representation of encounters and documents available for that patient. To display all of the information held for a patient, in a timeline: Search for and select a patient record. From the Patient Summary, click the Timeline tab on the patient Context Menu. Working with Timeline The Timeline shows the information for a patient presented according to when that information was generated or received, as shown in the following screenshot:

55 55 The following table describes the way you can interact with Timeline. To See the details of an item in the Timeline Description Hover your mouse over the relevant node. The details for that item are displayed, as shown in the following screenshot. Zoom in on a selected time frame See what the markers mean Select a time frame in any panel of the timeline to zoom in on a specified time frame. Click the Reset Zoom link to redisplay the full timeline. Click the Show Key link above each section of the timeline to display the key for that section. A key guide is displayed, advising what the different markers in that section identify. For example, the following screenshot shows an example of the Encounters key. Hide sections of the timeline Click the Collapse icon to the left of a timeline section name, to hide sections of the timeline. This enables you to hide sections of the timeline that you are not interested in so you can focus on relevant information. Click the Expand icon section again. to the left of a timeline section name, to display the Clinical Portal will remember the sections you have displayed and hidden. The next time you access the Timeline, sections you have hidden previously will remain hidden.

56 56 USING WORKLISTS A Worklist is a collection of individual patients that you have grouped together. One of the features of the NC HealthConnex portal is the ability to customize worklists to which patients can be assigned. Many providers choose to create high-risk patient groups to which they can assign patients who might need more attention or different treatment methods. You can create a worklist to suit your own purposes and only you can see the worklists that you create. There are six customizable worklists, which can be renamed and configured from this screen. Clicking the Rename link will allow you to name the worklists to indicate the intent of the group. Clicking on the Settings icon in the upper right hand of the worklist will allow you to configure what columns you would like to see when the worklist is displayed. By default, there are 6 blank worklists with a limit of 100 entries each that you can use to create the worklists you need: You can perform the following functions with a worklist: View a Worklist Add a patient to a worklist Replace a patient on a worklist from a search Remove a patient from a worklist Rename a worklist Viewing Worklists To view the patients on your worklists: Your worklists will display in the My Worklist section of the Homepage Select the individual patient record from the worklist.

57 57 Each worklist is limited to 100 entries. If a worklist is full, a warning displays, as shown in the following screenshot: You cannot add new entries to an already full worklist. You will have to manually delete entries from the worklist before adding new entries. Once a worklist is displayed you can: Change which columns are displayed by clicking the Column icon Change the order that items are displayed in a column by clicking the Sort icon at the top of the column.

58 58 Adding Patients to Worklists You can add patients to a worklist from the results of a Patient Search, or from the Patient Context Menu. However, if a worklist is already full, you cannot add new entries without deleting some existing entries. From a Patient Search To add patients to a worklist from the results of a patient search: From the Search Results panel, select the patients you want to include on a worklist. In the Add checked results to worklist list, select the worklist you want to add the selected patients to, as shown in the following screenshot: From the Context Menu To add patients to a worklist from the Context Menu: Place a patient in context. Click the Worklist icon next to the patient name. If the patient is currently on a worklist, the color of the icon will match the color associated with that worklist. If the patient is on two or more worklists, the background color will match the first worklist the patient is on. Select the worklist to which you want to add the patient, as shown in the following screenshot:

59 59 Replacing Patients on a Worklist You can replace the patients on a worklist from the results of a patient search. However, if the number of selected patients is greater than the worklist size limit of 100 entries, you must first deselect some patients before a worklist can be replaced. To replace the patients on a worklist: Search for a patient. In the Search Results panel, select the patients you want to include on your worklist. From the Replace worklist with checked results list, select a worklist, as shown in the following screenshot. This replaces all the patient names in the worklist with the names selected from the search results.

60 60 Removing Patients from Worklists You will need to remove patients from a worklist if the worklist has reached its limit of 100 entries. To remove patients from a worklist: Select the Worklists><NameOfWorklist> menu item. The selected worklist screen displays the list of patients in the worklist, as shown in the following screenshot. Select the checkboxes next to the names of the patients you want to remove from the worklist. Click the Remove button. Or, you may remove patients from a worklist using the Context Menu. To remove a patient from a worklist: Place a patient in context. Click the Worklist icon next to the patient name. If the patient is currently on a worklist, the color of the icon will match the color associated with that worklist. Select the worklist from which you want to remove the patient, as shown in the following screenshot:

61 61 Renaming a Worklist You can personalize the names of your worklists to be more relevant to your work. For example, you can call your worklists Cardiology, General Medicine, and so on. On the menu bar, click Worklists><worklist>. Click the Rename link, as shown in the following screenshot. Enter a new name for the worklist, as shown in the following screenshot: Click the Save link. Refresh your page in the browser to update the menu entry points to reflect the new worklist name.

62 62 NOTIFICATIONS Notifications of clinical events may be subscribed to and received by Level 1 Primary Providers only. If subscribed, the user will receive a notification for a patient with whom the provider has a relationship. A relationship is data-driven-meaning that the provider ID (NPI or organization ID) has been included in the HL7 message for the specific patient and clinical event. The NPI or provider ID must also be included in the user account details for the provider. To include the NPI or Provider ID in your user account, contact your Participant Account Administrator. This is a very important step to enable clinical notifications. My Subscriptions The My Subscriptions entry point in the Notifications menu allows a user to subscribe to notifications in order to receive notifications when a specific event occurs for a patient or group of patients with which the user has a relationship. The user is able to subscribe to various notifications based on the relationship he/she has with the patient or patients and the access privileges of the user. If the checkbox alongside a notification event is checked, the user will receive notifications of that event. The My Subscriptions screen, as shown below, displays when selected: For reference: Concerto User Messaging = Portal Messaging. Concerto is referring to one component of the Orion Health suite of products. Portal messaging is enabled with the creation of the Clinical Portal user account; no additional set-up is required by user or Participant Account Administrator.

63 63 My Subscriptions fields are detailed as follows: Label My Address Description External address to receive notifications. If a user modifies the field from this screen, the My Details screen will be updated to ensure both fields are in sync. Notifications sent to this address will be summary in nature and will not include detailed information. Delivery Channel Descriptions: Notify By Concerto User Messaging Notify By Notify in Daily Summary Notify in Daily Summary Concerto User Messaging Sends the notification (containing patient information) securely to Clinical Portal user account messaging (Received Messages) Sends the summary notification (without patient information) to the address identified Sends a daily summary (without patient information) of the notifications, as opposed to individual notifications Sends a daily summary of the notifications (containing patient information) securely to Clinical Portal user account messaging (Received Messages) An example of a summary that does not contain patient information is displayed below:

64 64 An example of a message that DOES contain patient information is displayed below: Each individual subscription may be manually changed if required. To change the Delivery Option of a specific notification, check the box next to the notification to be modified. To select an additional Delivery Option, check the box next to the option and click OK. To revert to defaults, click Use Defaults. Finally, click Save to save the modifications to the notification delivery. Additionally, a user may change notifications based on the type of relationship the user has to the patient or group of patients. To change the notifications by type, click the Change to subscribe by Relationship Type link. This action allows a user to subscribe to notifications for other types of patient/provider relationships. Once displayed, the user may change the delivery options for each notification subscription based on the relationship type. Available relationship types are: Admitting MD Attending MD Primary Care Provider (PCP) Referring MD Specialist

