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NextGen Share Direct Messaging

End User Training

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o Slides & Recording will be made available after the session.

o Notice:o Failure to meet regulatory requirements or failure to implement and utilize the necessary technology will impact eligibility, may result in missed

incentives and/or penalties. TSI Healthcare (TSI) attempts to provide basic guidance of current policy, CMS guidelines, and NextGen documentation. TSI does not present findings or guidance as expert advice regarding federal policies, their requirements, data collection methods, or reporting guidelines. “Meaningful Use” requirements and other incentives programs are defined by the various agencies and offices of the US Federal Government and are subject to change. As guidelines change, NextGen’s approach and TSI’s guidance may also be adjusted without notice. TSI does not administer incentive payments, guarantee eligibility, or guarantee the accuracy of analysis and any statements about the program. TSI Healthcare and the NextGen® family of products and services can only provide the tools to achieve these requirements; however the responsibility remains on the provider to achieve, correctly collect data, maintain documentation, and report on each measurement. Should the Client have any questions as to the interpretation of ARRA, the HITECH Act or other relevant rules, regulation or incentive programs, and/or their application to the specific practice, the Client should contact the appropriate government agency directly.

Agendao Introduction

o Fundamentals of Direct messaging o Meaningful Use

o NextGen Workflow o Sending Direct Messages

o Provider Directory o Compose Referral o Send Referral

o Receiving Direct Messages o Direct messaging routing o View and Access Referral CCD o Clinical Reconciliation

Introduction

What is Direct Messaging?

o Direct Messaging is a system that allows providers to send structured data from one EHR directly into another EHR through a secure electronic cloud‐based messaging system

o Send Direct messages to share clinical data during referrals and transitions of care

Gmail

AOL

Yahoo

NextGen Share

Data Motion

Email Direct Messaging

MedAlliesDirect

Direct Messaging vs. NextGen Share

Direct Messaging vs. NextGen Share

EmailDirect Messaging

NextGen Share Gmail

Nationwide Messaging Network

Nationwide network of connected providers who can securely exchange clinical data

Share patient data with more ease and

efficiency

Improved Patient Outcomes

Expand network of medical colleagues

MEANINGFUL USE

Direct Messaging & Stage 2 Meaningful Use

o Core Measure 15‐ Summary of Care o Measure 1. Provide a summary of care record for more than 50% of transitions of care and

referralso Measure 2. Electronically transmit a summary of care record for more than 10% of referrals or

transitions to a recipient

o Exclusion. Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from all 3 measures.

Sending & Receiving Direct Messages

NextGen Workflow:

Direct Addresses o What is a Direct address?

o Similar to an email address, a Direct address is the unique address that providers will use to send & receive Direct messages

o Who gets a Direct address?o Each provider with a Direct messaging license is assigned a Direct address

o If you are interested in additional Direct messaging licenses, contact your Client Solutions Advisor.

o Your practice is assigned a default Direct addresso MUST be linked to a default provider

o What are my providers’ Direct addresses? o Each provider’s Direct address is in the following format:

o Ex: [email protected]

o Uses the sub‐domain name provided in your implementation paperwork

o Open a ticket with [email protected] to receive your providers’ and practice’s Direct addresses

SENDING DIRECT MESSAGES

ACCESS REFERRALS ORDERS TEMPLATEStep 1:

Option 1: My Plano Click on the My Plan active text o Select the Referrals tab from the top toolbar.

Option 2: Orders Sectiono In the left‐hand column, select Referrals.o Click Add. The Referrals Order template

appears.

Intake Template

Option 2

Option 1

Today’s Orders Sectiono In the left‐hand column, select Referrals.o The Referrals Order template appears.

SOAP/Dictation/Provider Template

Checkout Template

Today’s Orders Sectiono In the left‐hand column, select Referrals.o Click Add. The Referrals Order template appears.

Integrated Workflow: Referrals and Transitions of Care

SEARCH PROVIDER DIRECTORYStep 2:

Access Direct Messaging Provider Directory

Search and Select Intended Recipient Search Directory pop‐up by provider name, specialty, organization or location and select recipient.

TSI TIP: The local directory contains providers whom you have previously Search just the local directory if you are searching for a provider whom you have previously discovered for a quicker, easier search.

