HospiDirect Reference Guide Last updated: December 13, 2017 Optum and the Optum logo are registered trademarks of Optum. All other brand or product names or trademarks are registered marks of their respective owner. Optum. All rights reserved.
Table of Contents HospiDirect Reference Guide Overview... 3 Access... 3 Passwords... 4 Navigating Screens/Toolbars... 5 Census Viewing for Active and Termed Patients... 6 Patient Search/Edit/Discharge... 7 Add New Patients... 9 Allergy Interaction Section/Patient Demographics... 9 Adding New Medications... 14 Viewing Medications... 16 Editing Medications... 18 Reactivating Discontinued Medications... 21 Medical History/Clinical Profile... 24 DUR... 26 MTM and Clinical Consulting Service Clients... 27 HospiDirect Reference Guide Page 2
HospiDirect Reference Guide Overview This document provides guidance for the use of the HospiDirect online patient eligibility manager. HospiDirect provides Optum clients with the ability to easily manage their patients eligibility and information. With HospiDirect, you can add or discharge patients and add or discontinue medications directly into the system as well as view or update patient information. The changes and additions made via this online management tool are updated in the system immediately. NOTE: You may see examples or displays of data, links or icons that you may not have permissions to see in the actual applications. Users are restricted to the information they need to do their jobs and the permissions for your access may not include all of the screens or features contained in this manual. Access Once you have received your username and password from your Optum Account Manager, you are ready to begin utilizing HospiDirect. HospiDirect is a web-based application that is designed to work best with Internet Explorer 6.0 or higher. Begin by logging into the client exclusive section of the website. This opens access to the educational level tools and resources. From the client portal, select the HospiDirect link and the member login dialog box will appear in your browser window. Enter a valid username and password and click the sign in button. The HospiDirect home screen will appear. This screen contains the buttons and components that make it easy to navigate the system screens. HospiDirect Reference Guide Page 3
Passwords Your Optum Account Manager will provide you with access information for your initial log in and the system will require you to immediately change your password when you log into HospiDirect for the first time as well as every thirty (30) days as prompted by the system. If you do not reset your password manually before the thirty (30) days, you will be locked out on day thirty-one (31) and will need to contact your Account Manager to have a new temporary password sent to you. System will prompt user to change their password 10 days prior to expiration. Please contact your Optum Account Manager to request assistance with setting up system users. The following are required criteria for password creation: Minimum characters 5 Requires at least 3 of the following: o Minimum uppercase 1 o Minimum lowercase 1 o Minimum numeric character 1 o Minimum non-alphanumeric character 1 Only 1 password change allowed per 24-hr period For new passwords, user will be required to supply the answer to their security question User cannot reset password to one of the last five passwords used Some tips to remember when you are creating a password: Avoid weak passwords such as words found in a dictionary; names of family, pets, friends, coworkers, etc.; the company name, location or derivation; birthdays and other personal information; and work or number patterns. Passwords should never be written down or stored online. Try to create passwords that can be easily remembered. One way to do this is to create a password based on a song title, affirmation, or other phrase. For example, the phrase might be: This May Be One Way To Remember and the password could be TmB1w2R! or Tmb1W>r~ or some other variation. Change Password To change your password, click the change password button in the top, right of the page. The change password screen will appear. Enter your current password in the old password field, your new password in the new password and confirm password fields. Once all fields are complete, click the save button. To exit the screen without changing your password, click the cancel button. HospiDirect Reference Guide Page 4
Forgotten Password The HospiDirect login page will always display a link, Forgot password?. All users can click on this link to initiate an access recovery process. Users will be asked to re-enter their username and click the submit button. The system will identify the status of the user s account. If account has been deactivated or has encountered an intrusion lock, the system will display a message indicating to the user that the account is deactivated and advise the user to contact Optum for further assistance. For all other users, the system will generate a temporary, strong password and send this unencrypted to the user s email address, which is stored in the user s database record. After logging in using the new password, the system will require that the password be changed. Password Lock-Out For security purposes, password lock outs occur when a user has incorrectly entered the username / password combination three (3) consecutive times. This situation will require the user to contact Optum for assistance. The best way to avoid this issue is to keep track of your current username and password. However, if you forget or are unsure of your password, select forgot your password link located on the login page. The user will be asked to re-enter his/her username and click the submit button. The system will generate a temporary password and send it to the user s email address on file. After logging in using the new password, the system will require that the password be changed. Navigating Screens/Toolbars This section is intended to give a general overview of how the program functions and how the various components can be used to access, edit and enter the information to perform your job. The top area under the Optum logo is where you will find the tabs for various pages (i.e. home, member demographics, group management, meds, medical history, DUR, etc.) as well as links for items such as HospiNews, passwords and logout options. The home/search for members is the screen that will appear once you have logged into the system. From this page, you will search for current patient records and add new patients into the system. You will notice the link to add new member on the upper right side of the Search criteria section. HospiDirect Reference Guide Page 5