65 65 USING CLINICAL PORTAL MESSAGING Clinical Portal Messaging enables the secure sending and receiving of s between clinicians within NC HealthConnex. Messages can only be sent to, and received by, users that have access to the Clinical Portal application. Clinical Portal Messaging differs from Communicate Webmail in the following ways: Clinical Portal Messaging is available between users with an active NC HealthConnex Clinical Portal account. Portal messaging is included in your NC HealthConnex account. Communicate Webmail messaging is available between users with a Direct messaging account. This may include users from outside the NC HealthConnex, and are members of the Direct Trust. Communicate Webmail accounts must be requested and approved by Communicate Webmail Organization Administrators tasked with the approval responsibility. Select the Portal Messaging menu option from the menu bar: You can view the number of messages that you have received but not yet read next to your user name in the Global Menu: An exclamation mark! next to the number indicates that at least one of the messages you have received has been marked as Important by the sender. Click on the number to view the messages. Sending Messages To send messages: Select the Portal Messaging>New Message menu item. The New Message screen is displayed, as shown in the following screenshot Complete the fields on the screen:

66 66 Field Description To Click the To... button and select the clinician to whom you want to send the . Importance Subject Select the level of importance you wish to attach to the message, High, Normal or Low. If you want the message to be marked as important, select High from the drop-down list. Type the text you want to be displayed for this message in the recipient's inbox. Message Type your message. If you want the text to wrap to the width of the recipient's screen, select the Word Wrap checkbox. Click the Send button. Reading Messages To read messages: Select the Portal Messaging>Received Messages menu item. Alternatively, you can click the Received Messages icon in the Global Menu as shown in the following screenshot:

67 67 The Received Messages screen is displayed, as shown in the following screenshot: From the Received Messages screen, you can: Select a message to open and view the message If a patient record/id is displayed, select the patient ID to open the dynamic patient summary Sent Messages To view sent messages, select the Portal Messaging>Sent Messages menu. A list of messages you have sent to other Clinical Portal users is then displayed. The following options are available on the Sent Messages list: Delete: Select the checkbox next to a message then click the Delete button to permanently remove the message. You will not be asked to confirm this action. Select All: Select the checkbox next to the To field. This action selects all messages with a single click, allowing you to easily remove all messages. New Message: Click the New button to open the New Message screen, from which you can create a new message. Select: Select a message to view the message details: If you have sent patient documents or results, you can select the patient or the attachment and display the details in Clinical Portal.

68 68 COMMUNICATE SINGLE SIGN ON To put it simply, if your NC HealthConnex connection is Communicate Webmail Single Sign On-enabled, you no longer have to log in to Communicate Webmail separately to access your secure mailbox. You can now access both Clinical Portal and your Communicate mailbox with one username and password combination. Users log in once to gain access to Clinical Portal, and this seamlessly gives you access to the Communicate Webmail menu. If you have a Communicate Webmail account and wish to utilize the Communicate Webmail Single Sign On (SSO) feature in NC HealthConnex portal, please contact your Participant Account Administrator to ensure that you have both a DSM Communicate Address and Username. This information, as well as your Organization ID will be required to integrate Direct Secure Messaging into your portal. The following two pages are instructions to complete the integration process and enable the Communicate>My Mailbox entry point. After SSO has been enabled, a new COMMUNICATE menu option will be visible on the left pane when users sign into Clinical Portal.

69 69 INSTRUCTIONS FOR ENABLING SINGLE SIGN ON SETTING UP SINGLE SIGN ON BETWEEN NC HEALTHCONNEX CLINICAL PORTAL AND NC HEALTHCONNEX DSM Single Sign On (SSO) is a new feature for North Carolina Health Information Exchange Authority (NC HIEA) participants that allows clinicians to have one entry point for both the Clinical Portal and Secure Messaging (DSM aka Communicate Webmail). Both tools seamlessly integrate, and users only have to keep track of their Clinical Portal credentials, allowing them to be automatically logged into DSM when on the portal. To enable this feature, you must verify the existence of a DSM web account and a matching Clinical Portal account. The account names do not have to match, accounts just have to exist (and be active) in both systems for the same user. The steps below outline what you need to do to complete this process. NC HealthConnex Direct Secure Messaging (DSM/Communicate) 1. Verify the user has an account, if you do not have an account, contact your Participant Account Administrator who can create an account if one does not exist. Alternatively, the user can self-register for an account. 2. Verify the user has logged in at least once and the account is not disabled or pending login. (Upon a search for a user in the DSM Administration site, you will be told if the user has ever logged in and if the account is currently disabled; your Participant Account Administrator can do this for you.) To complete the integration in the next step, you will need to provide the following information: a. Communicate Address (ex. Jane.Doe@direct.web.nchie.net) Note: this is the full address to which messages are sent. b. Communicate User Name (ex. Jane.Doe) Note: this is the portion of the DSM address before sign. Remember the period between first and last name. c. Organization ID (ex. direct.web.nchie.net) Note: this is the portion of the DSM address after sign. NC HealthConnex Clinical Portal 1. Verify the user has an account by searching for the user. Contact your Participant Account Administrator to create an account if one does not exist. 2. Edit the account by clicking on the user in the list to show user details or enter these values for a new user. a. Under Group Memberships, add the Communicate Webmail User group to the user s list of active groups. b. Click Update Preferences to save and refresh the page. c. Under Communicate Webmail Users, fill in the following fields: i. Communicate User Name ii. NPI (optional, may be left blank if not known) iii. Organization ID iv. Communicate Address d. Click Update Preferences to save your changes.

70 70 The next time you log into the Clinical Portal, you will see a new menu option on the navigation bar on the left. The menu will say Communicate. When the menu is expanded, it will contain My Mailbox. The user can click on the My Mailbox link to see their NC HealthConnex DSM messages. Here is an example of how the menus look before this configuration (will vary by user role): And after:

71 71 COMMUNICATE (DIRECT SECURE MESSAGING) WEBMAIL Selecting the Communicate>My Mailbox menu option/entry point will initiate the authentication into Communicate. This authentication occurs automatically without any user interaction, and creates a session for the user in Communicate. Users can subsequently use their mailbox, as if they had logged into Communicate directly. Communicate functions remain the same as with the Communicate Webmail option (standalone). When the user's Clinical Portal session ends, their Communicate session will also be terminated. Communicate Webmail enables the secure sending and receiving of s between associates that are members of the DirectTrust. The ability to easily send encrypted messages between Orion Health HISP subscribers and non- Orion Health subscribers (trusted HISPs for example, HealthVault). Direct Message Portal (webmail). Standard webmail capabilities including secure sending/receipt of messages and attachments, and viewing CDA attachments in the browser. Focus on Web Content Accessibility Guidelines (WCAG) 2.0 recommendations for making Web content more accessible. Messages can only be sent to, and received by, associates who have access to the Direct Messaging application not to regular accounts such as Gmail or Yahoo. Using the Global Menu The Global Menu can be accessed from any screen in Communicate Webmail. Item Last Logged In Home Help Logout Description Displays the date and time that you last logged into Clinical Portal. It only displays for a few seconds every time you log in. Displays your home page. This can be a default home page configured by your administrator or a home page you have selected from the My Preferences screen. Displays the online help. Selecting this button closes Communicate Webmail.

