2015 User Conference DIRECT Messaging and Electronic Transitions of Care April 24, 2015 Presented by: Greg Anderson CEO EHR Session A30

2015 Office Practicum User Conference 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

2015 Office Practicum User Conference 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 . 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

2015 Office Practicum User Conference ■Regular ■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 Why do you need a DIRECT address?

2015 Office Practicum User Conference 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

2015 Office Practicum User Conference 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

2015 Office Practicum User Conference 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

2015 Office Practicum User Conference 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

2015 Office Practicum User Conference EMR Direct Organizational Application

2015 Office Practicum User Conference EMR Direct Individual Application

2015 Office Practicum User Conference Choosing your DIRECT address ■Option 1 - If you have an domain: create a subdomain for DIRECT mailboxes: ■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

2015 Office Practicum User Conference Choosing your DIRECT address ■Option 2: If your organization doesn’t have its own 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: ■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 addresses that you may already use

2015 Office Practicum User Conference DIRECT 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

2015 Office Practicum User Conference Setting up DIRECT addresses in OP 14 ■DIRECT addresses go in the Address Book under the existing non-secure address field ■To send DIRECT messages, you must have a valid DIRECT in the Address Book ■DIRECT messages may only be sent to recipients who are listed in your Address Book with a valid DIRECT address ■In order to receive DIRECT messages, the sender must match a listing in your Address Book with a valid DIRECT address that you recognize

2015 Office Practicum User Conference Setting up DIRECT addresses in OP 14

2015 Office Practicum User Conference 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 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

2015 Office Practicum User Conference Sending DIRECT messages from OP 14

2015 Office Practicum User Conference 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 address

2015 Office Practicum User Conference Sending DIRECT referrals from OP 14

2015 Office Practicum User Conference 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

2015 Office Practicum User Conference Outbound message from Event Chron

2015 Office Practicum User Conference 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

2015 Office Practicum User Conference Receiving DIRECT messages in OP 14

2015 Office Practicum User Conference 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

2015 Office Practicum User Conference Receiving DIRECT referrals in OP 14

2015 Office Practicum User Conference Reconciling problem list

2015 Office Practicum User Conference Reconciling medication allergies

2015 Office Practicum User Conference Reconciling medications

2015 Office Practicum User Conference 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 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 , and start filling your Address Book

2015 Office Practicum User Conference

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