RelayClinical Service Feature Guide RelayClinical Notify

RelayClinical Service Feature Guide RelayClinical Notify Release 15.11 November 2015 Health Connections Brought to Life

Table of Contents Overview... 3 Benefits... 3 Models... 3 Alternate Deployment Option... 3 Notification Type and Content... 4 What s Inside... 4 How Can We Help?... 5 Navigating Notification Messages... 6 Receiving Notification Messages in RelayHealth Inbox... 7 Routing and Enabling/Disabling Notification Messages... 8 Setting for All Providers in Practice (Default)... 8 Setting for Individual Provider(s) in Practice... 9 Monitoring Notification Messages in the InterOp Portal... 10 Search for Messages in Message Search View... 10 Review Search Results and Message History... 12 Common HL7 ADT Errors and Resolution Steps... 15 Designating Data Administrators... 16 Appendix A: RelayClinical Notify Frequently Asked Questions... 17 Appendix B: Sample Notification Messages... 19 Scenario 1: Patient Admitted to Emergency Department... 19 Scenario 2: Patient Admitted to Hospital... 20 Scenario 3: Patient Discharged from Emergency Department... 21 Scenario 4: Patient Discharged from Hospital... 22 1999-2015 RelayHealth and its affiliates. All rights reserved. 2

Overview The RelayClinical Notify feature allows providers and/or care team members to receive electronic notifications of their patients hospital and emergency department admission and discharge events. To enable these notifications, the RelayClinical service accepts inbound HL7 ADT messages (A03 - Discharge/End Visit and A04 - Register a Patient). In response to the ADT, RelayHealth delivers notification of the admit/discharge event(s) to the provider/care team member RelayHealth inbox(es) as a standard message type. Benefits Care team members with active connections to a patient are notified upon significant care transitions Care team members or Practice Administrators can route notifications to specified inboxes in accordance with workflow preferences Care team members who prefer not to receive notifications can disable notifications or Practice Administrators can disable notifications on behalf of the care team member Data Administrators have visibility into Notify transaction processing with ADT transaction status and details available in InterOp Portal Models RelayClinical Notify supports the notification models below all of which leverage RelayHealth s enhanced processing architecture. All Providers This model allows the service to notify all RelayHealth providers who have an existing relationship with the patient when that patient has an admission and/or discharge event from an emergency department or hospital. In this model, RelayHealth discovers the list of connected providers from the patient s record rather than provider or practice information sent in the ADT message. This model provides the highest level of visibility into the patient s care events as it allows all members of the patient s care team to receive notification. Primary Care Provider (PCP) Only This model continues the previously available functionality of Primary Care Provider notification upon a patient s admission and/or discharge from the emergency department or hospital. This configuration supports facilities that have the ability to send the PCP's Provider ID and Practice ID in the ADT A03 / A04 transactions sent inbound to RelayHealth, when those facilities do not also require notification to other care team members. Primary Care Provider (PCP) + All Providers In this combined model, the service sends the admission and/or discharge notification to the PCP and all other RelayHealth providers with whom the patient has an existing relationship. This configuration supports facilities that have the ability to send the PCP's Provider ID and Practice ID in the ADT A03 / A04 transactions sent inbound to RelayHealth. When the service finds a matching PCP, that provider receives the admit/discharge notification, and the service uses the patient information in the inbound ADT to discover the list of any additional associated providers who should receive the notification. Alternate Deployment Option The RelayClinical Notify feature may be configured to send notifications as an HL7 MDM message delivered to the provider's EMR. If your healthcare organization has chosen to deploy RelayClinical Notify using the outbound MDM configuration, the admit/discharge notification messages will be delivered to the EMR as well as the designated RelayHealth inbox (e.g., provider, practice, custom, etc.). 3

Notification Type and Content Notification content and event triggers are dependent upon the notification model configured for the customer sending the ADT transaction to RelayHealth, the type of ADT sent to RelayHealth (A03 or A04), as well the data transmitted to RelayHealth within the ADT. For example, customers sending RelayClinical Notify ADTs to RelayHealth may choose to send the ADTs upon any or all of the following events: Hospital admission Hospital discharge Emergency department admission Emergency department discharge Using data included in the ADT messages sent to RelayHealth, providers and/or care team members receive notifications that may include: Patient Name Date of Birth Event Type Attending Doctor * Diagnoses/Complaints * Admit Date * Discharge Date * Facility Name * Discharge Disposition * * If received in the ADT Please refer to Appendix B: Sample Notification Messages in this document, for ADT inbound scenarios and sample notification messages. What s Inside This Feature Guide provides an overview of the RelayClinical Notify feature. In this Guide you ll find: A brief navigational overview Instructions for all users that identify the steps you ll take to review notification messages in RelayHealth inboxes Instructions for Practice Administrators that describe how to enable, disable, and/or route notification messages at the practice and provider levels Instructions for Data Administrators that describe how to search for RelayClinical Notify ADT transactions in the RelayHealth InterOp Portal. Instructions for Practice Administrators that describe how to grant Data Administrator privileges to a user in the practice. Additionally, this document includes the following supplemental information: Appendix A: RelayClinical Notify Frequently Asked Questions Appendix B: Sampe Notification Messages 4

