User Manual/Guide for Direct Using encompass 3.0. Prepared By: Arête Healthcare Services, LLC

Transcription

1 User Manual/Guide for Direct Using encompass 3.0 Prepared By: Arête Healthcare Services, LLC Document Version: V1.0 10/02/2015

2 Contents Direct Overview... 3 What is Direct?... 3 Who uses Direct?... 3 Why should you care?... 3 How is Direct used?... 4 How does Direct work?... 4 Direct Accounts in encompass... 5 Organizational Account... 5 Direct Messages in the Owner Triage... 6 Owner Triage Controls... 6 Direct Message Viewer... 6 Managing Direct Message Folders... 7 Forwarding Direct Messages to Other Users... 7 Attaching Messages and Data received via Direct to a Patient s Chart... 7 CDA Attachments... 8 Pending Window... 9 User Manual/Guide for Direct using encompass 3.0 v1.0 2

3 Direct Overview What is Direct? Direct is a national encryption standard for securely exchanging clinical healthcare data via the Internet. It is also known as the Direct Project, Direct Exchange and Direct Secure Messaging. It specifies the secure, scalable and standards-based method for the exchange of Protected HIPP (PHI). It was developed in 2010 under a part of a federal project for standards-based healthcare communications. As a part of qualifying for incentive payments under the Meaningful Use Stage 2 criteria issued by the Office of the National Coordinator for Health IT (ONC), healthcare organizations and providers must meet data transfer requirements using Direct Messaging. These requirements can be demonstrated with Electronic Health Records that comply with the ONC s 2014 Edition EHR Certification Criteria which specifies electronic exchange of transition of care records with Direct Messaging. Who uses Direct? Hospitals Providers/Clinicians Care Team Members Patients Laboratories Pharmacies Long Term Care Skilled Nursing Specialists Dental Why should you care? Direct helps to cut costs and deliver improved quality of care. On the clinical side, Direct Messaging addresses gaps in transitions of care which have been identified as a significant patient safety issue. Incomplete exchange of patient health information among providers when transitioning from one care environment to another is a point of vulnerability that can compromise the overall quality of care a patient receives. On the business side, Direct Messaging can reduce or eliminate the costs associated with fax workflows by transitioning relatively expensive fax communication to less expensive workflows. User Manual/Guide for Direct using encompass 3.0 v1.0 3

4 Direct Messaging provides many additional benefits including: Strong security and privacy protection of PHI One unified standard that all systems can leverage Improved communications between providers Easily sent and received referral information Efficient report exchange Ease of sharing patient information Improved practice workflow How is Direct used? Here are some of the ways Direct can be used to communicate or share private health information: Transitions of care: Continuity of Care Document (CCD), Consolidated Clinical Document Architecture (C-CDA documents) Physician consult requests Admit-Discharge-Transfer Requests (ADT) Medication reconciliation Lab/Test results Patient communication Order submission Report distribution Peer to peer collaboration How does Direct work? Direct can be incorporated into a variety of user interfaces such as an client, a mobile device, healthcare IT system portals or as an automated data delivery feed. Any of these interfaces are capable of sending or receiving Direct messages. But in order to participate, both sender and recipient users will need a specific Direct address provided by their Health Information Service Provider (HISP) (see below). Healthcare IT systems can integrate Direct in multiple ways depending on the desired workflow. User Manual/Guide for Direct using encompass 3.0 v1.0 4

