RPMS DIRECT Secure Messaging
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1 RPMS DIRECT Secure Messaging Meet the Measure November 13, 2014 Glenn Janzen, Chief Enterprise Architect-IHS Meghna Patel, Business Analyst- DNC Duane Rozsnyai, Project Manager- DNC
2 Agenda Meaningful Use Stage 2 and DIRECT Secure Messaging. RPMS DIRECT Overview: Use Cases. Meet the Measure tasks. Measures: Secure Messaging with Patient. Patient Electronic Access to VDT. Transmit care summaries for transition of care. RPMS DIRECT Secure Messaging 2
3 Meaningful Use Stage 1: Capture structured information in EHRs. Stage 2: Exchange structured information among Providers and Patients. Electronic transmission of patient care summaries across multiple settings. More patient controlled data. RPMS DIRECT Secure Messaging 3
4 DIRECT Requirements for Stage 2 1. CPOE 2. E-Prescribing 3. Record demographics 4. Record vitals 5. Record smoking status 6. Use clinical decision support 7. Patients view, download, transmit 8. Clinical summaries to patients 9. Protect electronic health information 10. Incorporate lab results 11. Generate patient lists 12. Reminders for follow-up care 13. Patient educational resources 14. Medication reconciliation 15. Transmit care summaries for transitions of care 16. Report immunizations 17. Secure messaging with patients plus menu items 18. Report syndromic data 19. Record electronic notes 20. Imaging results 21. Record family history 22. Report cancer cases 23. Report other registry cases RPMS DIRECT Secure Messaging 4
5 How does RPMS DIRECT Work? Your RPMS DIRECT Addresses are used to route information: It looks like an address. Used only for health information exchanges. An Individual may have more than one DIRECT address. Can be used to send messages to only other trusted DIRECT address. RPMS DIRECT Secure Messaging 5
6 RPMS DIRECT Use Cases Federal Providers > Federal Providers. Federal Providers > Non Federal Providers. Non-Federal Providers > Federal Providers. Non-Federal Providers > Non-Federal Providers. RPMS DIRECT Providers > IHS PHR Patients. IHS PHR Patients > RPMS DIRECT Providers. Send and receive messages from RPMS DIRECT users, IHS PHR Patients, and other Trusted DIRECT partners. RPMS DIRECT Secure Messaging 6
7 Use Secure Electronic Messaging Objective (Ambulatory Only): Use secure electronic messaging to communicate with patients on relevant health information. Measure: A secure message was sent using the electronic messaging function of CEHRT by more than 5 percent of unique patients (or their authorized representatives) seen by the EP during the EHR reporting period. Exclusion: Any EP who has no office visits during the EHR reporting period, or any EP who conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 3Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period. RPMS DIRECT Secure Messaging 7
8 Meet the Measure Tasks Complete RPMS DIRECT Deployment: Register and grant access: Message Agent. Facility DIRECT Address. Providers. Healthcare professionals. Map Message Agent and Facility DIRECT Address in the RPMS. Assign Message Agent to a patient and/or patient group within RPMS Designated Primary Provider (DPP) Package. Complete PHR Deployment: Set up PHR Administrators and Registrars to support patient registration. Complete PHR patient registration process (i.e. EUID Link) to enable PHR access. Encourage patients and patients personal representatives to use PHR-My Messages Tab. RPMS DIRECT Secure Messaging 8
9 Message Agent and Facility DIRECT Address Designee Initial responder and distributor of the secure messages: Front Desk or Patient Check-in. Message Agent are a new provider type in RPMS. Message Agents can be assigned Facility DIRECT Address. When Message Agent is not assigned to a patient and/or patient group message will be sent to the Facility Address. RPMS DIRECT Secure Messaging 9
10 Assign Message Agent How to assign: Small sites may only need one. Larger sites may need more than one. Always consider having at least one backup to cover leave, sick days, etc. Patients can be assigned to a Message Agent in the RPMS Designated Primary Provider package: Can assign individual patients to a Message Agent. Can assign all of a provider s patient to a Message Agent. A provider can be a message agent, but we recommend using someone else on your team while you are starting out. RPMS DIRECT Secure Messaging 10
11 Measure Logic - Denominator Denominator Inclusions: The number of unique patients with one or more face-to-face visits with the EP as primary provider during the EHR reporting period, where the visit has a Service Category of A, S, O or M. Search for all visits up to the last day of EHR Reporting Period. RPMS DIRECT Secure Messaging 11