Immediately Searchable vs. Ultimately Reachable

o 200,000+ providers immediately searchable in out‐of‐the‐box NextGen Share Provider Directory‐ NextGen Share Network 1. Providers using NextGen Share 2. Providers using Direct messaging systems with whom NextGen has “Directory Sharing Agreement”

(MedAllies, Allscripts, etc.)

o 600,000+ providers on Direct messaging network and ultimately reachable through NextGen Share

o Providers using accredited Direct messaging systems o TSI Healthcare can add external providers who use Direct messaging to your NextGen Share Directory and the

NextGen Share network

o Analogy: Email address book

Add External Providers

To add providers who are not in your out‐of‐the‐box NextGen Share Provider Directory:

1. Contact practice to confirm if they are using Direct messaging 2. If so, ask for a list of all providers’ Direct addresses and name of EHR system3. Open a ticket with [email protected] that lists each provider’s name, Direct address, and EHR

system

Please add the following provider(s) to our NextGen Share Direct messaging Provider Directory:

Provider Name , Direct Messaging Address, EHR systemProvider #2 Name, Direct Messaging Address, EHR system

COMPLETE REFERRAL & ADD ATTACHMENTSStep 3:

Complete Referral

Diagnosis is only field required to complete referral

Add Attachments

**Attachments must be documents saved to a patient encounter. ICS images can be attached in UD2

SEND REFERRAL MESSAGE Step 4:

Send Referral through Direct Messaging1. Once you complete referral, click “Add” to add order to “Referrals Ordered this Encounter” grid

2. Highlight referral order and select “Share”

1

2

Creates referral cover letter Names: sending provider, receiving provider, key issues and included attachments

Converts all attachments to PDFs Generates Continuity of Care document (CCD) Electronically transmits message and attachments to recipient’s EHR Counts referral/transition in numerator for MU2 Core 15: Measure 1 & Measure 2

When you hit “Share” to send a Direct message, the system:

Step 1: Launch NextGen Share Provider Directory to search & discover connected providers

Step 2: Complete referral form

Step 5: Click Share to Send referral through Direct network‐count towards MU

Step 3: Add Attachments

Step 4: Click “Add” to add to Referrals Ordered this Encounter Grid

Integrated Workflow to Send Direct Messages

Confirm Status of Direct Message2 primary locations in NextGen EHR:

1. Comments field of referral order

2. Transitions of Care‐ Referral (Sent) in Categories tab

RECEIVING DIRECT MESSAGES

Why is this important?o MU3 requires providers to:

1. Incorporate an electronic summary of care into a patient’s chart >40% received transitions/referrals

2. Reconcile medications, allergies & problems >80% received transitions/referrals

o In addition to being MU3 requirements, these workflows will increase the ease and efficiency of receiving/coordinating referralso Automated, streamlined integration of patient data

o Establish good habits now!

INCOMING MESSAGE ROUTING Step 1:

Incoming Message Routing

Your EHR

Rosetta Holding Tank

Provider’s EHR Inbox

Staff must manually send message from RHT to Inbox

ROSETTA HOLDING TANK

Q: Who is responsible for the Rosetta Holding Tank?

o A: Whoever is in charge of managing new patient coordination

o This staff member will follow the same process already in place…just without paper. Consider:o Do you ask providers for permission to accept each new patient?

o If so, you will need to show provider the referral message in the RHT to confirm that they want to see the patient before doing anything with message in RHT

o Do you need to confirm with provider if they are accepting new patients?o If so, will need to confirm before doing anything with message in RHT

o Ultimately, you don’t want to create charts or import data for patients that aren’t going to be accepted by the practice or seen by the provider

Access Rosetta Holding Tank

Rosetta Holding Tank

Incoming Direct messages will have Type Message “HIEDocument”

Step 1: Confirm if New or Established Patient

EstablishedPatient

NewPatient

Successful Match

Unsuccessful Match

TSI Tip: Search first by patient name. If

unsuccessful, search DOB to ensure patient is not already in EHR & help prevent duplicates

If Referral is for Established Patient…

You can immediately export referral message out of Rosetta Holding Tank into patient’s existing chart in EHR.

Clinical Reconciliation: Import CCD data

into chart (see next section)

Referral leaves RHT and goes to

recipient provider’s EHR

Inbox

Call Patient to schedule

appointment

If Referral is for New Patient…

TSI Healthcare recommends that you create a patient’s chart and export the referral CCD out of the Rosetta Holding Tank into EHR before the patient’s appointment.

o This way, your providers and staff can reconcile the clinical data listed on the CCD with the patient during their encounter.

While message is still in RHT, call Patient to schedule

appointment using # on CCD

1. Create new patient in EPM

2. Create new chart in EHR

Clinical Reconciliation: Import CCD data into chart (see next section)

Referral leaves RHT and goes to recipient

provider’s EHR Inbox

TSI Tip: Call pt before creating their chart to avoid creating

ghost patients

Routing Rules 1. Order Result Notifications

o Assign certain staff members to be notified of the receipt of incoming Direct messages in their own EHR Inbox for specific providers

2. Assigned Provider o Any user who is linked to a specific provider in the “Assigned Provider” field in File Maintenance will receive

incoming NextGen Share tasks in their Inbox for their assisgned provider

3. PAQo Incoming Direct messages can be sent to a provider’s PAQ should they wish to view and signoff on them there

These rules apply to Direct messages that are automatically sent to the recipient provider’s EHR Inbox AND to those manually matched out of the Rosetta Holding Tank into the EHR.