The middle section of this page contains the search criteria used to narrow your search and find what you are looking for quickly. Once you have entered the desired criteria, click the search now button below the search fields. The search results will display at the bottom of the screen where you can select the desired record to open it. You may customize the number of records per page that appear using the dropdown on the right side of the results section (i.e. 10, 20, 30, 40, 50 records). The pages of the search can be navigated using the arrow buttons at the bottom of the search results. Census Viewing for Active and Termed Patients User may search for members based on current eligibility status. From the home/search for member screen, the user is able to search for and view a list of all, active or termed patients for the hospice. In the search criteria section, you will notice a member status field. Select the desired option from the drop-down menu and click on the search now button at the bottom of the screen. This list is not exportable, but a useful viewing tool. HospiDirect Reference Guide Page 6
Patient Search/Edit/Discharge Once logged into HospiDirect, user will have access to functions based on permissions level. Only one user at a time may update a patient s data. From the home/search for members screen, enter one or any combination of patient s first name, last name, ID or date of birth into the search criteria section and select the search now button. The search will display any records that match the criteria entered. Select the patient from the list by clicking on the desired record displayed in the search results section. This will open the patient data on the member demographics screen. If patient is not in the system, select add new member button on the top, right side of the search criteria section (see add a patient section ahead). The member demographics screen displays the data for the active patient selected. User is able to update this information as needed and once done, click the save button at the bottom of screen. Click on each tab to update and save each page. If the save & add new button is selected, user is able to add additional patients. Medications can be added by clicking on the top toolbar tab, Meds, from the patient s data record. User can also access other screens of the patient s data record via this toolbar. HospiDirect Reference Guide Page 7
MOVE TO GROUP BUTTON: This button allows user to move patients to other groups for which users have access. When selected and completed, this option will term the patient from the current group. It will open a new pre-populated screen to enter the new group and start date information. Member Demographics Fields Include: Note: All fields that are listed below with an asterisk * are required. Carrier, Account & *Group IDs *Member ID/*Patient Type (CSR assistance required to change patient ID) *First, Middle Initial & *Last Name Facility Name/Information If facility patient, the facility information fields are required. If not in a facility, patient s home address should be listed in this section. Pharmacy Information *Intake Data Source/*Intake Name *Eligibility Start & End Dates (Discharge defaults to start date plus 5 years and must be changed to discharge patient sooner). *Gender & *Date of Birth *Hospice Diagnosis/ICD10 or Diagnosis Code (Filling in either will auto-populate the other field selections). Complete ICD code may not be listed so please choose the closest option. *Allergies Patient Discharge The member demographic screen allows user to discharge a patient from the system. Update the eligibility end date field to end benefits for this patient. This date auto populates to 5 years following admission and must be changed to discharge patient sooner. HospiDirect Reference Guide Page 8
Add New Patients To add a new patient into the system, start from the home/search for members screen. Select add new member button in the top, right corner of the search criteria section. HINT: Be sure to check that the patient is not already in the system before choosing to add a new patient (See Patient Search/Edit/Discharge above). This will open the member demographics screen where user will enter the patient s information and click save at the bottom of the screen. User may access any of the other screens by selecting the desired tab in the top toolbar menu. After the patient s demographic information is entered and saved, click the save button at the bottom of screen. If user selects the save & add new button, a blank demographics screen appears to add another patient, however, no medications exist until user enters those in the medication screen which can be accessed from the patient data record by clicking the toolbar link MEDS at the top of page. Adding Allergies in Patient Demographics To enter allergies, user types in an allergen in the free text field. Options will populate the drop-down for selection. If no allergies exist or are not known, an applicable selection must be made from the drop-down list. The information utilized by HospiDirect is based on Medi-Span s allergen pick list file and is intended to supplement the knowledge of healthcare professionals regarding correct use of medications. Certain drug selections such as multi-ingredient compounds will not display interactions and will be indicated as unscreened. Other drugs indicated by Medi-Span s allergen pick list file that have no possible ingredient interactions will also be shown as unscreened. Unscreened is a term used to demonstrate no system supported interaction, but does not rule out definitively the possibility of an ingredient interaction with a profiled medication. This information is advisory only and is not intended to replace sound clinical judgment in the delivery of health care. HospiDirect Reference Guide Page 9
