Table of Contents Introduction... 3 1 Provider Portal Overview... 5 1.1 User Access... 8 1.2 RHIO Explore... 8 1.3 RHIO DIRECT... 9 1.4 emolst... 9 1.5 RHIO Participant Directory... 9 1.6 Care Zone Enrollment... 9 1.7 Information... 10 1.8 Data Normalization Coding... 10 1.9 Training and Security... 10 1.10 Support Request... 13 1.11 My Community Profile... 15 2 RHIO Support... 20 3 Participant Responsibilities... 21 3.1 Data Sharing Agreement... 21 3.2 Guidance Document for Participants... 22 3.3 HIPAA Compliance... 22 3.4 Role as RHIO Administrator... 22 3.5 Access Roles... 25 3.6 Viewing Patient Information: Disclaimer Messages... 27 4 Patient Consent Policies & Procedures... 28 4.1 Consent Choices... 29 4.2 Consent Forms... 30 4.3 Managing Patient Consent... 37 4.4 Automated Consents... 37 4.5 Setting & Updating Consent through Explore... 37 4.6 Emergency Access (Break The Glass)... 37 Last Update: 5/31/2018 11:58 AM Page 1 of 83
4.7 Setting Multi-Entity Consents through RHIO Provider Portal... 37 5 Rochester RHIO Auditing Policies & Procedures... 38 5.1 Audits... 38 6 Rochester RHIO Services... 38 6.1 Explore... 39 6.2 Contribute... 67 6.3 DIRECT... 68 6.4 Alerts & MyAlerts... 70 6.5 MyResults Delivered... 71 6.6 Subscribe/Forward... 72 6.7 emolst... 72 6.8 Custom Orders... 72 7 Glossary of General Terms... 73 8 Glossary of Data Source Acronyms... 81 9 Glossary HIE Image Viewer Icon Functions... 82 Last Update: 5/31/2018 11:58 AM Page 2 of 83
Introduction ABOUT ROCHESTER RHIO Rochester RHIO is a secure electronic health information exchange that gives authorized users access to community and statewide health data like test results, lab reports, radiology results, and clinical documents. Our nonprofit, community-based organization was created to give health care providers fast access to accurate information about patients to increase the quality of health care delivery and reduce unnecessary costs. The Rochester RHIO provides a range of services that promote and support the movement toward a patientcentric view of clinical information. The RHIO employs the most advanced information safeguards and has established policies and procedures to protect patient privacy and security. A statewide Master Patient Index (MPI) and Record Locator Service (RLS) is used to identify, locate, and present information for patients. Rochester RHIO services support both a query-based approach to requesting clinical information and a clinical messaging model where results are directly and securely routed to subscribing, ordering, referring, and copied or included providers. MISSION The mission of the Rochester RHIO is to provide the Rochester medical service area with a system for a secure health information exchange that allows for timely access to clinical information and improved decision making. The primary goal is to share patient healthcare information in a secure environment to improve patient care and to reduce system inefficiencies. The Rochester RHIO is a critical link in the Statewide Health Information Network of New York (SHIN-NY), and seeks to collaborate with health information exchange efforts across New York State. VISION Customer Service Vision Statement: RHIO staff is focused on providing our Participants, stakeholders and patients with professional customer service that fully meets the needs of our customers. Last Update: 5/31/2018 11:58 AM Page 3 of 83
Service Area Map The Rochester RHIO provides services to a 13-county region in the Finger Lakes Region of New York State; Allegany, Chemung, Genesee, Livingston, Monroe, Orleans, Ontario, Schuyler, Seneca, Steuben, Wayne, Wyoming and Yates. Last Update: 5/31/2018 11:58 AM Page 4 of 83
1 Provider Portal Overview Rochester RHIO User Guide Rochester RHIO s Provider Portal acts as a gateway for users to access RHIO Explore, Direct, and other RHIO services. It is through the Provider Portal that users can create service tickets, use regional directories, access training and locate reference materials. Provider Portal Landing Page BEFORE LOGIN: From this landing page, users have quick access to our list of Data Sources, Newsletters and other publications, reference links and Regional Account Representative Locator by zip code. AFTER LOGIN: Enter the following web address in web browser: https://providerportal.grrhio.org/. The Provider Portal can be accessed from our main web site (grrhio.org) by clicking on the Provider Portal link at the top left of the home page. It is available through most web browsers (Mozilla, Firefox, Safari, Google Chrome, etc.) Users can bookmark or favorite this web address for easy return access. Last Update: 5/31/2018 11:58 AM Page 5 of 83
Enter username and password, then click the LOGIN button. Forgotten Username or Password: For users who forgot password, click Forgot your password? above the Login button and the system will prompt users to reset their password without having to call RHIO Support. For addition details on password reset requirements see User Access Section of this User Guide. If user doesn t have an account, they should see the RHIO Administrator for their organization to request access. Once logged into the Provider Portal, users may access a number of RHIO services and information by selecting any of the tabs displayed below: Provider Portal Tab Descriptions: User Access RHIO Explore RHIO DIRECT This tab allows RHIO Administrators access to a full list of their organization s users. RHIO Administrators can filter this data and/or export to excel. User Access tab provides valuable information on individual user account status allowing RHIO Administrators of organizations the ability to see when user accounts are created, disabled, and modified and via filter options, which users have completed training and single sign-on services they have been enabled. Following log in, most users will default to the first tab titled RHIO Explore. Explore users will click on the red Continue to Explore icon to launch a patient search. For users without access to Explore, will see this tab grayed out. Users can click on the RHIO DIRECT tab for access to the RHIO DIRECT Messaging Inbox, a secure, HIPAA compliant way of sending and receiving referrals, CCDs and other PHI. Last Update: 5/31/2018 11:58 AM Page 6 of 83