72 72 Message List Conventions The following list describes the conventions used in the message lists within a folder. Unread messages are displayed in bold against a light gray background. Read messages have a white background and the subject of the message is not highlighted in bold. Starred messages have a light orange background with an orange star next to the sender or recipient's name. [When a message is flagged, an orange star appears next to the message in the message list. Flags provide a visual cue and remind you to follow up on a message.]

73 73 Working With Messages This section describes working with messages. Sending, receiving, and forwarding messages and attachments will make up the bulk of your work with Communicate Webmail. Receiving New Messages Incoming messages are displayed in the Inbox, or if you have message rules defined, they are automatically filtered into message folders according to the message rule. When you log into Communicate Webmail, the Inbox is displayed by default. Select the Inbox folder to view new messages. To view the messages in other folders, select the folder from the list of folders. NOTE: If you are using Internet Explorer 8 and you have many messages in your Inbox, it will take a long time to load and display an error message. For optimal performance, it is recommended that you use Firefox or Internet Explorer 9 and later to view your Inbox. To expand the message details panel, select the Message Details icon.

74 74 The following table displays the name of each field on the message details panel, along with an explanation of each field: Field Description Original Sender Forwarded by From Sent By On-Behalf of To Cc Date Received The original sender's name and address (if the message is auto-forwarded) The intermediary sender's name and address (if the message is auto-forwarded) The sender's name and address The sender's name and address (when the message is sent by a shared mailbox user) The person on whose behalf the messages are being sent (when the message is sent by a shared mailbox user) The recipient's name and address. The recipient's name and address to whom a copy of the message was sent. The date and time when the message was received.

75 75 Field Description Subject View Mode The subject line of the message. Indicates whether the displayed message content is HTML or Plain Text. If the message contains both HTML and Plain Text, the message content is shown in HTML by default. A link is displayed which enables you to switch the message content between HTML and Plain Text. Receiving Messages from a Proxy (Shared) Mailbox If you receive a message from a mailbox, which is being managed by a proxy, then you will see a message similar to the following: Proxy's Name (in this case, Joe Fremantle) on-behalf of Mailbox Owner's Name (in this case, Jill Doping) to When you reply to this , you will be replying to the owner of the mailbox, in other words you will be replying to Jill Doping. Unread Messages When you have new (unread) messages in a folder, Communicate Webmail displays the folder name in bold. The number of new (unread) messages are shown to the right of the name. When a new message is delivered to a hidden sub-folder, Communicate Webmail displays the lowest visible parent folder in bold. The number of new (unread) messages in a hidden sub-folder is not visible

76 76 until the parent folder has been expanded to reveal the sub-folder. Sorting Messages By default, messages are sorted by date in descending order. You can change the sort order of your messages by selecting the Sort recent at top option. The table below lists the sort options that you can choose from. Sort Option Description Sort recent at top Sort oldest at top Sort starred at top Sort unread at top Sort by sender Displays the latest message at the top of the list Displays the oldest message at the top of the list Displays all messages flagged for follow up at the top of the list Displays all unread messages at the top of the list. Alphabetically orders the message list based on the sender's first name

77 77 Flag Messages for Follow Up Flags provide a visual cue and remind you to follow up on a message. When a message is flagged, an orange star appears next to the message in the message list. You can sort your Inbox for starred messages. Flagging A Message 1. Double-click the message to open it. 2. Select the icon to mark the message for follow up. The icon changes to. Compose a Message 1. Select the New button. 2. On the New Message page, mandatory fields are marked with an asterisk (*). Complete the following fields: Field FROM Description The From field should default to your mailbox. If you have access to a shared mailbox, then you can choose from which mailbox you want to send your message. TO Start typing the recipient's name. Communicate Webmail displays a list of matches as you type. Select the recipient's name from the list. The autocomplete list displays a maximum of 15 items. Therefore, if the address or contact group you are looking for is not displayed, enter a few more letters to reduce the matches. Alternatively, you can search for a provider using the provider search. To send the message to multiple people, select Add Recipient.

78 78 CC SUBJECT MESSAGE To send a copy of the message to another person, select Add Cc Recipient and start typing the recipient's name. Communicate Webmail displays a list of matches as you type. Select the recipient's name from the list. Type a subject line for your message. Type your message. You can customize the font style and insert links using the rich-text formatting buttons. Refer to Use Rich Text to Format my Message and Signature for details. 3. If you want to send an attachment, select the Browse... button, and locate the file you want to attach. Refer to Working with Attachments for details. 4. Select the Send button to send your message, or the Discard button to discard your draft. A message is displayed to confirm your has been sent. NOTE: Once a message has been sent, it cannot be recalled. A copy of the message is stored in your Sent folder. If your cannot be delivered, a Delivery Failure Notification is delivered to the sender. Depending on the cause of the delivery failure, the notification may take an hour or more to arrive. Therefore, we recommend following up urgent messages in person. Refer to Delivery Receipts in Communicate Webmail for more details.

79 79 Use Rich Text to Format My Message and Signature To format the text in your message or signature, select the text, then use the style and formatting buttons to select the options you want. Icon Description Figure 2 Bold button Makes the selected text bold Figure 3 Italic button Italicizes the selected text Figure 4 Underline button Underlines the selected text Figure 5 Bulleted List button Creates a bulleted list Figure 6 Numbered List button Creates a numbered list Figure 7 Insert Link button Creates a hyperlink Inserts your signature in the body of the message This icon is only visible if you have enabled signature in your Preferences.

80 80 To change the paragraph style, select one of these options: Style Description Paragraph Heading 1 Heading 2 Applies the Paragraph style to the selected text Applies the Heading 1 style to the selected text Applies the Heading 2 style to the selected text Find A Provider This section describes how to find the Direct address of another Communicate user, when composing, forwarding or replying to a message. 1. In your mailbox, click to compose a message. 2. On the New Message page, click the Show Provider Search link. 3. In the Provider Search pane, enter the first or last name of the provider you are searching for, and press ENTER. Tip: All the search fields are case-insensitive, and accept exact as well as partial word searches. 4. If you get too many results, and you want to narrow down your search: a. Click the More Options link. b. Enter your search criteria and press ENTER. 5. Click the To link to copy the provider's address to the To field. Click the Cc link to copy it to the Cc field. To hide the Provider Search pane, click the Hide Provider Search link.

81 81 Forward A Message Sometimes, you may want to forward an message to a colleague to answer. When you forward an , it will include any attachments that were part of the original message. You may remove these attachments, or add new ones. Refer to Working with Attachments for more information. 1. Select a message to open it. The message displays in the right-hand pane. 2. Select the Forward button. A copy of the original message is automatically inserted as plain text. All attachments in the original message will be included in the forwarded message by default. 3. Enter the names of the recipients in the To field. 4. Type your message. 5. Select the Send button to forward the . The original message in your Inbox will display the Forward icon. When you are forwarding a message from a shared mailbox, the From field always displays 'on behalf of'.

82 82 Replying To A Message 1. Select a message to open it. The message displays in the right-hand pane. Incoming HTML messages are sanitized to remove potentially malicious content. This means that images, links and certain styles may not display. In the proxy mailbox when a user marks a message as Read, then it will be marked as Read for all other shared users as well. 2. To display message details, such as, who the message is from, the subject of the message, and the date the message was sent, select the Message Details icon. When the message details panel is expanded, the time zone is displayed next to the date and time that the message was received. This time zone is taken from the computer's operating system of the logged-in user. 3. Select the Reply button to reply to the sender of the message, or the Reply All button to reply to all the recipients of the original . The Reply Message page opens in a new window, and a copy of the original message is automatically inserted as plain text.

83 83 When replying to a message as a proxy, the From field will always display On-behalf of <mailbox owner>. 4. Compose your reply. 5. Select the Send button to send your message, or the Discard button to delete your draft. A confirmation message is displayed when your message is transmitted successfully.

84 84 Sent Messages The Sent Messages folder contains copies of all messages you have sent. To view your sent messages, select My Mailbox > Sent. When you send a message from a shared mailbox, a copy of the sent message is saved in the Sent folder of the shared mailbox. Sorting Sent Messages By default, messages display in descending order. You can change the sort order of your messages by selecting the Sort option.

85 85 The following table lists the sort options that you can choose from, along with an explanation of the functionality of each sort option: Sort Option Description Sort recent at top Sort oldest at top Sort starred at top Sort unread at top Sort by recipient Select this option to view the latest message at the top of the list. Select this option to view the oldest message at the top of the list. Select this option to view all starred messages at the top of the list. Select this option to view all unread messages at the top of the list. Select this option to view all messages in alphabetical order according to the recipient's first name. Working With Sent Messages Even though a message has been sent, you may still work with it. You may: Reply to the message by selecting the Reply button, or reply to all recipients by selecting the Reply All button. Forward the message to a new recipient by selecting the Forward button. Mark the message as unread by selecting the Mark as Unread link. Mark the message as important by selecting the star icon. Refer to Flag Messages for Follow up for details. View more information about the message by selecting the Message Details icon. Delete the message by selecting the Delete button. Working With Drafts Draft messages are messages that you have composed, but not yet sent. Communicate Webmail automatically saves a draft of your message in the Drafts folder every 2 minutes while you are writing. In addition, when you forward, reply or reply all to a message, your drafts are instantly saved as you write. This is very useful if you have to step away from your desk, or accidentally close the compose pane before sending. You can also manually save a message as a draft by selecting the Save as Draft button.

86 86 Editing A Draft 1. From the menu, select My Mailbox > Drafts. 2. Select the draft you want to edit. 3. Select Continue Editing, and complete your message. 4. Select the Send button to send the message. If your draft is no longer required, you can permanently delete it by clicking the Discard button.

87 87 Clicking Discard permanently deletes your draft. In other words, you will not find your draft in the Trash folder. Sorting Drafts By default, messages are sorted by date in descending order. You can change the sort order of your messages by selecting the Sort recent at top option. The table below lists the sort options that you can choose from. Sort Option Description Sort recent at top Displays the latest message at the top of the list Sort oldest at top Displays the oldest message at the top of the list Sort starred at top Displays all messages flagged for follow up at the top of the list Sort by recipient Alphabetically orders the message list based on the recipient's first name Working With Attachments Attachments are files which are attached to an . For example, an image or a document may be sent as an attachment. Attachments are uploaded from, downloaded to, and stored on local computers. If you download an attachment, you are responsible for using appropriate safeguards to prevent improper use and/or disclosure of any personal identifying information (PII) including patient protected health information (PHI). You also agree not to use or disclose PII or PHI contained in a downloaded attachment other than as permitted or required by applicable law.

88 88 Adding An Attachment To A Message 1. Compose a new message. 2. In the Attachments field, click the Browse button to locate and upload your document or image. If your attachment size exceeds the configured limit (50 mb per ), an error message is displayed. If you send the message, it will be delivered without the attachment. If you upload multiple attachments and the total size of all the attachments exceeds the configured limit (50 mb per ), an error message is displayed and the Send and Save as Draft buttons become unavailable. You can remove attachments by selecting the Remove icon. When using Mozilla Firefox and Safari, the attachment size is checked before the file is uploaded to the server. In the case of Internet Explorer 8 and 9, Communicate Webmail attempts to upload the file to the server before it displays the error message. If a virus is detected, an error message is displayed and the attachment will not be saved. 3. Select the Send button to send the message.

89 89 Download An Attachment When you receive a message with an attachment, the Attachment icon is displayed next to the message. 1. In your mailbox, select the message containing the attachment. If the attachment is a CCD or CDA, the patient's information is displayed in the header of the attachment, otherwise it is not displayed. If the attachment is a CDA, PDF, image or plain text file, the attachment is displayed as a link. Click the link to view the attachment in the body of the message. If the message contains an XDM file, each attachment will display separately under the main attachment name.

90 90 2. Select the Download button. You will be prompted to open or save the attachment, or select a download option. Option Description Download as PDF View printable version Downloads the attachment as a PDF. Displays the attachment in a printable format. Click the Print button to print the attachment. This option is only available for CDA and PDF documents. Attachments are vulnerable to viruses. Only open attachments from sources you trust. Forwarding A Message With An Attachment Messages containing attachments may be forwarded to another user, as described in Forward a Message. Attachments may be removed from messages to be forwarded, or more attachments may be added. Attachments are scanned for viruses when they are uploaded, but not when they are forwarded.

91 91 Delete Messages Deleted messages are stored in the Trash folder. Please note that if you delete a draft, the message is not moved to Trash. It is permanently removed. If you delete messages from a shared mailbox, the messages are moved to the Trash folder of the shared mailbox. Select a message, then select the Delete button. The message is moved to Trash. Deleting Multiple Messages This option is not available on an ipad. 1. Select the messages you want to delete. To select multiple... Do this... Consecutive messages Select the first message in the series, hold down the Shift key, then select the last message in the series. Non-consecutive messages Hold down the Ctrl key, and select individual messages.

92 92 2. Select the Delete button. If you are deleting multiple messages from the draft folder, the button will say Discard instead of Delete. Please note that if you delete drafts, the messages are not moved to Trash. They are permanently removed. Sorting Deleted Messages By default, messages display in descending date order. You can change the sort order of your messages by selecting a Sort option.

93 93 The following table lists the sort options you can choose from. Sort Option Description Sort recent at top Displays the latest message first Sort oldest at top Displays the oldest message first Sort starred at top Displays all starred messages at the top of the message list Sort unread at top Displays all unread messages at the top of the message list Sort by sender Displays all messages in alphabetical order according to the sender's first name Emptying The Trash Folder Messages remain in the Trash folder until you choose to delete them permanently. 1. Select the Trash folder. 2. Select the messages you want to delete. To select multiple... Do this... Consecutive messages Select the first message in the series, hold down the Shift key, then select the last message in the series. Non-consecutive messages Hold down the Ctrl key, and select individual messages. 3. Select the Delete button.

94 94 Find A Message You can filter the messages in a folder by address and message subject. In the Search <folder> field, enter the term or the first few letters of the term you want to search for. Communicate Webmail looks up the address and subject of each message, and only displays the messages that match the string you entered. If the term you enter contains the following punctuation characters, they are ignored: At sign (@) Hyphen (-) Underscore (_) Full stop (.) Print Messages If you are viewing the message as Plain Text, then the message is printed in plain text. Similarly, if you are viewing the message as HTML, then the message is printed in HTML format. 1. If you want to change the print format: a. Click the icon. b. In the View Mode field, click the link to change the mode to Plain Text or HTML. You cannot select the View mode for system-generated messages. For example, MDNs and auto-replies.

95 95 1. Click the Print icon. 2. Select your print options in the Print dialog. Working With Shared Mailboxes You can authorize another person to manage your mailbox on your behalf. Refer to Authorize Another Person to Manage your Mailbox to learn how to do this. If you are authorized to access another user's mailbox, a new section (titled SHARED MAILBOXES) appears in the left pane below MY MAILBOX. You can interact with a shared mailbox the same way you interact with your own mailbox.

96 96 Things To Note Contacts and Preferences The contacts and preferences are the personal contacts and preferences of the user. These are not shared. Dragging and Dropping Messages You cannot drag and drop a message from one mailbox to another. Folders If you have multiple mailboxes, when you create a new folder, you will be requested to select a mailbox in the Add Folder dialog. Folders can only be moved within a mailbox. Notifications External notifications are only sent to the address you have configured in Communicate Account Management Portal. In other words, not every shared mailbox user gets a notification when new mail arrives or delivery fails. Authorize Another Person to Manage Your Mailbox You can manage who has access to your mailbox using the Preferences screen. External notifications are only sent to the address you have configured in Communicate Account Management Portal. In other words, not every shared mailbox user gets a notification when new mail arrives or delivery fails. If you want to change your primary address, you must edit your user profile. 1. On the left pane in Communicate Webmail, select Preferences. 2. On the Preferences screen, under Shared settings, select the Share My Mailbox checkbox to enable sharing. 3. In the Give Access To field, start typing the name of the user you want to share your mailbox with. Possible matches are displayed as you type.

97 97 4. Select a user from the list. 5. If you want to share your mailbox with additional users, click the Add user link. 6. Click the Save button. Note that your shared settings will not take effect until you save.

98 98 Managing Folders Folders enable you to manage your mailbox and organize messages so you can find them easily. There are two types of folders: System Folders User-defined Folders System Folders The system folders are Inbox, Drafts, Sent, and Trash. You cannot move, rename, or delete these folders. System folders are always displayed at the top of the list of folders, followed by any folders you create. Inbox - New mail arrives in the inbox when you first receive them. The Inbox is displayed by default when you log in to Communicate Webmail. Refer to Receive New Messages for details. Drafts - Draft messages are messages, which have been composed, but have not been sent. Any type of message can be saved as a draft, whether it is a New, Forward, Reply, or Reply All message. Refer to Working with Drafts for details. Sent - The Sent folder contains copies of all messages you have sent. Refer to Sent Messages for details. Trash - Deleted items are placed in the Trash folder and remain there until you manually delete the message (in the Trash). The message is then permanently deleted and cannot be restored.

99 99 User-Defined Folders Communicate Webmail enables you to create folders to organize your mail. Folders you create are displayed below the system folders, in the list of folders. Folder names must be unique at each level. Folder names are case-sensitive, meaning Referrals and referrals are not considered the same name. Add A Folder In addition to the system folders (Inbox, Drafts, Sent, and Trash), you can create custom folders to store your mail messages. 1. Select the Add Folder icon at the bottom of the screen. 2. Type a name for the folder. 3. Select the parent folder for the new folder. You can create two folders with the same name, as long as they are not in the same parent folder. For example, you can have a folder called Referrals in your Inbox as well as in Sent. 4. Select the Add button. Delete a Folder Communicate Webmail enables you to delete custom folders you have created. You cannot delete system folders (Inbox, Sent, Draft, and Trash). 1. In your mailbox, select a folder from the folder list. 2. Select the Delete icon. A warning message is displayed. 3. Select Delete to confirm the deletion. When you delete a folder, its contents are moved to the Trash folder. You can recover contents from the Trash folder by moving it to another folder. If there are messages in the folder that you want to save, move them to another folder.

100 100 Renaming a Folder 1. From the menu, select Webmail > My Mailbox, then select a folder. 2. Select the Rename icon. 3. Enter a new name for the folder, then select the Rename button. Move a Folder You can either drag and drop folders from one location to another using your mouse, or move them using the Move Folder dialog. 1. Select the folder you want to move. 2. Select the Move icon. 3. Select a new location for the folder, then select the Move button. If a folder with the same name already exists in the intended location, you will not be able to move the folder. You cannot move a folder from one mailbox to another. Move Messages Between Folders You can either drag and drop messages from one folder to another using your mouse, or move them using the Move Message dialog. You cannot move messages from one mailbox to another. Messages you have received can be moved to any folder, except Sent or Drafts.

101 101 Dragging and Dropping Messages 1. Select the messages you want to move. To select multiple... Do this... Consecutive messages Non-consecutive messages Select the first message in the series, hold down the Shift key, then select the last message in the series. Hold down the Ctrl key, and select individual messages. 2. Drag and drop them into the destination folder. Using the Move Message Dialog 1. Select the message you want to move. 2. Select the Move Message icon. 3. Select the folder you want to move the message to, then select the Move button. Moving Multiple Messages This option is not available on ipads. 1. Select the messages you want to move. To select multiple... Do this... Consecutive messages Non-consecutive messages Select the first message in the series, hold down the Shift key, then select the last message in the series. Hold down the Ctrl key, and select individual messages. 2. In the right pane, select the Move button.

102 Select the folder you want to move the messages to, then select the Move button. Managing your Mailbox Communicate Webmail enables you to configure auto-forwarding, configure an out of office auto-reply, create message rules, create contact groups, and configure a message signature to manage your mailbox.