The example below illustrates a user entering aspirin in the allergen field. Once the allergen is selected, the user must select a reaction from the drop-down list. After reaction is selected, click the add button which adds the allergy to the grid. If the allergen is not found, users can attempt to find ingredient matches using the ALT button. HospiDirect Reference Guide Page 10
Once a drug selection is made, the selected allergens that comprise the drug are listed. Select allergen from list shown and click OK to confirm. Once confirmed, the user will be back on the member demographics page and must then select reaction. If no match can be found, then the user can select additional unspecified allergen from the drop-down, free text in the allergen in the other box that is present, pick a reaction and ADD it. This allergen will NOT be screened against new or existing medications so interactions cannot be shown. Allergy and Allergy Interaction Displays There are multiple locations in HospiDirect that display allergens/reactions and indicate if there is an allergy interaction. Hovering over notification on all except member demographics page shows ALL active allergens and reactions. HospiDirect Reference Guide Page 11
When adding a new medication in the Add Meds Record, an existing allergen alert appears if there is an interaction. The allergy notification section on DUR page also displays all allergy interactions: The Member Demographics page alert will appear when a new allergen entry interacts with existing medication once page is saved: There is an Allergy section on MTM assessments but not on No Change Letters: HospiDirect Reference Guide Page 12
On admin tab, users are able to select the report management to access an allergy interaction summary. An allergy interaction summary can be pulled up by group for a specific number of days, not to exceed 60 days. Client notification of allergy interaction outside of the User Interface: HospiDirect Reference Guide Page 13
Adding New Medications New Patient: The add/edit meds record screen is where you enter all of the patient s medications. As you start typing the drug name field, a list of drugs will appear and you simply select the correct choice. Update and add new will allow you to add another medication without returning to the meds page. Update saves the data and returns you to the meds page. Existing Patient: For an existing patient, search and access the patient data record and select the meds tab in the toolbar on the top of the page. This will open the medication list for this patient. From this screen, you are able to view/edit/discontinue medication information and/or click the add meds link to enter new medications. The save and add new button will allow you to add several medications before reviewing or moving to another page. Save finishes the process. Note: The patient discontinued medication on date auto populates to five (5) years after the start date. HospiDirect requires a determination of medication relation to a patient's terminal prognosis. A related medication is a medication that the hospice has determined to contribute to the patients decline and therefore related to the terminal prognosis. A non-related medication is a medication that the hospice has reviewed and has determined not to contribute to the patients decline and therefore, is not related to the terminal prognosis. Drug Info Users can click the link on new or existing medications to search/view Lexicomp information. HospiDirect Reference Guide Page 14
Med Fields Include: Note: All fields that are listed below with an asterisk * are required. *Drug Name Indication NDC/GPI/DEA Class Unknown Form and Strength As you start typing the drug name field, a list of drugs will appear and you simply select the correct choice, using your arrow and enter buttons. Enter reason for medication use Fields will auto populate. Do not be concerned if the NDC is different from what the pharmacy may be dispensing. This field allows you to enter the medication even if you do not know the exact form and strength. You must first choose a specific med with form/strength and then select this field. Medication coverage as marked in this grid only applies to this selected form/strength. Therapeutic Category *Status *Related *Medication Start/End Dates Medication Coverage Span *Directions for Use (replaced SIG) Notes Quantity/Day Supply The grouping of drugs with similar pharmacologic, therapeutic and/or chemical characteristics. The status field is driven by date and will automatically change to discontinued if the end date is less than the current date. Status of suggested will act/perform the same as if current if chosen where coverage is concerned. The related field will auto-populate based on coverage selection, but can be manually changed. Medication end date will auto-populate to 5 years after the start date that is entered. This section shows the coverage dates for the drug. If a drug has more than one span of dates, others will also be displayed. The collapse view allows user to view only the current medication span. This section allows different coverages for a single medication without the need to terminate and re-enter the medication. All coverage spans must be inclusive and continuous of the medication profile start and end dates. Medication directions and notes. Enter notes as needed. Enter information noted. HospiDirect Reference Guide Page 15
Viewing Medications The meds records search results screen includes a nested grid which expands to show all current directions for use entries. The main field contains medication and first directions for use entered. If medication has multiple directions for use, a plus (+) sign will show along with the number of directions for use. User will click on the plus (+) sign to expand and collapse the nested grid. When expanded, this grid contains the directions for use status and full directions for use. The grid remains on screen until collapsed or medication is further drilled into. HospiDirect Reference Guide Page 16
