Transcript DIRECT Messaging and Electronic Transitions of Care April

2015 User Conference
DIRECT Messaging and Electronic Transitions of Care
April 24, 2015
Presented by:
Greg Anderson
CEO
EHR Session A30
Agenda
 What is DIRECT and why do I care?
 How do I enroll for DIRECT?
 How do I set up DIRECT in OP?
 How do I send and receive DIRECT
messages in OP?
 How do I create and process document
attachments?
 Q&A
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What is DIRECT?
From the DIRECT
charter document:
The DIRECT Project specifies a simple, secure,
scalable, standards-based way for participants to send
authenticated, encrypted protected health information
(PHI) directly to known, trusted recipients
 DIRECT messages go from one healthcare provider to
another, like regular email. Unlike HIEs, there is no
intermediate repository and no copies are retained
anywhere except the sending and receiving systems.
 2014 Certified EHR Technology must support DIRECT
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Why do you need a DIRECT address?
■ Regular email:
■ not necessarily secure “at rest”
■ may not be encrypted in transit
■ does not guarantee the identity of the sender
■ does not guarantee the identity of the recipient
■ is not attached to the patient chart
■ DIRECT messaging solves all of these problems:
■ HISPs (Health Information Service Providers)
handle all messages securely via “trust anchors”
■ senders and recipients must be identity-proofed
■ tightly integrated with EHR
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Avoiding the HIPAA Police
■ Preconditions of trust
■ Sender assured receiver is
who they claim to be
■ Receiver has same level of
assurance in sender
■ Both have assurance that
message content was not
modified in transit
■ Exposure to PHI is under
complete control of sender
and receiver
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Cool! Sign me up!
■ Not so fast. How do I know I can I trust you? This is
a very exclusive club.
■ Identity-proofing documents
■ Articles of incorporation
■ NPIDs
■ Passports
■ Driver licenses
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EMR Direct: OP’s DIRECT Partner
■ EMR Direct is a HISP for
numerous EHR vendors
■ accountable to the HIPAA Security Rule
■ must have contractually binding legal
agreements with the sender or receiver of
directed exchange of PHI, including all terms and
conditions required in a BAA
■ uses “trust anchors” to determine that it is safe to
exchange messages with other HISPs
■ sends private messages over the public Internet,
protected by strong encryption
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EMR Direct Enrollment Process
■ Self-service forms on OP web site
■ Step 1: Identity-proof your organization
■ Complete organizational application,
return via fax/scan to OP
■ OP submits organizational application
to EMR Direct on your behalf
■ You receive a fax with an authorization code,
contact EMR Direct to confirm receipt
■ Step 2: Identity-proof each individual who needs a
DIRECT mailbox
■ Requires drivers license, must be notarized
■ Return to EMR Direct, not OP
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EMR Direct Organizational Application
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EMR Direct Individual Application
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Choosing your DIRECT email address
■ Option 1 - If you have an email domain:
[email protected]
create a subdomain for DIRECT mailboxes:
[email protected]
■ Advantages: recognized at a glance by
colleagues, contains the word “direct” to indicate
special purpose
■ Disadvantages: one-time upfront fee, may
require your IT provider to reconfigure your
Internet name services
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Choosing your DIRECT email address
■ Option 2: If your organization doesn’t have its own
email domain, or if you don’t want to spend the
extra money on a custom subdomain, OP can
create a unique subdomain under opdirect.net:
[email protected]
■ Advantages: immediate availability, don’t have
buy a unique primary domain if you have no
need for one, still contains the word “direct” to
indicate special purpose
■ Disadvantages: looks different from non-secure
email addresses that you may already use
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DIRECT email address rules
■ No sharing! Every provider must have a unique address
■ Nurses and non-clinical users may request addresses,
subject to identity-proofing
■ Generic addresses (i.e., “referrals”, “medical-records”)
are allowed but discouraged. If used, they must be
assigned to a specific individual at any given time.
■ Only one address per user - you cannot be associated
with both an individual address and a generic address
■ Addresses are paid on a month-by-month basis and
may be added and removed as needed at any time
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Setting up DIRECT addresses in OP 14
■ DIRECT email addresses go in the Address Book
under the existing non-secure email address field
■ To send DIRECT messages, you must have a valid
DIRECT email in the Address Book
■ DIRECT messages may only be sent to recipients who
are listed in your Address Book with a valid DIRECT
email address
■ In order to receive DIRECT messages, the sender
must match a listing in your Address Book with a valid
DIRECT email address that you recognize
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Setting up DIRECT addresses in OP 14
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Sending DIRECT messages from OP 14
■ DIRECT messages are created on the same New
Message Form as all other OP messages
■ When you create a message, if you have a valid
DIRECT address, then the list of possible recipients in
the “To” dropdown will include everyone outside your
practice with a valid DIRECT email address
■ New messages may be addressed to a combination of
internal and external providers, but external replies
only come back to the original sender
■ As with internal messages, DIRECT messages and
replies are captured to the patient chart
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Sending DIRECT messages from OP 14
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Sending DIRECT referrals from OP 14
■ Meaningful Use Stage 2 requires that 50% of
outbound transitions of care be transmitted
electronically with a copy of patient records
■ When you create a new Referral Letter, if you have a
DIRECT address then the options at the bottom of the
form include a [Send] button
■ [Send] button creates a CDA (electronic document
with patient records) and opens a new Message with
the CDA as an attachment
■ You can add your own message and choose anyone
in the Address Book with valid DIRECT email address
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Sending DIRECT referrals from OP 14
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Other outbound messages in OP 14
■ In addition to Referral Letters, you can also create
and send DIRECT messages with CDA attachments
from Encounter Summary and Event Chronology
■ Encounter Summary Sheet creates an electronic
document for the selected encounter
■ Event Chronology compiles a document for all or a
selected subset of records
■ If exactly one encounter (sick or well) is selected,
CDA document is encounter-oriented
■ Otherwise CDA document is chart-oriented
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Outbound message from Event Chron
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Receiving DIRECT messages in OP 14
■ Inbound DIRECT messages from external providers
are on a separate tab in the Message Center
■ New unread DIRECT messages turn the Message
phone red, with a distinct unread count in the icon
■ DIRECT messages from external providers may be
replied to like any other message
■ Unsolicited external DIRECT messages (those which
are not in reply to a message you originated) can be
associated with a patient chart when appropriate
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Receiving DIRECT messages in OP 14
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Receiving DIRECT referrals in OP 14
■ External DIRECT messages may include attachments
■ Attachments appear in a new column on the right side
of the Responses pane
■ When you click on an attachment, it is opened in the
correct viewer, based on its type (image, PDF, etc.)
■ Clinical documents open in a special viewer which lets
you read the report, then clinically reconcile any
information you would like to incorporate back into the
patient chart without manual retyping
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Receiving DIRECT referrals in OP 14
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Reconciling problem list
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Reconciling medication allergies
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Reconciling medications
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DIRECT Messaging: The Future is Now
■ MU2 transition of care requirement is
driving rapid adoption in 2015 as all EHR
users upgrade to compatible software
■ Ability to send routine, secure messages
within the healthcare community is long overdue
■ Sending and receiving clinical documents as email
attachments is much faster and more convenient than
faxes and paper mail
■ Enrollment takes time - start planning now!
■ Ask colleagues in your referral network for their
DIRECT email, and start filling your Address Book
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We want your feedback!
2015 Office Practicum User Conference