**Please open a ticket with the TSI Helpdesk for assistance with setting up Direct messaging routing rules

VIEW REFERRAL AND ATTACHMENTS Step 2:

View Referral CCD & Attachments 1. Right‐click on the referral task in the Inbox. Select “Go to patient’s chart”

2. Click on Categories panel of Patient History bar. Find “Transition of Care‐ Referral”

o NOTE: If message is sent from non‐NextGen system, referral documents may be found in “HIE Documents” category

3. Open folder to view CCD, attachments and all other contents included in the referral message.

Example CCD

CLINICAL RECONCILIATIONStep 5:

Clinical Reconciliation

o When you receive an electronic CCD for a patient through Direct messaging, you can reconcile and import:

MedicationsAllergiesProblemsDiagnosis CodesProcedures

o MU Stage 3 Requiremento Medications, Allergies & Problems o Important to establish good habits now!

WHO, WHEN & WHERE TO RECONCILE CCD DATAClinical Reconciliation:

Suggested Workflow 1: Clinical StaffClinical staff medications, allergies & problems

Suggested Workflow 2: ProviderProvider medications, allergies & problems

Clinical Staff

Provider

Medications X

Allergies X

Problems X

At a minimum, TSI Healthcare suggests that your practice reconcile CCD medications, allergies and problems with the patient during their appointment

**The purpose of this functionality is not just data abstraction

Suggested Workflow 3: HybridClinical staff medications & allergies

Provider problems

Clinical Staff

Provider

Medications X

Allergies X

Problems X

Clinical Staff

Provider

Medications X

Allergies X

Problems X

First step determine who will reconcile which parts of the CCD

Suggested Workflow 1

Clinical StaffMedications, Allergies & Problems

Medication Reconciliation Pop‐Up

1. From the Medications section on Intake/Home Page, click “Reconcile” to open medication reconciliation pop‐up

2. Under “Reconciliation Type,” click “E‐reconciliation” to launch reconciliation module

Clinical Staff Medications, Allergies & Problems


ProvidersMedications, Allergies & Problems

Recommended: Clinical Reconciliation Module

1. Click “View” then “Clinical Reconciliation” to launch clinical reconciliation module

Alternate: Medication Reconciliation Module



ProvidersMedications, Allergies & Problems


Clinical StaffMedications & Allergies Providers Problems

Clinical Staff Medications & Allergies

Medication Reconciliation Pop‐Up



Option A: Histories‐ Problems1. From the Problems section on the Histories

template, click “Add” to launch the problemsmodule

Option B: Patient Information Toolbar1. Click “Problems” in the Patient

information toolbar to launch the problems module

Provider ProblemsProblems Module

Option C: Patient History Toolbar1. Click the Problem Module in the

Patient History toolbar to launch the problems module

2. Once you have launched the Problems module, select “Reconcile” to launch the reconciliation module

HOW TO RECONCILE & IMPORT CCD DATAClinical Reconciliation:

Open CCD in Reconciliation Module

1. Once you have accessed the reconciliation module, select the entry for the Continuity of Care Document entry in the Documents tab

Clinical Reconciliation Module 2. Click the Import tab. For each category (Meds, Allergies, etc.):

o EHR Panel shows clinical data currently in your EHR for this patiento Import panel shows clinical data from referral CCD o Reconciliation Summary panel shows what your EHR will contain after reconciliation.

Import Referral CCD Data3. Import Panel‐ reconcile clinical data on CCD with data in your EHR. It suggests which items to import from CCD into your EHR with the following statuses:

o Add ‐ Item is listed on CCD but not your EHR. Import into EHR.o Ignore‐ Item exists both on CCD and in EHR. No action necessary. o Replace‐ Replace item in EHR with item listed on CCD.

Reconcile Existing Clinical Data 4. EHR Panel‐ reconcile data already listed in your EHR with the patient. Can assign the following statuses based on patient updates

o Keep‐ No action taken. This is the default status for all items in EHR panel. o Stop‐ Stop medication. (Under Medications Tab)o Resolve‐ Resolve allergy or problem (Under Allergies and Problems Tabs)

Complete Reconciliation5. Once you make all necessary status changes, review Reconciliation Summary section to confirm what EHR will list after reconciliation. Click Confirm to complete reconciliation.

6. Repeat with other CCD categories as necessary.