Directions For Use Replaces SIG Column The Directions For Use terminology replaces the previous SIG column. The medications details grid will display: status; from date; to date; Directions For Use; and updated date. If user hovers over the status field, a popup box will display the following information: created date; updated by; updated date; and reference number. Current and discontinued directions for use will display, with page expansion as required. Directions For Use and Patient Profile/Patient Assessment Outputs If the medication has multiple Directions For Use populated, then the output of the patient profile AND assessment will display the medication for each Directions For Use. The drug is essentially populated X times with same information to show the different Directions For Use. DUR Assessment Example: Multiple Directions for Use HospiDirect Reference Guide Page 17
HospiDirect Reference Guide Page 18
Patient Profile Example: Multiple Directions For Use Editing Medications The drug name cannot be edited. If a medication is entered in error, it needs to be deleted with a note stating that it was entered in error. Search and access the patient data record and select the meds tab in the toolbar on the top of the page. This will open the medication list for this patient. Select the row/ record for the medication you wish to edit or discontinue which will open the data screen for that medication. In this screen, you may edit the information except for the actual drug name. You may discontinue a medication by entering a medication end date in that field which is similar to the process noted for discharging a patient. If changing the form or strength of the same medication, you must first discontinue the original form and strength. Please note that the end date of the first form and strength must be one day before the start date of the new form and strength. Once done, click on the save button at the bottom of screen. You may sort the list by columns by clicking on the column top of the desired choice. If you select the save and add new button, you are able to add several medications before reviewing or moving to another page. Then, save finishes the process and user must select the medical history screen if data is to be entered there. HospiDirect Reference Guide Page 19
Prior Authorization Required (PA Request) When non-formulary medications are added to a patient s profile, the name and source of the authorizer must be placed in the auth by field. If a hospice only allows certain people to authorize non-formulary medications, then this field will be a selectable dropdown list. If the person making/requesting the change is not authorized to do so, then no match will/should be entered (by the internal users or system will default the value for external users) in which case the appropriate authorizer must be contacted to obtain authorization to add the coverage. Discontinuing Medications Users have the ability to discontinue multiple medications at one time from the medication coverage grid. A link is available to discontinue one, some or all medications. All medications selected will be discontinued for the same date. If the date selected is prior to any medications current coverage span, that medication will not be discontinued. A pop-up message will appear to inform the user which medications could not be discontinued and these medications can still be selected individually to be discontinued. The default date will be today, but user will have the option to change the date. HospiDirect Reference Guide Page 20
In this example, the medication Pepcid could not be discontinued from the medication grid because the latest coverage span starts after the discontinued date: In this instance, the user would need to go into the individual medication profile to discontinue. HospiDirect Reference Guide Page 21
Reactivating Discontinued Medications Users may reactivate discontinued medications by selecting the R that appears in the D/C All column on the Meds grid. In the case of multiple identical medication entries, only the most current instance of the medication is available for reactivation. Once selected the user is taken to an individual Reactivate Meds Record page that will permit the user to reactive the medication with a minimal amount of redundant effort. Field Default in as: Editable? Drug Name Previous medication (from discontinued entry) No Indication Previous Indication (from discontinued entry) Yes Profile Status Current Yes Patient Started Medication On Today s date Yes HospiDirect Reference Guide Page 22
Patient Discontinued Today s date + 5 years Yes Medication On Related Same as previous Yes Med Coverage: Formulary Reads current formulary info No From Date Same date as Patient Started Medication On: date. Note: This should default in just like it does on a new order now Yes To Date Same date as Patient Discontinued Medication On date Yes Coverage Same as previous coverage Yes Authorizer Same as previous authorizer Yes Directions for Use: From Date Same date as Patient Started Medication On date. Note: This should default in just like it does on a new order now Yes To Date Same date as Patient Discontinued Medication On date Yes Directions for Use Same as previous directions Yes Update Button saves medication and takes user back to medication list N/A Update and Reactive Next Add button next to update as an option to continue through the discontinued medication list N/A Skip and Reactivate Next Add button next to update as an option to quickly continue through the discontinued medication list N/A HospiDirect Reference Guide Page 23
