Welcome to EpiCare Link! As an affiliated provider of Trinity Health Of New England regional

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1 Thomas W. Turbiak, MD, FACEP Regional Chief Medical Informatics Officer Emily L. Hahn BSN, MSN Regional Chief Nursing Informatics Officer Welcome to EpiCare Link! As an affiliated provider of Trinity Health Of New England regional healthcare network, you are the catalyst for your patients care. We are thankful you have elected to partner with us in providing care for your patient. In order to efficiently coordinate treatment we are proud to provide you with EpiCare Link a web based portal where you can easily look up your patient information contained from EpiCare EMR. It allows you to stay informed and give you timely access to your patients medical information from any computer or internet-enabled mobile device. EpiCare Link is all Online at no cost to you and there is no software to install. This online portal provides secure, convenient access to patient information through your browser when and where you need it. Your access is easy to set up, and there s no software or hardware to maintain, so you can concentrate on caring for your patients. NO TRAINING IS REQUIRED! As your patients are cared for by our providers, you'll receive notifications and updates. You will also have the necessary information you need to help maintain your patients ongoing medical care. EpiCare Link encompasses the complete patient registration, scheduling, clinical and billing information for the Trinity Health Of New England regional hospitals and clinics. Some of the many features offered with this portal are: Lab, imaging and test results Radiology imaging (Fuji Mobility) Hospital admissions (notifications and reports) Discharge summaries Consultation notes Surgery notes Summary of Care Medication Lists And more! For more information or to request an application, epicmd@trinityhealthofne.org

2 What is EpiCare Link? EpiCare Link is a web based application connecting Trinity Health Of New England based affiliates via secure access to select capabilities and patient information within EpiCare electronic medical record. With EpiCare Link, affiliate providers can: Access patients medical records at any of the member hospitals of Trinity Health Of New England Affiliate providers providing care can access medical records, which can improve the quality of care for the patient. Review billing information Affiliate providers who admit or refer patients to a Trinity Health Of New England member hospital inpatient facility can have their billing staff review clinical documentation to verify that client billing is accurate and supported. This feature may be utilized for coding and charge reconciliation. Affiliate providers may include: referring providers, referred to providers, contracted providers, support staff delegates and employers. Request Access If you are interested in gaining access to EpiCare Link; please complete and submit the attached forms listed below. Request for Employee Access to EpiCare Link Complete the Medical Practice Information selection of the form. Choose a Sponsor/Administrator who will act as your office s primary EpiCare Link contact. The Sponsor/Administrator is responsible for authorizing new account setups and account deactivations. In the event that the Sponsor/Administrator is not available, we recommend that you include a backup person on this form. The Sponsor/Administrator will only be authorized to request new accounts for your office. Please be aware that we cannot accept the office manager s signature as appropriate authorization for your practices s initial account setup. EpiCare Link Access and Confidentiality Agreement Each person who will use EpiCare Link must complete this form in its entirety. Feel free to make as many copies as necessary for employees requesting a new account. Examples of Organization Acknowledgement Signature can be that of a Doctor/Provider, Owner, or established Sponsor/Practice Administrator. Fax to: or; epicmd@trinityhealthofne.org

3 Welcome to EpiCare Link! As a Trinity Health Of New England Post Acute Care Referral facility, we look forward to working with you in the safe transitions of care for the patients we serve. To efficiently coordinate care we are proud to provide you with EpiCare Link a web based portal where you can easily look up pertinent information on patients who have been accepted by your organization for the next level of care. It allows you to stay informed as the patient s condition progresses and provides timely access to information from any computer or internet enabled device. The primary goal of EpiCare Link access is to facilitate a safe transition for patients and reduce the potential for readmission Each affiliated provider will be granted a number of EpiCare Link access users: sub acute beds = up to sub acute beds = up to sub acute beds = up to 7 Home Health = 7 Each access will be granted to a single staff member for their use only (i.e. username/login and password cannot be shared) Facility/organization required Access will be provided to the following provider roles: Admission Director/designee Licensed clinical staff that are: Responsible for assessment/acceptance of patients Require direct access to patient information for patient care planning Staff members employed by affiliated provider Administrators will ensure that all EpiCare Link policies and procedures are followed System activity will be audited regularly for compliance EpiCare Link is Online at no cost to you and there is no software to install. This online portal provides secure, convenient access to patient information through your browser when and where you need it. There is no training needed. Request Access If you are interested in gaining access to EpiCare Link; please complete and submit the attached forms. Request for Employee Access to EpiCare Link Complete each section of this form. Choose an Administrator who will act as your organization s primary EpiCare Link contact. The Administrator is responsible for authorizing new account setups and account deactivations. They will also serve as the key contact for auditing purposes. In the event that the Administrator is not available, we recommend that you include a backup person on this form. (Ex. Director of Nursing). The Administrator (and back up) will only be authorized to request new accounts for your organization. EpiCare Link User Access and Confidentiality Agreement Each person who is requesting access and will use EpiCare Link must complete this form in its entirety. Fax/ Completed Forms to: (Fax) or; epicmd@trinityhealthofne.org ( )