12 Measure Logic - Numerator Numerator Inclusions: Count the number of patients in the denominator who sent a secure electronic message to an EP/Message Agent during the EHR Reporting Period. The message may be received before the encounter as long as the message is in the reporting period. The message must be received by the EP/Message Agent using Certified EHR Technology determined in the following manner: RPMS sends EHR reporting period date range and Patient ID from denominator and queries API BPHRMUM (located in namespace BPHR) goes to PHR finds patients then sends request to direct log stored on direct mail server. PHR API BPHRMUM returns: The last date the patient used secure messaging. RPMS DIRECT Secure Messaging 12
13 Access the PHR RPMS DIRECT Secure Messaging 13
14 Patient Composes Message Note: All data displayed in the following images contain test data only and DO NOT contain real patient or provider data (PHI/PII). 1. Select a Visit. 2. Click the My Messages Menu. 3. Click Compose (sends to Assigned Message Agent). RPMS DIRECT Secure Messaging 14
15 Patient Sends Message Select a Subject. Type Message. Click Send Mail. RPMS DIRECT Secure Messaging 15
16 Patient Sent Message The Sent Folder Displays Sent Messages: API BPHRMUM Searches for PHR access first, then sent messages within the reporting period. Encourage patients to access the PHR and communicate to their Healthcare team through the PHR My Messages Menu. RPMS DIRECT Secure Messaging 16
17 Secure Messaging for Additional Measures Patient Electronic Access: View, Download, & Transmit. Use of My Messages within the PHR to transmit messages. Summary of Care: Uses DIRECT Address to send Transition of Care/Summary of Care document. RPMS DIRECT Secure Messaging 17
18 Patient Electronic Access Objective: Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP. RPMS DIRECT Secure Messaging 18
19 EP Measures Measure A: More than 50 percent of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information, with the ability to view, download, and transmit to a third party. Measure B: More than 5 percent of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information. RPMS DIRECT Secure Messaging 19
20 EH Measures Measure A: More than 50 percent of all unique patients discharged from the inpatient or emergency departments of the eligible hospital or CAH (POS 21 or 23) during the EHR reporting period have their information available online within 36 hours of discharge. Measure B: More than 5 percent of all patients (or their authorized representatives) who are discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH view, download, or transmit to a third party their health information during the EHR reporting period. RPMS DIRECT Secure Messaging 20
21 Summary of Care Objective: The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary care record for each transition of care or referral. Measure 1: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50 percent of transitions of care and referrals. RPMS DIRECT Secure Messaging 21
22 Summary of Care (cont.) Measure 2: The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN. Measure 3: An EP must satisfy one of the following criteria: Conducts one or more successful electronic exchanges of a summary of care document, as part of which is counted in "measure 2" (for EPs the measure at 495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR (b)(2). Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period. RPMS DIRECT Secure Messaging 22
23 Transmit Clinical Summary (1) Note: All data displayed in the following images contain test data only and DO NOT contain real patient or provider data (PHI/PII). The patient needs to have a referral as part of the visit. 1. Click the CCDA button. RPMS DIRECT Secure Messaging 23
24 Transmit Clinical Summary (2) 2. Select GENERATE CCDA for Visits/Referrals RPMS DIRECT Secure Messaging 24
25 Transmit Clinical Summary (3) 3. Select the Referrals Tab. RPMS DIRECT Secure Messaging 25
26 Transmit Clinical Summary (4) 4. Check the referral that you want to submit (transmit). To transmit CCDA as-is without customization, click Submit. To review or customize the CCDA before transmitting, click Review/Customize. RPMS DIRECT Secure Messaging 26
27 Transmit Clinical Summary (5) The CCDA can be customized by unchecking sections that you do not want to submit/transmit. Once you complete the customization, check Finalized and click Submit. RPMS DIRECT Secure Messaging 27
28 DIRECT Form Dialog RPMS DIRECT Secure Messaging 28
29 Transmit Clinical Summary (6) On the DIRECT Form dialog: Username: Provider s (your) RPMS DIRECT Address. Password: Provider s (your) RPMS DIRECT Password. Message Header: Type the recipient's DIRECT Address in the To: field. Type Provider s (your) RPMS DIRECT Address in the From: field. Type a Subject. Click Send. Note: Do not remove any text from the Message Body text RPMS DIRECT Secure Messaging 29
30 RPMS DIRECT Implementation Send messages internally: Participating Internal partners (Indian, Tribal, and Urban facilities). Patients with PHR access. Send messages externally: Trusted external partners. Part of the same Trust bundle/trust framework to ensure security and policy requirements align. Working with ONC and DirectTrust (Trust Framework) to achieve external exchange. RPMS DIRECT Secure Messaging 30
31 Questions? RPMS DIRECT Secure Messaging 31
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