Medical History/Clinical Profile From an existing patient s data record, the medical history (clinical profile) can be accessed by selecting the medical history tab in the toolbar at the top of the screen. To select ICD10 in the patient conditions for quick list selections on the left side of the screen, click in the box to the left of the condition and the item will be added to the list on the right defaulting to related, which adds it to the patient s profile. If the condition is not related, then the box can be unchecked. To add a condition that is not in the quick list, type in the diagnosis, then select the correct condition from the drop-down list and click the add button. If not related, the related box can be unchecked prior to adding the condition. Once added to the patient s profile, user will still have the option of removing it from the list by discontinuing or deleting the condition via the buttons on the right. Free text entries of conditions not related to a specific ICD10 will not be permitted. From this medical history screen, complete or edit the fields for the patient s medical history and select save button at the bottom of screen. HospiDirect Reference Guide Page 24
Medical History Fields Include: Click and drag/add the applicable fields in each category. If other is selected, an explanation must be provided in this field. User may select multiple choices in the list by clicking Ctrl/Click to highlight and then click add. Palliative Performance Scale Score (PPS) OR Karnofsky Score Current Ambulation Weight User may enter kg or lb Height Functional Assessment Staging Score (FAST) Current Swallowing Other (Please Specify) Available to free text swallowing status Patient Conditions Updated By/Update Date (auto-populated by user sign in) HospiDirect Reference Guide Page 25
DUR The DUR screen is used to display patient DUR information (i.e. drug to drug interaction; drug allergy interaction; food allergy interaction; duplicate therapy; clinical rules) and to manage selected patient s clinical consultation notes for those clients who have elected to have a higher level of service with our Medication Therapy Management (MTM) or HospiOnDemand (HOD) programs. From an existing patient s data record, the DUR screen can be accessed by selecting the DUR tab in the toolbar at the top of screen. For most users, this is an informational screen that pulls information from the patient s medical history and clinical consultation notes. It is limited by user permissions on which fields can be edited (electronic clients can edit all). Clinical Notes: Visible to all users, however ability to add is restricted to Electronic Intake Only and Optum Pharmacists Patient/Family Goals: Visible to all users, however ability to add is restricted to Electronic Intake Only and Optum Pharmacists Allergy Interactions: Visible to all users Drug Interactions: Visible to all users Duplication of Therapy: Visible to all users Clinical Concerns: Visible to all users Clinical Rules: Visible to all users Generate Assessment Link: Visible to Electronic Only clients and Optum internal users HospiDirect Reference Guide Page 26
MTM and Clinical Consulting Service Clients MTM and HOD clients have selected a higher level of service to include specialized clinical consulting on a fee for service basis. The same basic instructions as reviewed in previous sections are applicable for all clients, however, there are a few factors that MTM and HOD clients should consider. For HOD clients, pharmacists will assist with entering new admissions including medications (for non-integrated clients) and medical history during the initial verbal consultation. For MTM clients, it is important to enter complete information in each screen in order to produce accurate assessment letters. If you are unsure of your access level, please refer to your hospice administrator for further instruction. Patient Assessment Letters At various points in the patient review process, the assessment will generate a notification or a patient assessment letter. Optum will prepare these communications and deliver them according to the service options selected by hospice clients. A notification consists of information about a patient s review which requires the attention of a particular user profile. Note: Insufficient data will generate an incomplete assessment. Assessment Complete A patient assessment letter is the final step of the assessment process and consists of information during patient admission, medication processing and clinical review. Assessment letters are prepared and formatted into a PDF file and are stored, recorded and retrievable in read only view. Pharmacists will review new admissions and generate an assessment within 5 days of patient enrollment in HospiDirect when all required data is provided. Based on service level, existing patients may receive a reoccurring review at least every 15 days thereafter. Note: For new clients being implemented, existing patients will receive current patient clinical reviews within 30 days. Notification/assessment letter delivery is determined by the service level options selected and delivery method setting. This option is not accessible unless all of the required information has been entered. Assessment Letters may be accessed from the patient s data record by clicking on the assessment letter icon/button on the top toolbar. This will display a list of all assessment letters generated for this patient along with date generated, the send date and send method. A letter search tool will be available to authorized profiles. The search filter includes letter ID, date generated, and date send range. For clients who have selected the electronic assessment service, users will simply select the generate assessment letter link located in the top right of the DUR screen. This will provide a PDF version of the assessment which has not been reviewed by a pharmacist. What if Optum is Missing Needed Information? Optum needs all of the required patient information within 48 hours of the patient being added to the system. If the required information is not received, hospice will receive an incomplete assessment letter with the limited data submitted, on the 5th day after enrollment to the Optum system. After an insufficient letter notice has been generated, no further assessments will be sent until the required data has been input. Once the required fields have been completed, an initial assessment will be generated within 15 days of the date the input was completed. HospiDirect Reference Guide Page 27