How Can We Help? RelayHealth is ready to support you every step of the way as you use the service. You can request assistance, propose suggestions, or submit comments by any of the following methods: Use the Contact Us link at the bottom of your Home page to send a secure message directly to our RelayHealth Support organization. You can also call our toll-free number and speak to one of our Support representatives from 4:30 am to 5:00 pm Pacific Standard Time. Call 1-866-RELAY-ME (1-866-735-2963) and select option 1. Speak with your RelayHealth Deployment Specialist or Project Manager. These RelayHealth professionals welcome your suggestions and comments about the service, your experiences with system use, and any concerns you may have. 5

Navigating Notification Messages The Notify feature delivers notifications to RelayClinical providers and/or care team members about their patients admissions and discharges from hospitals and/or emergency departments. The service delivers notifications to RelayClinical inbox locations according to the message routing specified by your Practice Administrator. For example, admin/discharge notifications may be routed directly to a provider s inbox, a practice inbox, or a custom inbox. Regardless of routing, care team members will simply click the message subject to review the notification content. The message s subject identifies the type of notification (admit, discharge) as well as the patient s name. A RelayHealth Implementation Services representative can configure the Notify feature to send notifications upon any or all of the following events: Hospital admission Hospital discharge Emergency department admission Emergency department discharge The deployment selected by sending healthcare organization determines the type of notifications providers and care team members receive in the service. 6

Receiving Notification Messages in RelayHealth Inbox Your Practice Administrator can route notification messages to any inbox, including a custom inbox. Follow the instructions below to access these messages. 1. From your Home page, click your inbox or the inbox to which notification messages route for your practice (e.g., practice inbox, custom inbox, etc.). 2. Click the message s subject (Patient Admit Notification or Patient Discharge Notification). The message sender is RelayHealth Clinical Notify. 3. The Message Details display. After reviewing the message, you may: Archive the message This action removes message from the inbox. Save the message You may optionally click the Mark printed copies of this message as Confidential checkbox, and save the message. When you return to the inbox, you may print the message for the patient s chart with the Confidential indicator. Close the message With this action, the message remains in the inbox. Options: To print the Admit or Discharge notification, click the checkbox to the left of the message, and at the bottom of the inbox list, click Print Copy for Chart. To archive the message and remove it from the inbox, click the checkbox to the left of the message, and at the bottom of the inbox list, click Archive. 7

Routing and Enabling/Disabling Notification Messages Practice Administrators can specify routing of RelayClinical Notify messages. This configuration can be performed as a default routing setup for all providers in the practice or on an individual provider basis. RelayClinical Notify messages are not supported at the practice level and do not appear as an option under the Practice Message Settings area. Follow the instructions below to set default routing and/or individual provider routing. Setting for All Providers in Practice (Default) To set default routing for notification messages, follow the instructions below: 1. From any page in the service, click the Settings link at the upper right corner of the page. Click the Practices tab. 2. If you are a member of multiple practices, select the appropriate practice from the Practice tab s dropdown. 3. On the vertical navigation panel, click Provider Message Settings. 4. The View Provider Default Message Settings screen displays. Under the Clinical Messages section, click ED Notification. If you want to disable Notifications, simply click the No radio button and click Save. 5. Use the Route to dropdown to select the appropriate inbox for delivery and click Save. 6. The service displays a warning related to providers who will not be affected by the new routing. Click Confirm. 7. The View Provider Default Message Settings screen displays. You may optionally update notification routing for all providers in the practice by clicking the Update Settings For All Practice Members link. 8

Setting for Individual Provider(s) in Practice To set routing for notification messages according to individual provider preferences, follow the instructions below: 1. From any page in the service, click the Settings link at the upper right corner of the page. 2. On the Members tab, use the dropdown to select the appropriate provider. 3. On the secondary navigation bar, click the Settings button. 4. On the vertical navigation panel, click Message Settings. 5. To the left of the ED Notification message type, click Edit. 6. Use the Route to dropdown to select the appropriate inbox and click Save. You may optionally disable this message type for this provider, if necessary. Select the No radio button next to the Enable this message type and click Save. 9