5 Direct Accounts in encompass Arête partnered with SureScripts in 2014 to provide Direct accounts for all providers with a National Provider Identifier, or NPI, and organizations using encompass. In essence, a Direct account is a secure account that allows the exchange of messages and attachments between providers or organizations using data encryption for securing clinical content. Due to the security measures, Direct messages can only be sent from and received by other Direct accounts. As a SureScripts partner, the accounts created within encompass are immediately shared with all other SureScripts partners and a wide number of HISPs through what are known as Direct circles of trust. These relationships continue to grow as this relatively new technology begins to take hold across the medical industry. Direct accounts in encompass use domain, and follow a specific format using the first initial and last name followed by a dot (.) and the 3 character practice code. Joe Smith of Get Well Clinic (or gwc) jsmith.gwc@ehrdirectmail.com Security and Health Insurance Portability and Accountability Act (HIPAA) concerns stipulate that unlike other systems in encompass, Direct messages cannot be pre-processed by other users, but must be received by the intended provider. To assist in workflow performance, encompass makes it easy to forward messages within the practice to other providers or authorized agents to perform any actions required based on messages received. Organizational Account A single organizational account is created for each practice using encompass. Similar to provider accounts, organizational accounts use domain and follow a specific format of simply the 3 character practice code. Get Well Clinic (or gwc) gwc@ehrdirectmail.com Access to use the organizational account for both sending and receiving is granted through an Access Control Level (ACL) in the user admin named DIRECT_ORG_ACCESS. This ACL can be added to any users who may be required to transmit a patient Summary of Care (SoC) or Referral using Direct or to users who handle administrative tasks such as attaching received information to patient charts (E.G. immunization reports from a pharmacy). User Manual/Guide for Direct using encompass 3.0 v1.0 5

6 Direct Messages in the Owner Triage Messages received via Direct will appear in the Owner Triage which can be found in encompass under Dashboard -> Owner Triage. An icon will also appear on the system bar for System bar icon for Direct users with a personal Direct account or access to the Organizational account displaying the number of unread messages for the account. Clicking on the icon will launch Owner Triage and automatically select Direct for display. Direct messages will be listed in the Owner Triage by date with the most recent first, displaying the date, sender, subject and patient (if applied). Unread messages will appear bold. Clicking on a message will open the Direct Message Viewer. Owner Triage Controls Several controls are displayed in the Owner Triage to allow for navigation through records. Owner Type Direct Folder Per page Load Paging Allows selection of the user who owns the records. In the case of Direct Messaging this selection cannot be changed to another user per security and HIPAA regulations. Allows selection of the type of records to display for the selected owner. For inbound Direct Messages select Direct. Outbound messages use Direct Outbound. Allows selection of the folder to view messages. By default, all users have 2 folders, In and Archive. All incoming messages will originate in the In folder. Note: Outgoing messages are considered a different type and can be viewed by selecting Direct Outbound in the type control. Note: Unlike other controls, changing the Direct Folder will automatically re-load the records for the selected folder. The number of records to display. Loads records based on the control selections. Shows which records are being viewed by number as well as the total number of records found. Controls are available for moving between pages. Direct Message Viewer Clicking on a message from the Owner Triage will open the Direct Message Viewer. Each message consists of 2 sections, headers and attachments. Header information is typical of most systems, displaying the sender, subject, date received, folder and the patient the message is attached to (once attached). The Attachment section will contain all the meaningful data from the message. This data is broken into distinct User Manual/Guide for Direct using encompass 3.0 v1.0 6

7 segments by type such as HTML, TEXT, or CDA. Managing Direct Message Folders By default, all users have 2 folders, In and Archive. Other folders can be created and managed either in the Message Viewer or the Owner Triage. Changing a message folder Create a new folder Archive button Renaming a folder Removing a folder Select a folder from the dropdown in the Message Viewer. Select New Folder in the dropdown in the Message Viewer. A prompt for a name of the new folder will appear. Creating the folder will automatically move the message being viewed to that folder. Click the Archive button to move the message to the Archive folder and close the viewer. If the message is currently in the Archive folder clicking the button will move the message to the In box and close the viewer. Select the folder to rename in the Owner Triage. Two links will appear below the folder selection. Click rename and apply the new name in the prompt provided. Note: In and Archive cannot be renamed. Select the folder to remove in the Owner Triage. Two links will appear below the folder selection. Click remove and confirm the action in the prompt provided. Note: In and Archive cannot be removed. Forwarding Direct Messages to Other Users Forwarding a message Select an account from the dropdown in the Message Viewer and click Forward. Note: The Organizational account will be selected by default on all messages viewed by provider accounts, allowing messages to be forwarded with 1 click on the Forward button. Organizational account users will have an empty option by default and will need to select a user for forwarding each time. Attaching Messages and Data received via Direct to a Patient s Chart As mentioned previously, a Direct message is really composed of a single header section and one or more attachments. There is no body as is typical with most . Only attachments can be placed in a patient s chart, although the message itself must first be linked to the patient. This is due to the specific nature of Direct attachments, which can each contain a wide array of clinical data. Linking a message to a patient will NOT make the message appear in the patient s chart. Only message attachments can be applied to the chart. User Manual/Guide for Direct using encompass 3.0 v1.0 7