103 103 Automatically Forward s You can set up your mail preferences in such a way that any message you receive (except Message Disposition Notifications [MDNs] and automatic replies) is automatically forwarded to a specified contact group. [Message Disposition Notifications (MDNs) or Delivery Receipts are sent between a sender's system and recipient's system to indicate if mail delivery has been successful or if delivery has failed. Notification messages indicate the disposition of a Direct message (for example, processed, successfully delivered, unsuccessfully delivered).] For example if you are out of the office for a period of time and you wish to have members of the care team review your incoming s, you can specify a group that will automatically receive a forwarded copy of incoming s. You must create a group (with one or more members) prior to setting up the auto-forward feature. Known Issues Please note that you cannot: Automatically forward your messages to another Direct address, but as an alternative, you can add a contact group with just one person in it, and have your s forwarded to that contact group. Set up rules for automatic forwards such that only messages that match the conditions specified in the rule are forwarded. When a message is automatically forwarded, an Auto-Forward Sent icon displays next to the message in the sender's message list, while the recipient's message list has an Auto-Forward Received icon next to the forwarded message. In addition, in the recipient's mailbox, messages that are automatically forwarded include a via <lastforwardedby> label in the header of the message specifying who last forwarded the message.

104 104 Enabling Automatic Forwarding 1. Select Preferences. On the Preferences page, select the Enable Auto-forwarding checkbox, then select the group to whom you want to automatically forward your messages. You must have at least one contact group in your address book. 2. Select the Save button. Turn on Automatic Replies You can set up Communicate Webmail to automatically respond to your s when you are away from the office or away at a workshop or on holiday. This helps inform people that your response may be delayed. Automatic replies may include details such as alternative contact information. 1. Select Preferences. 2. On the Preferences page, select the Enable Auto-Reply checkbox, enter the message you want to send while you are away. 3. Select the Save button.

105 105 Use Rules to Manage Messages Use rules to decide what happens to s when they arrive. For example, you can automatically redirect certain to a particular folder in your Inbox. Messages can be automatically filed into the Inbox, any custom folders, and the Trash folders. Messages cannot be automatically filed into the Sent or Drafts folders, or any subfolders of the Trash folder. 1. Select Preferences. 2. On the Preferences page, under Message Rules, select the Add Rule link. 3. Define the condition. Condition Description Subject Contains Enter the subject to filter on. For example, filter messages that have the word Referral in the subject. From Enter the address of the sender. For example, filter messages from admin@hie.hco.com 4. Define the action to be taken when a message meets a condition. For example, in the Move to Folder field, select the folder to file the message in when the condition matches. Multiple rules can be defined for a mailbox. Rules are run in the order they are defined in the Message Rules settings. If there is more than one condition that matches an incoming message, only the first rule in the list is executed. If an incoming message matches a condition, but the folder into which the message must be filed has been deleted, moved or renamed, then the message will be left in the Inbox.

106 Select the Save button to save your changes. Deleting a Rule Select the Delete icon next to the rule that you want to delete. Add a Signature to my Messages Communicate Webmail enables users to automatically add a custom signature to all new, reply, and forwarded messages. This helps to identify the sender of the message. Message signatures can include details such as credentials and contact information. 1. Select Preferences 2. On the Preferences page, select the Enable Signature checkbox 3. In the Signature box, type the text that you want to include in the signature 4. Customize your signature text using rich text

107 107 Please do not copy and paste content (text as well as images) from external sources into the signature editor. 5. Select the Save button. When you are composing a message from your individual mailbox and you have enabled signature in the preference screen, the signature will be inserted in the message compose screen automatically. However, if you are composing a message from the shared mailbox, you will have to add your signature manually or select the Signature icon from the rich-text editor toolbar. Refer to Use Rich Text to Format my Message and Signature for more details.

108 108 Working with Address Book An Address Book enables you to manage your contacts and contact groups and send messages to them. You can also search or sort the contacts and contact groups in your Address Book. This section describes how to work with Address Book. Manage Contacts To view a contact: 1. Select the Address Book link at the bottom of the left pane. The Address Book screen is displayed. 2. Select the contact. The contact details are displayed in the right pane.

109 109 To add a contact: 1. Select on the New drop-down button and select the New Contact option. The New Contact screen is displayed. The mandatory fields are marked with an asterisk (*). 2. Add the contact details: Title - select the title for the contact from the drop-down menu. First Name - enter contact's first name. Last Name - enter contact's last name. - enter contact's address. The addresses of providers from the Provider Directory are preloaded into the system. Start typing the name and the auto-complete functionality provides a drop-down list with matches. Select the contact from the list. Organization - enter contact's organization name. Specialty - enter contact's specialty. Group - select Add Group link to add the contact to a contact group. 3. Select the Save button.

110 110 To delete a contact: 1. Select the contact from the Address Book. 2. Select the Delete button. A warning message is displayed. Select Confirm to delete the contact. The contact is also deleted from its group. Select Cancel to cancel deletion. To update a contact: 1. Select the contact in the Address Book. 2. Select the Edit button. The Edit Contact screen is displayed. The mandatory fields are marked with an asterisk (*). 3. Update contact details and select the Save button. Sending Messages to a Contact in Address Book You can choose to send messages to a contact in your Address Book in one of two ways: Select the Message button for the contact, the New Message screen will be displayed with the contact populated in the To field. Type the contact in the To or Cc field while composing a New Message. The auto-complete functionality will provide a drop-down list with matches. Select the contact from the list.

111 111 Manage Contact Groups A contact group enables you to maintain a list of addresses and provides an easy way to send an message to everyone in the group at the same time. For example, if you frequently send messages to a group of people for referrals, you can create a contact group that contains the addresses of everyone you want to send referral messages. A message sent to this contact group is sent to all recipients listed in the contact group. Viewing a Contact Group 1. Select Address Book. 2. Select the contact group from the address book. The contact group details will be displayed in the right pane. Adding a Contact Group 1. Select New, then select New Group. 2. On the New Group dialog, add the contact group details.

112 112 Name - Name of the contact group. Description - Description of the contact group. Participants - Select the Add Contact link to add a contact to the group. Start typing contact name, and the auto-complete functionality provides a drop-down list with matches. Select contact from the list. You can also delete contact from a contact group by selecting the Delete icon for the contact. 3. Select the Save button. Deleting a Contact Group 1. Select the contact group in the Address Book. 2. Select the Delete button. A warning message is displayed. Select Confirm to delete the contact group. Select Cancel to cancel the action. Updating a Contact Group 1. Select the contact group in the Address Book. 2. Select the Edit button. The Edit Group screen is displayed. The mandatory fields are marked with an asterisk (*). 3. Update the contact group details. 4. Select the Save button.

113 113 Sending Messages to a Contact Group You can choose to send messages to a contact group in your Address Book in one of the two ways: Select the Message button for the contact group, the New Message screen is displayed with all the contacts of the group populated in the To field. Type the contact group name in the To or Cc field while composing a New Message. The auto-complete functionality provides a drop-down list with matches. Select the contact group from the list, the To or Cc field gets populated with all contacts in the group. There is a limit of 15 addresses and contact groups in the auto-complete list. If the address or contact group you are looking for is not displayed in the auto-complete list, type more characters to reduce the number of matches. Sort and Search Contacts and Contact Groups By default, contacts and contact groups are displayed in ascending alphabetical order. You can change the sort order of address book by selecting the Sort option as show in the following screenshot: The following table lists the sort options that you can choose from along with an explanation of the functionality of each sort option: Sort Option Description Sort by name Select this option to view contacts and contact groups in alphabetical order. Sort groups at top Select this option to view contact groups at the top of the list.