Monitoring Notification Messages in the InterOp Portal RelayHealth s InterOp Portal empowers our customers to troubleshoot issues that may occur in data exchange. Providers and staff members who have Data Administrator privileges may use the InterOp Portal s Message Search feature to monitor the exchange of RelayClinical Notify ADT transactions. Users who have Practice Administrator privileges may adjust user privileges in the Settings area of the service and may assign Data Administrator privileges to themselves or to other practice users. Data Administrators may search for and review RelayClinical Notify ADT transactions for any practice in which they have Data Administration privileges. Follow the instructions below to search for and review RelayClinical Notify transactions. Search for Messages in Message Search View Message Search provides multiple criteria used to filter the search and provide a targeted list of messages for review. Follow the instructions below to search for and review messages in the Portal s Message Search view: 1. While logged in to the RelayClinical service, click the Data Administration link displayed at the upper right of any page in the service. 2. The InterOp Portal launches in a new browser window. Click the Message Search tab in the global navigation bar, or click the blue Search for Messages button at the center of the screen. 10

3. Message Search defaults to search by Message Attributes. Select Product from the Search Messages By dropdown. 4. The Product Category is Notifications. 5. Select the preferred Product Type from the dropdown: ER Admit All Providers ER Discharge All Providers Hospital Admit All Providers Hospital Discharge All Providers ER Admit PCP ER Discharge PCP Hospital Admit PCP Hospital Discharge PCP NOTE: If you are searching for inbound messages from an organization deployed with the combined All Providers + Primary Care Provider RelayClinical Notify model, please select from the All Providers options in the list above. 6. You may optionally specify a Message State (All, Processing, Processed, Failed, Resubmitted, or Suppressed). 7. Using the Message Content section (click arrow to the right of Message Content heading to expand) you may optionally specify: Patient Name (last name only or first and last name) Provider Name (last name only or first and last name) Practice dropdown (select desired practice from list) 8. Date Range defaults to today. If you prefer, click the Date Range field to specify an alternate range (e.g., Yesterday, Last 7 Days, or Custom Range). 9. Click Search to view messages that match your search criteria. 11

Review Search Results and Message History Search Results Messages matching the search criteria display in table format below the Message Search criteria panel. If you prefer to clear your previous search selections and search for messages using different criteria, click Reset in the search panel and perform the steps above. The Search Results table indicates: Message Type, Message Id, Sending (Inbound from Source to RelayHealth), and Receiving (Outbound from RelayHealth to Endpoint) for each matching message. Message Type For HL7 messages, this is the message type from MSH 9 segment (e.g., ADT). Message ID For HL7 messages, this is a unique message ID from the message s MSH 10 segment. Sending These are messages received into RelayHealth. Receiving These are messages sent out from RelayHealth. The Receiver column, if populated, indicates the practice(s) to which RelayHealth transmitted an HL7 format message. In most cases, the Receiving column will not be populated for Notify messages, as notifications sent to providers/care team members transmit as secure system messages to a RelayHealth inbox. The service will return up to 250 matching messages in Search Results. If necessary, you can access additional search results using the page navigation tool at the lower left of your screen. If the service returns a high number of messages, but the individual message you are searching is not displayed in the search results, please review your selected search filters and attempt the search again using a higher constraint level. For example, select a shorter date range. If no messages match your query, the portal displays No Messages Found at the lower left of your screen. 12

Message States The Search Results list uses visual indicators that allow you to review message activity at-a-glance. Search results indicate the message processing state with gray Processed, Failed, Resubmitted, and Suppressed icons; the Failed message icon is the only icon displayed in red. Messages that process successfully, but with an error, include a clear error description as well as red highlighting. Message State Processing Processed Resubmitted Suppressed Failed Description Message is actively processing. Message processed successfully. Click the gray Processed icon to review message attributes and message content. Message resubmitted. Resubmitted messages did not process properly the first time and RelayHealth resubmitted them for processing. Click the gray Resubmitted icon to review message attributes and message content. Message suppressed. A suppressed message occurs when a practice subscribes to a certain message type or source but none of the providers within the practice match a provider in the message. By default, Suppressed messages do not display in search results unless selected as a search filter. To view suppressed messages, click the orange toggle icon displayed in the Receiving column header: If no suppressed messages exist on the page, the toggle button is blue: Message failed. Click the red Failed icon to review message attributes, detailed error message, and message content. To review detail associated with an individual transaction (including tracking details and HL7 message content), click the Message State icon to launch the Message History screen. 13