8 Messages can be attached to a patient using the patient lookup in the header section of the Message Viewer shown here. Once a message is attached to a patient the header section will display the patient name, date of birth, as well as the Chart Cart and View Chart buttons. Each attachment will also display an add to chart button. To remove or change the patient, click on the patient s name as it appears in the header section and confirm the action in the resulting dialog. Note that unlinking a patient from a message will NOT remove any attachments that have been added to the chart. Each add to chart button will display the icon of the archive type it will appear as based as follows: text/plain, text/html -> Chart Note application/pdf -> Document cda, application/xml -> Care Document Clicking add to chart on an attachment will open the respective editor for each type, allowing for modification before adding to the patient s chart. Note that some data will not be editable, such as the chart note content since this content comes from a different source. Once an attachment has been added to a chart, the button will change to read edit on chart, indicating that the attachment has been added, and allowing the resulting record within the chart to be edited by clicking the button from within the attachment. In some cases additional work may be required to fully update the patient s chart. For example, some pharmacies will send immunization notification to the primary care provider. Some messages may only contain a PDF document and no clinical data (see CDA heading below). In this case, it is advisable to attach the PDF as a document to the patient s chart, but also to add the immunization record using the Chart Cart button. CDA Attachments These are XML attachments based on the Clinical Document Architecture (CDA) defined by Health Level 7 International (HL7). CDA documents contain discrete data that can be imported to the patient s chart. User Manual/Guide for Direct using encompass 3.0 v1.0 8

9 Currently, encompass can accept medications, allergies, diagnoses and immunizations from CDA attachments. When adding a CDA attachment to the chart archives, the editor dialog will display all records that can be added to the chart summary. Click on each record to add them. Note that the CDA attachment will immediately appear in the chart archives; however, summary data will be placed in a pending status. If summary items are added during the attachment of a CDA document, the Pending dialog will open immediately following the CDA editor closing. For more information on the Pending window, please see below. CDA attachments are immediately available in the archives after adding to a chart, but summary items are placed in a pending state and must be added to the chart using the Pending window. Pending Window The Pending window exists as a checkpoint and possible separation of duties between receiving chart summary data and applying it to the chart. The window displays all pending items to the left, and all existing items to the right, allowing the user to verify that data is not duplicated in the chart should it be received from multiple sources such as CDA documents. The window also allows practices the ability to separate the workflow of attaching incoming records, such as CDA documents, and applying the data to the chart summary. For example, a practice may allow certain staff members to attach the CDA document as they would an uploaded document, but the providers may want to retain the authority to add the records to the chart for just themselves, allowing them to review the records with the patient during the next patient visit. Within the chart, the Pending button is located next to the ScriptPad button at the top of the summary. Clicking this button opens the Pending window as described above. To apply pending records to the chart, simply click on the items on the left side of the window. This action will highlight and move the record to the list on the right. When done adding all items, click the Add Selected Items button located at the bottom of the window. To reject pending items, click on the trash can icon. The items selected will be highlighted red. Click the Remove Selected Items button at the bottom of the window to reject the pending item(s).. User Manual/Guide for Direct using encompass 3.0 v1.0 9