114 114 Searching Contacts and Contact Groups To search for a contact or contact group in an Address Book: 1. Select Address Book. 2. In the Search field, enter the full or partial name of the contact or contact group that you want to filter. Communicate Webmail looks up the name of each contact and contact group and only displays the contacts or contact groups that match the string that you entered. Delivery Receipts in Communicate Webmail Message Disposition Notifications (MDNs) or Delivery Receipts are sent between a sender's system and recipient's system to indicate if mail delivery has been successful or if delivery has failed. Notification messages indicate the disposition of a Direct message (for example, processed, successfully delivered, unsuccessfully delivered). Communicate Webmail displays only Delivery Failure Notifications. Success notifications (both processed and successful delivery notifications) are not displayed in the interface. If delivery has failed, the MDNs trigger a Delivery Status Notification (DSN), to indicate delivery has failed to one or more recipients. Delivery Failure Notifications may be generated for any of the following reasons: Message has been rejected Delivery has failed Delivery cannot be confirmed

115 115 The following screenshot shows an example of a message rejection or a delivery failure.

116 116 The following screenshot shows an example where delivery cannot be confirmed.

117 117 Protected Health Information Care must be taken to keep Protected Health Information (PHI) secure. Although Communicate Webmail is secure, information on local systems may be accessed by unauthorized users if care is not taken. This may happen if: The system is left in an insecure state; for example, you do not log out of Communicate Webmail when you finish your session. Attachments or draft messages are left open for others to see. To ensure PHI is not accessed by an unauthorized user: Always log out at the end of your session. To do so, select the Logout button. This closes all open drafts and attachments automatically. Always check all windows and tabs are closed before stepping away from your computer, as attachments and drafts may be open in new windows in your browser. Follow all security guidelines recommended by your system administrator. Taking Care Not to Miss Vital Messages When an has been opened, it is automatically marked as read. There is a risk that a message may be selected accidentally, causing it to be marked as read. There is an automatic delay between messages being opened and being marked as read; additionally, you can manually mark a read message as unread. If an fails to send, a delivery failure notification message will be delivered to the sender. Depending on what caused the sending to fail, the delivery failure notification message may take an hour or more to arrive. This means that it may be some time before the sender is aware that the failed to send. Therefore, it is recommended that urgent information is followed up in person.

118 118 TECHNICAL REQUIREMENTS Browsers NC HealthConnex Clinical Portal is currently (September 2016) operating on Clinical Portal version 8.3, and is subject to change. The following table lists the supported browsers, as well as the supported operating system for each browser: Browser Version Operating System Google Chrome Google Chrome is supported in Clinical Portal and later versions. Latest version Clinical Portal administration screens are not supported in Google Chrome. Windows Mac OS Internet Explorer 8 Latest Windows Update version Windows Vista, Windows 7 Internet Explorer 9 Latest Windows Update version Windows Vista, Windows 7 Internet Explorer 10 Latest Windows Update version Windows 7, Windows 8 Internet Explorer 11 Internet Explorer 11 Enterprise Mode Internet Explorer 11 Metro Mode Latest Windows Update version Windows 7, Windows 8, Windows 8.1 Internet Explorer 11 is supported in Clinical Portal and later versions. Microsoft Edge Microsoft Edge is supported in Clinical Portal and later versions. Latest version Clinical Portal administration screens are not supported in Microsoft Edge. Windows 10 Mozilla Firefox Latest release channel version Windows Mac OS Mozilla Firefox Extended Support Release (ESR) Latest ESR version Windows Mac OS

119 119 Safari Safari is supported in Clinical Portal and later versions. Latest version available for the Mac OS version Mac OS Safari Mobile Latest IOS version IOS (on ipad only) Mobile Device Requirements Device Platform Version Notes Windows 8.x Touch screen input is not supported on Windows 8.x. Both "Internet Explorer on the Desktop" and "Internet Explorer in the Windows UI" modes are supported for Windows 8.x. ipad IOS The latest IOS version Recommended screen resolution of 2048 x Retina Display is recommended. The Clinical Portal administration screens are not supported on ipad.

120 120 HELP DESK SAS HIE Technical Support Communication Processes and Escalation Procedures Contacting the NC HealthConnex Technical Support Team at SAS: Participant Administrator Assignment: All Participants of the NC Health Information Exchange Authority (NC HIEA) should designate 1-2 System Administrators for their organization who will have authority to utilize the SAS HIE Technical Support Team and Help Desk. These Administrators should communicate their name and contact information to the SAS HIE Technical Support Team at Please also communicate any future changes to administration so that contact information will be kept up to date. All end-users from your organization should communicate any questions they have about usage of the portal to their Administrators. The Administrators should first try to answer the question for their end-users. If the Administrator is unable to answer the question or has discovered an issue with the application, they should then direct questions, themselves, to the SAS HIE Technical Support Team on behalf of their endusers using one of the options below. HIE Technical Support Communication Options: As a SAS HIE Administrator, you have three options for communicating with our SAS HIE Technical Support team: 1. SAS Support: HIESupport@sas.com 2. SAS Phone Support: Call Local: or- Toll Free: SAS Technical Support Form: In the Product field, select NC Health Information Exchange All three options are tied closely with our customer issue tracking/ticketing systems, which ensures documentation of all issues and conversations, as well as providing timely responses and feedback. Details of how to use each option are listed below. If you have questions about the options reach out to us. We are happy to help you determine the best option for your organization. Note: Please use only these three options. Avoid communication via individual accounts and phone extensions. This ensures that the entire team knows about all issues submitted and that all team members have backup in case they are away from their desk or office. If you have been working with a specific Analyst on an issue, you will be forwarded to them so they may continue to assist you (or you may request that this occurs).

121 121 General Technical Support Hours of Operation: Monday through Friday 8:00 a.m. to 8:00 p.m. Eastern Time See details below for after-hours emergency and outage support Information you should provide: (regardless of the communication option you utilize) Contact Name Contact Address Company Name Company Site Number Problem Description Steps to reproduce and demonstrate the issue Results the user received (i.e. if there was an error message what did it state, expected results were incorrect and how, etc.) Screen shots showing the error message as well as input prior to the error occurring Time, date and user experiencing the issue Client workstation details if appropriate (browser version, operating system, etc.) Is it an isolated incident or on going? IT Contact Name if applicable Escalations: If at any point you need to escalate an issue during regular business hours, feel free to contact Kristen Somers, Manager-SAS HIE Technical Support, at or It is helpful if you can provide your SAS supplied 10-digit Track number (see details on the 10-digit Track number below).