Message History The selected message s detail displays in the Message History feature. This screen provides multiple navigation and action options and detail displayed depends upon the message source, processing activities, and endpoint (if any). For example, in the Sending column, expand the Tracking Details and Message Content sections to view additional information by clicking the headings to toggle the sections (open/collapse). Tracking Details specify actions taken, duration of each action, whether each action was successful/failed, retry attempts (if any), etc. Message Content includes the data sent to RelayHealth in the inbound ADT message; expand the Message Content panel to inspect the ADT message. Additionally, the Message History area includes action options for Reprocess (inbound messages) and Retry (outbound to endpoint). These options appear at the top of the Sending and Receiving columns, and using these options will not create duplicate messages. Again, note that it is expected behavior to see no entries in the Receiving column for RelayClinical Notify messages, as the notifications sent outbound to provider/care team members are delivered to a RelayHealth inbox. 14

Common HL7 ADT Errors and Resolution Steps ADT Error Cause Resolution Provider not found Invalid Format [Input string was not in a correct format.] Patient location information (PV1.3) not found No relationship exists between provider [ProvId] and practice[pracid] Message is duplicate Validation failed: PID7[0]: 404 Date of birth must be specified Patient Matched by Id but did not pass the year of birth check. Validation failed: PID8[0]: 404 Gender must be specified The identifier 'xxxxx' was required but was missing from the listed patient identifiers. None of the providers in the message are configured in RelayHealth. A data field in the message is not formatted properly. The location of the patient is not in the message. The provider and practice IDs in the message are not configured in RelayHealth. RelayHealth previously processed a message with the same content. PID-7 does not contain a date of birth. RelayHealth matched the ID to an existing patient; however, the birth year did not match. PID-8 is missing. The ADT did not have the required patient identifier. Review message, if a provider in the message should be registered in RelayHealth, please contact Support. Resend message with a properly formatted field. Resend message with valid location information populated. Review message, if the provider should be located at the practice in the message within RelayHealth, please contact Support. No action required. RelayHealth will not process the duplicate message. Resend message with the patient s date of birth. Review the message to determine whether this is a valid error. If it is, RelayHealth has the ability to skip the year of birth check and only validate based on Patient Identifier with a configuration change. If desired, please contact your RelayHealth Project Manager. Resend message with the patient s gender. Resend message with the patient s identifier. 15

Designating Data Administrators Only users with Data Administrator privileges may access the InterOp Portal. Practice Administrators may grant this privilege to themselves or to others in the practice. If you are a Practice Administrator, follow the instructions below to grant Data Administrator privileges to other users in your practice. 1. Click the Settings link at the upper right of any page in the service, and select the practice from the dropdown if necessary. 2. On the Practice Setup page, click the name of the practice member to whom you are granting Data Administration privileges. 3. At the upper right of the Settings section, click the Edit Staff [or Provider] Settings link. 4. To the right of the Data Administration setting, click the Yes radio button. Click Save. The practice member now has Data Administration privileges in the RelayClinical service. From Data Administration link, the practice member will have the ability to search for and review this practice s messages InterOp Portal. 16

Appendix A: RelayClinical Notify Frequently Asked Questions My organization uses the Primary Care Provider + All Providers notification model. If I am the PCP, will I receive two notifications? No, you will receive one notification message. The service will recognize the duplicate and will not send the second notification. My organization uses the Primary Care Provider + All Providers notification model. If a patient s only active provider connection is with a Default Provider entity, who receives the notification? If the patient's only connected provider is the default provider entity, the admit and/or discharge notification transmits to the default provider inbox. Does RelayClinical Notify support notifications for outpatient events? Not at this time. Currently, the feature supports Inpatient and Emergency admit/discharge events. My patient was admitted to an emergency department, but I did not receive a notification. Why? The healthcare organization sending the ADT to RelayHealth has the option to send ADTs related to admit, discharge, or both from the hospital and/or emergency department. If, for example, the sending organization has elected to implement only the discharge notification option, you will not receive admit notifications. Additionally, your account may not be enabled to receive notifications or the notifications may currently route to a custom or practice inbox instead of your personal inbox. Please review the Routing and Enabling/Disabling Notification Messages section of this Guide to determine the configuration in your organization, or consult with your Practice Administrator who may configure notification routing on your behalf. Sometimes the notification messages I receive specify a facility and/or discharge disposition, and sometimes the messages don t include this information. Why? This is by design. When the emergency department or hospital sends the admit or discharge information to RelayHealth by ADT transaction, the Facility field and the Discharge Disposition fields are optional. If RelayHealth does not receive this information in the inbound transaction from the health system, the service will mask one or both of the fields instead of displaying blank fields in the message delivered to you. Please refer to Appendix B: Sample Notification Messages, in this document, to review notification scenarios and required/optional values. Can my organization customize the Subject or message content of a notification? No. The message subject, Patient Admit Notification or Patient Discharge Notification is dependent upon the type of ADT transaction sent to RelayHealth (A03 - Discharge/End Visit and A04 - Register a Patient) as well as the Patient Class information included in the ADT transaction. The event detail included in the notification is dependent upon the information sent from the hospital or emergency department to RelayHealth. I only need discharge notifications. How can I disable admit notifications? At this time, the RelayClinical Notify feature does not distinguish between enabling receipt of an admit or discharge notification. The type of ADT sent to RelayHealth determines the notification type you will receive (admit, discharge, or both). If your account has the ED Notifications message type set to Enabled under the Settings area of the service, and your healthcare organization has licensed and deployed the RelayClinical Notify feature, you will receive admit and/or discharge notifications for patients with whom you have an established RelayHealth relationship. 17