emolst Directory Care Zone Enrollment Information Data Normalization Coding Users who have emolst Single Sign On can click on the emolst tab to be automatically logged into the NYS emolst database. Users can view RHIO participant demographic information, locate practice general contact information or identify Explore users. For Care Zone users only. Care Zones allow patient consent to be obtained for one or more entities. See detailed instructions on Care Zone Enrollment tab if applicable. Users access general information about the RHIO and Health Information Technology (HIT). Current RHIO services and fees are listed in addition to an upto-date list of RHIO Data Sources, copies of RHIO consent forms, newsletters, state & federal initiatives and other helpful links. Users view current data standardization efforts in our community. This includes the ADT minimum data set, standardized LAB LOINC codes and report naming conventions which are updated monthly for successful interoperability, quality reporting and other community based data normalization efforts. Training Support Request My Community Profile Users access self-guided tutorials on RHIO services, training materials and register for RHIO hosted events & webinars. RHIO Provider Portal user requirements include annual refresher training as well as participating in / attesting to training prior to gaining full access to some core services. Training content includes RHIO services overview, updates, news and security/hipaa compliance requirements. Users create a support ticket in this secure HIPAA compliant environment to address various requests. Users can report a MyResults Delivered issue, request a password reset, complete duplicate patient record notification, make requests for RHIO materials and RHIO service inquiries. Users can verify and submit contact information updates here. This request is then forwarded to RHIO staff to review and update records accordingly. Some users who are also clinical care providers have access to additional fields where they can review and modify information such as preferred contact information for correspondence, mailings, and other patient care related activities, practice information, and specialties. Last Update: 5/31/2018 11:58 AM Page 7 of 83
1.1 User Access The User Access tab allows RHIO Administrators access to a full list their organization s users. RHIO Administrators can filter this data or export into an excel file. The User Access tab provided detail on individual user accounts along with the ability to see when those accounts were created, disabled, and modified. RHIO Admins can also filter to see which users have completed training and what single sign-on services their users have access to. Key Notes & Login Requirements: 1. The Provider Portal will time out after 20 minutes of inactivity 2. Password requirements: Users are required to reset passwords every 90 days Be at least 6 characters long Contain at least one number Contain at least one letter Last two consecutive passwords cannot be used 3. Reasons why a User Account may be Locked: Password change does not occur every 90 days No login occurrence for 60 days Incomplete annual training Entering password incorrectly after 5 attempts 4. What a User can do if User Account is Locked: Click on Forgot Password (only works when user neglects to change password after 90 days or after 5 failed log-in attempts) Contact RHIO Support Center at 1.877.865.7446 Email info@grrhio.org Submit Support Request Contact your RHIO Administrator 1.2 RHIO Explore RHIO Explore is a web-based clinical query tool provides patient-specific, community-wide clinical information. Some examples include: Laboratory Results, Radiology and Cardiology Reports (including images when available) and Clinical Documents, such as Hospital Discharge Summaries. Users can make patient health information queries for healthcare delivered in the 13-county region, or throughout New York State via the SHIN-NY. See RHIO Services Section 6.1. Last Update: 5/31/2018 11:58 AM Page 8 of 83
1.3 RHIO DIRECT The Rochester RHIO provides DIRECT messaging services to our community Participants. As a certified Health Information Service Provider (HISP), we are accredited through EHNAC as a member of the Direct Trust Organization. The RHIO HISP offers secured access through webmail to facilitate exchange of care summary documents and other clinical information between providers in our community. Unlike RHIO Explore that has information from many sources, DIRECT is a point-to-point exchange that allows one care provider to send confidential information to another care provider securely. While many EHR vendors are including DIRECT as part of their services to support Meaningful Use requirements, other users do not need to have an EHR to use DIRECT. See RHIO Services Section 6.2. 