122 122 Severity Levels and Response Times: Sev Level Condition Initial Followup * Update Frequency 1 A critical SAS HIE production system is down or does not function at all, and there is no circumvention/workaround for the problem; a significant number of users are affected, and a production business system is inoperable. 2 hours Every day 2 A component of SAS HIE is not performing, creating a significant operational impact. There is no circumvention/workaround for the problem. 4 business hours Every 2 business days ** Note: All Severity 1 and 2 issues occurring outside 8 am to 8 pm ET must be submitted via phone to guarantee response times listed. 3 A component of SAS HIE is not performing as documented; there are unexpected results; a workaround is available; there is moderate or minor operational impact. 24 hours *** Every 3 business days 4 Questions pertain to usage questions or clarification of documentation. 24 hours *** Every 10 business days 5 Customer offers suggestions or requests for new product features and enhancements. 24 hours *** Every 30 business days For problems that are assigned to a Technical Support consultant, initial follow-up is defined as the time between when the problem is initially reported and the specialist contacts the customer. For problems that require further research by the consultant who initially received the problem, initial follow-up is defined as the time between the initial contact with the consultant and a follow-up call. ollow-up as agreed upon by Customer Management and SAS Technical Support Management Does not include weekend or other non-business days

123 123 Technical Support Communication Options Details: 1. Support: Please send all requests or issue communication to Your will go directly to the SAS HIE Technical Support Team, a new issue Track will be created, and a 10-digit Track number will be assigned/ ed to you. This 10-digit Track number is important and should be used in all on-going issue communication. You can update an existing Track by sending the existing 10-digitTrack number in the subject line to HIESupport@sas.com or by replying to the new Track confirmation you receive. All members of the SAS HIE support team are immediately notified when a Track is raised in this manner, as is the Analyst who is currently assisting you. Verify that any SPAM software will not block our responses (from either HIEsupport@sas.com or technicalsupport@sas.com) Please be detailed in your problem description by including the following information: Steps to reproduce and demonstrate the issue Results the user received (i.e. if there was an error message what did it state, expected results were incorrect and how, etc.)? Screen shots showing the error message as well as input prior to the error occurring Time, date and user experiencing the issue Client workstation details if appropriate (browser version, operating system, etc.) Is it an isolated incident or on going? Please refrain from contacting the support team via direct addresses. Our goal is to respond to you as quickly as possible and document all communication around a specific issue. If you an Analyst directly, and that person is away or on vacation, you may experience delays in response times. ing the support address guarantees the will be handled quickly and the details of your communication will be captured in the issue tracking system via the 10-digit Track number. Note: All Severity 1 and 2 issues occurring outside 8 am to 8 pm ET must be submitted via phone to guarantee response times listed above. 2. Phone Support: Please use the following phone numbers to call the SAS HIE Technical Support Team: Call Local: or- Toll Free: , press option 2 You will then be prompted to enter "1" if you have a Track number (an existing issue) or enter "2" to speak with the operator (a new issue). If this is an existing issue, please locate your SAS HIE 10-digit Track number prior to making the call and provide it when prompted. If this is a new issue, the Technical Support Analyst will provide a 10-digit issue Track number during the call (be sure to ask for one if you do not receive it!).

124 124 If you entered "1" you will be routed to the Track owner during normal business hours (8 am -8 pm Eastern Time). If you entered "2" a SAS operator will answer the call. Ask to speak with a HIE Technical Support Representative (8am-8pm Eastern Time). If after hours, and not an emergency, you can leave a message for technical support. Note: All Severity 1 and 2 issues occurring outside 8 am to 8 pm ET must be submitted via phone to guarantee response times listed above. 3. SAS Technical Support Form: Please submit your issue via the online form at Before you proceed you should: Report urgent or critical problems by phone (see steps above) Verify that any SPAM software will not block our responses (from either HIEsupport@sas.com or technicalsupport@sas.com) Enter the basic Information on the form to create a Track with SAS HIE Technical Support. If you want to update an existing Track, click here. Problem Description - Be sure to include the following information: Steps to reproduce and demonstrate the issue Results the user received (i.e. if there was an error message what did it state, expected results were incorrect and how, etc.)? Screen shots showing the error message as well as input prior to the error occurring Time, date and user experiencing the issue Client workstation details if appropriate (browser version, operating system, etc.) Is it an isolated incident or on going? After you supply the basic information, click Next Page to proceed. Otherwise click Reset to start over. Shortly after you submit the form, you will receive an automatic that: Confirms that you have submitted the form successfully Provides the 10-digit Track number that has been assigned to your request. You will use this number to identify your issue moving forward. 4. Emergency Issues After-Hours: If your organization experiences a total HIE system or operational failure; this is considered a critical Severity 1 or 2 issue (see definitions above). Please have the system administrator and/or IT point of contact validate that the outage/issue is occurring for all users. If your contract states you have 24-hour support for Emergency Issues, please call the SAS phone support lines for assistance, or The SAS operator will forward you to a live, SAS Technical Support representative

125 125 who will gather information to initiate a Track. Please provide after-hours contact information for the main point of contact as well as the IT point of contact if applicable (i.e. VPN usage Participants) and ensure both are available to help triage issues at that time (both are required for emergency tickets to be addressed after hours if you connect to the NC HealthConnex via VPN). The SAS Technical Support representative will then contact an on-call SAS HIE/SSOD Support Representative to work with your team. On these occasions, you should expect a call back from a SAS HIE/SSOD Support representative within 2 hours of your initial contact. During off-hours support, you may be asked to provide your SAS Site Number. Because SAS cannot guarantee less than 24-hour response on problems tracked electronically, you should report Severity 1 or 2 problems by phone. If you chose to send an or enter a Technical Support Form, your issue will be addressed the following business-day morning. More information about SAS technical support services and policies can be found at

126 126 ABOUT OUR PARTNERS ABOUT SAS INSTITUTE The NC HIEA s technical partner is SAS Institute. Through innovative analytics, business intelligence and data management software and services, SAS helps customers at more than 80,000 sites make better decisions faster. Its world headquarters are based in Cary, North Carolina. SAS also operates the NC HIEA Technical Support Help Desk. ABOUT ORION HEALTH Founded in 1993 Orion Health is a leading global, independently owned software organization. With an inherent ability to interconnect a wide variety of healthcare information systems, Orion Health has become the world s leading provider of Health Information Exchange (HIE) and healthcare integration solutions. Today, Orion Health products and solutions are implemented in more than 30 countries, used by hundreds of thousands of clinicians and help to facilitate the care for tens of millions of people. Clinicians, provider facilities and OEM partners rely on Orion Health to facilitate data exchange between health systems, regional health solutions and affiliated providers, and medical devices. This results in improved care coordination, increased cost savings, efficiencies and enhanced quality of care. ABOUT DIRECTTRUST DirectTrust is a collaborative non-profit association of 142 health IT and health care provider organizations to support secure, interoperable health information exchange via the Direct message protocols. DirectTrust has created a trust framework that extends use of Direct exchange to over 59,000 health care organizations and 1,273,279 Direct addresses/accounts. This trust framework supports both provider-to-provider Direct exchange and bi-directional exchange between consumers/patients and their providers. DirectTrust s trust framework makes it easy for health care professionals, health IT vendors and their patients/customers to communicate securely, with identity proofing and regardless of end-user application. Over 300 EHR and PHR vendors products, and over 50 HIEs, participate in the DirectTrust network, ensuring interoperability and security via Direct for exchange of health information to more than half the professionals in the U.S. health care system. For more information about DirectTrust, go to

127 127 DISCLAIMER