I do not want to receive these notifications. How do I disable them? Individual providers can disable the ED Notification message type under the Settings area of the service. At the upper right of any page in the provider portal, click Settings. On the Settings page, Members tab, select your name from the dropdown list. Just to the right of the Members tab, click Settings again to access your personal account settings. Select Message Settings from the left navigation panel. Click Edit next to the ED Notification message type, and click the No radio button to disable the notifications for your account. Note: if your Practice Administrator has locked message settings for your practice, the lock will prevent you from disabling the notifications under your personal settings. Please contact your Practice Administrator directly to request that he or she disable the notifications on your behalf. Will I receive notifications for offline patients? Yes. The RelayClinical Notify feature will send notifications for online and offline patients. 18

Appendix B: Sample Notification Messages The scenarios below indicate the information that a provider and/or care team member may receive in an admit or discharge notification. Note that several values (bolded below), are optional meaning this information may or may not be sent from the care facility to RelayHealth. If received in the inbound ADT message, these optional values will be included in the notification sent to the provider and/or care team member. Scenario 1: Patient Admitted to Emergency Department RelayHealth receives ADT A04 message ADT PV1.2 (Patient Class, required) valued with E ADT PV1.7 (Attending Doctor, optional) valued with provider name and ID ADT PV1.39 (Servicing Facility, optional) valued with name of ED where the patient visit occurred ADT PV1.44 (Admit Date/Time, optional) valued with valid date or date and time ADT DG1.4 (Diagnoses, optional) valued with ICD-9/10 diagnosis 19

Scenario 2: Patient Admitted to Hospital RelayHealth receives ADT A04 message ADT PV1.2 (Patient Class, required) valued with I ADT PV1.7 (Attending Doctor, optional) valued with provider name and ID ADT PV1.39 (Servicing Facility, optional) valued with hospital name where the patient visit occurred ADT PV1.44 (Admit Date/Time, optional) valued with date or date and time ADT DG1.4 (Diagnoses, optional) valued with ICD-9/10 diagnosis 20

Scenario 3: Patient Discharged from Emergency Department RelayHealth receives ADT A03 message ADT PV1.2 (Patient Class, required) valued with E ADT PV1.7 (Attending Doctor, optional) valued with provider name and ID ADT PV1.39 (Servicing Facility, optional) valued with Name of ED facility where the patient visit occurred ADT PV1.44 (Admit Date/Time, optional) valued with valid date or date and time ADT PV1.45 (Discharge Date/Time, optional) valued with valid date or date and time ADT PV1.36 (Discharge Disposition, optional) valued with patient s discharge disposition ADT DG1.4 (Diagnoses, optional) valued with ICD-9/10 diagnosis 21

Scenario 4: Patient Discharged from Hospital RelayHealth receives ADT A03 message ADT PV1.2 (Patient Class, required) valued with I ADT PV1.7 (Attending Doctor, optional) valued with provider name and ID ADT PV1.39 (Servicing Facility, optional) valued with Name of hospital where the patient visit occurred ADT PV1.44 (Admit Date/Time, optional) valued with date or date and time ADT PV1.45 (Discharge Date/Time, optional) valued with date or date and time ADT PV1.36 (Discharge Disposition, optional) valued with patient s discharge disposition ADT DG1.4 (Diagnoses, optional) valued with ICD-9/10 diagnosis 22