4 REQUEST FOR EMPLOYEE ACCESS TO EPICARE LINK (Post Acute Care/Home Health/Skilled Nursing/Long Term Care) To facilitate review of this request, please provide complete, accurate and legible information. I. Type of Request New Facility Request for Access Existing Facility with Access to EpiCare Link: Requesting Additional Employee(s) Access II. Facility Information Facility Name: Address, City/State Zip: Please Indicate If You Are Affiliated With: Saint Francis Hospital/Mount Sinai Johnson Memorial Hospital Saint Mary s Hospital All of the Above None of the Above Office Number: Amount of Beds at Facility: Fax Number: III. Employee Information (Facility Staff Only) Each staff must complete the Access & Agreement Form 1. Full Name: Role/Function : 2. Full Name: Role/Function : 3. Full Name: Role/Function : 4. Full Name: Role/Function : 5. Full Name: Role/Function : Last 4 of SS#: 6. Full Name: Role/Function : Last 4 of SS#: 7. Full Name: Role/Function : Last 4 of SS#: Facility Administrator Full Name: Role/Function/Title: Back Up Facility Administrator Full Name: Role/Function/Title: Telephone Number (if different): Telephone Number (if different): For Official Use Only Access & Agreement Forms Received: Yes No Date Processed By:

5 Post Acute Care Referral Provider EpiCare Link User Access and Confidentiality Agreement I understand that the Post Acute Care Provider ( PAC Provider ) named below has entered into an agreement with Trinity Health Of New England and it member hospitals to participate in the Trinity Health Of New England Post Acute Care Referral Network. As part of this Network, Trinity Health Of New England is permitting this facility and its workforce ( Users ) to have access to and use Trinity Health Of New England s EpiCare Link which is licensed by Trinity Health Of New England from Epic Systems Corporation ( Epic ), for the sole purpose of accessing the electronic health records for patients who are, or are being evaluated for, transitioning from hospital care at any of Trinity Health of New England s member hospitals to postacute care provided by this PAC Provider. I understand that this PAC Provider wishes me to have access to EpiCare Link as one of the PAC Provider s Users for this purpose. I understand that such access to and use of EpiCare Link will allow me to view and use confidential information about patients not generally available or known to the public, including but not limited to individually identifiable information and protected health information (as defined under the Health Insurance Portability and Accountability Act of 1996 and associated regulations ( HIPAA ) ( Confidential Information ) of patients with whom I or other PAC Provider Users have a treatment relationship or who are being evaluated by PAC Provider for a treatment relationship. I agree to use EpiCare Link and access, use and disclose Confidential Information as follows: I understand that federal and state laws, regulations and professional ethical standards including, but not limited to, HIPAA and state privacy laws and regulations, protect the confidentiality of the Confidential Information to which I will have access and I will access, use and disclose Confidential Information in strict conformance with such laws, regulations and ethical standards. I will only access and use Confidential Information through EpiCare Link for which I have a legitimate need and then only the minimum amount and type of information necessary to achieve that legitimate purpose. I understand that my access and use of EpiCare Link is subject to audit by Trinity Health Of New England at any time in connection with Trinity Health Of New England s Corporate Compliance, Patient Privacy, Security and other requirements under state and federal law. I understand that if I access, use or disclose protected health information about patients for which I have no legitimate need, this could result in termination of my access to Epic System and other serious adverse consequences to me. I understand that EpiCare Link is the sole property of Trinity Health Of New England, Epic or others from whom Trinity Health Of New England licenses EpiCare Link and includes valuable trade secrets of Trinity Health Of New England, Epic or others. I will not challenge the ownership by Trinity Health Of New England, Epic or their third party licensors of EpiCare Link or any intellectual property associated with or contained in EpiCare Link. I will not attempt to enforce against Epic, its direct or indirect customers or its sub licensees any patent, copyright, trademark or trade secret that is or could be an extension of or is intended to work with EpiCare Link. I will keep confidential any information not generally available or known to the public about the functionality, operation, use, source code, data structure, implementation, performance or maintenance of EpiCare Link, and any proprietary information related to any equipment, software data, code sets or other information used with, by or loaded into EpiCare Link. I will not, nor will I assist any other person to, copy, modify, reuse, disassemble, decompile, reverse engineer or otherwise translate or attempt to replicate EpiCare Link to create an independently operating application or database that either uses EpiCare Link to avoid any limitations on PAC Provider s or my use of EpiCare Link or is designed to provide overlapping functionality with EpiCare Link.

6 I understand that Trinity Health Of New England will issue me a unique user ID/login and password. I understand that I am not permitted to share this User ID/login or password with anyone. I will report immediately to PAC Provider s representative signing below (or his or her designee) any violations of this EpiCare Link User Access and Confidentiality Agreement by me or any others having access to EpiCare Link as soon as I learn of them. User Acknowledgement My signature below indicates that I have read and understand all of the above and agree to follow all provisions of this EpiCare Link User Access and Confidentiality Agreement. Signature: Printed Name: Date: Post Acute Care Facility Administrator Acknowledgement My signature below indicates that the applicant is a workforce member of the below named Post Acute Care Provider and has a valid business need to access and use EpiCare Link in connection with the Post Acute Care Provider s participation in the Trinity Health Of New England Post Acute Care Affiliated Network. Signature: Printed Name: Date: