1. 2015 User Conference Electronic Transitions of Care April 24, 2015 Presented by: Greg Anderson CEO EHR Workshop 231

2. 2015 Office Practicum User Conference Agenda ▪Setting up DIRECT credentials and email addresses ▪Creating outbound messages, transitions of care, and encounter notes ▪Receiving inbound messages and transitions of care ▪Processing inbound transitions of care ▪Q&A

3. 2015 Office Practicum User Conference Setting up DIRECT credentials in OP 14 ■After you complete the identity-proofing process, OP will assign practice-level credentials on our messaging hub ■Before you can send or receive messages, you must enter these credentials on the Correspondents Form (Utilities → System Admin → e-Correspondents) ■Scroll to “EMRDirect Secure Messaging”, then enter your Login ID, password, and Login URL ■Click [Save] (green checkmark), then close the form

4. 2015 Office Practicum User Conference Hands On: Setting up DIRECT credentials

5. 2015 Office Practicum User Conference Setting up DIRECT addresses in OP 14 ■DIRECT email addresses go in the Address Book below 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

6. 2015 Office Practicum User Conference DIRECT email address rules in OP 14 ■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

7. 2015 Office Practicum User Conference Hands On: Setting up DIRECT addresses 1.Open Address Book ( or F4), search for yourself 2.Double-click your name or click (edit pencil) 3.On Edit Address Panel, go to [Address] Tab and enter a valid DIRECT email address in the labeled new field 4.Click, then 5.Repeat steps 1 - 4 for at least one external colleague with whom you exchange patient information

8. 2015 Office Practicum User Conference Hands On: Setting up DIRECT addresses “Publish” determines whether an external provider’s DIRECT address is available on the View/Download/Transmit page of the patient portal. It’s best to get permission from the other party before checking this box.

9. 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 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

10. 2015 Office Practicum User Conference Sending DIRECT messages from OP 14

11. 2015 Office Practicum User Conference Hands On: Send simple DIRECT message To send a simple DIRECT message without an attachment: 1. Start a new Message ( or F10), pick a test patient 2. Click the “To:” dropdown, scroll to the bottom and find someone whose DIRECT email you entered in the previous exercise 3. Enter a brief Subject and Message 4. Click, wait for delivery confirmation

12. 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 button ■ 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

13. 2015 Office Practicum User Conference Hands On: Sending DIRECT referrals To send a DIRECT message with an attached transition of care: 1.Open Chart ( or F8), pick a test patient 2.Go to Referrals/Trans tab, click to start a new referral. Choose “Referral to a specialist”, set “Referred To:” as someone whose DIRECT email you entered in the previous exercise, enter brief reason for referral (body) 3.Click, wait for new Message to appear 4.“To:” field is populated, and attachment icon is visible. Edit Subject and/or Message as necessary 5.Click, wait for delivery confirmation

14. 2015 Office Practicum User Conference Hands On: Sending DIRECT referrals

15. 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

16. 2015 Office Practicum User Conference Review: Sending from Event Chron

17. 2015 Office Practicum User Conference Review: Sending an Encounter Note

18. 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

19. 2015 Office Practicum User Conference Hands On: Receiving DIRECT messages 1.Open Schedule Form ( or F7), go to Messages tab 2.Switch to “Unread External” tab, read and respond to any new external messages just as you would handle internal messages 3.If “non-patient message” really does relate to a specific patient, click Choose Patient button in Patient Name column to associate with the appropriate chart

20. 2015 Office Practicum User Conference Hands On: Receiving DIRECT messages

21. 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 ■Can associate with patient if not mapped on receipt

22. 2015 Office Practicum User Conference Reviewing DIRECT referrals in OP 14

23. 2015 Office Practicum User Conference Hands On: Reconcile problem list, step 1 ■Switch to Problem List tab ■Compare lists side-by-side, then proceed to [Merge>>]

24. 2015 Office Practicum User Conference Hands On: Reconcile problem list, step 2 ■Choose which items to add, ignore, retain, or remove ■Can update Status, Onset Date, Resolved Date, Privacy Level and Sort Order on surviving items during this step ■When finished, proceed to [Review>>]

25. 2015 Office Practicum User Conference Hands On: Reconcile problem list, step 3 ■“Last chance” before committing back to chart ■When satisfied, press [Submit] button

26. 2015 Office Practicum User Conference Hands On: Reconciled problem list (chart) Can display Source on demand (blank means a record you created in OP) ■Flip to Chart and confirm intended results

27. 2015 Office Practicum User Conference Review: Reconcile medication allergies

28. 2015 Office Practicum User Conference Review: Reconcile medications

29. 2015 Office Practicum User Conference

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