1.4 emolst emolst is a secure, web-based application that allows users to complete the NYS emolst application. This tab offers Single Sign on, and takes RHIO users directly to the website without the need for a second login. 1.5 RHIO Participant Directory The Rochester RHIO Participant Directory includes organization and participating practice locations in addition to user contact information. Users can search by organization, person, title as well as city or county. This directory is updated routinely and is based on information provided to RHIO by our active participants. This comprehensive tool provides user contact information for all users including office staff. Available information includes address, name, credential, Explore access, phone number and DIRECT address. Users can navigate the directory via drop down menus and search or filter information as needed. 1.6 Care Zone Enrollment Care Zone is a way to log list-based consents for a participating group of organizations. Care Zones are used to coordinate and help patients manage their care. For users with access, the Care Zone Enrollment tab will display after log in. In order to flag consent status for patients in this Care Zone, users will need to search for a patient by entering Last Name and Date of Birth. Include entire birthdate using the / and a 4-digit year or use the calendar tool. Click the red lookup button to locate patient. After choosing the correct patient, user ill access the following screen to validate the patient demographics. Click either enroll or disenroll and enter effective date. Click OK to save. Last Update: 5/31/2018 11:58 AM Page 9 of 83
1.7 Information Users access general information about the RHIO and Health Information Technology (HIT) in this section including: current RHIO services offered, fees, an up-to-date list of RHIO Data Sources, copies of RHIO consent forms, RHIO newsletters and updates regarding state and federal regulations and initiatives. Information Tab Sections include: RHIO Services; Data Sources; News;; EHR Connectivity; Patient Consent, Information & Materials; Fees; RHIO Facts; Support for Meaningful Use; Data Sharing Agreement; Emergency Services Directory (STEP); Technology; Rochester RHIO Website; and Contact Us. Patient Materials include: Rochester RHIO helps participating physicians and organizations inform patients in our community through public relations and advertising activity. Upon request, participating providers can receive patient Q&A flyers, tri-fold brochures containing key facts and contact information, such as follows: Patient Brochures (English) Patient Brochures (Spanish) Patient Consent Forms (English) Patient Consent Forms (Spanish) Patient Consent Forms (other languages online only) RHIO clipboards RHIO flyers RHIO magnets RHIO pens 1.8 Data Normalization Coding The accurate coding of results is critical to the effective comparison of values to support patient care and quality reporting. Community care providers are working with the Rochester RHIO to address the need for accurate, standardized codes for results across the community. When a patient utilizes multiple labs and results are monitored longitudinally in a flow sheet format, test results on different rows can alert the clinician to methodology differences requiring clinical judgment when comparing and interpreting results especially if the test description or name may be the same. Laboratory clinical experts from each hospital lab have worked together to assign consistent LOINC codes to a large number of lab tests done at each organization participating in this regional data normalization effort assigning different LOINC codes only when clinically indicated. Actual LOINC codes used by each Lab in the Rochester RHIO service area are logged on this tab in an excel spreadsheet that allows providers, practices, and health systems to download and use this data to update their internal IT system to enhance accuracy of practice, community and population level analytics. 1.9 Training and Security Onboarding and Annual Training Requirements (based on State QE/DOH requirements): Last Update: 5/31/2018 11:58 AM Page 10 of 83
Mandatory training can be completed in the following ways: Self-Directed Computer Training Modules Participate in a RHIO Webinar Attend a RHIO hosted Information Session Schedule onsite training with a RHIO Regional Account Representative RHIO Administrator Access (Pre-Training) Welcome Email: Welcome to the Rochester RHIO! Are you wondering what your responsibilities are as a RHIO Administrator? Well wonder no more! The RHIO Administrator Training video provides RHIO Admins with a detailed description of their role and responsibilities. Completion of this training is another step in providing RHIO Admins access to online applications, tools, and resources. It also aligns with required participation of annual refresher trainings. To get started, log into the RHIO's Provider Portal at http://providerportal.grrhio.org/ by entering your Username and password. Once logged in, click the Training tab. Select RHIO Administrator Training located on the left menu bar and click the red text phrase Begin web course: RHIO Administrator training to launch the video. Don t forget to attest! It s a critical step in issuing access, and starts the clock for annual refresher training next year. Rochester RHIO's security and privacy policies also require that users reset their password every 90 days. In addition, user accounts will lock after 60 days of inactivity, or failure to participate in Rochester RHIO s required annual refresher training. This required training can be completed by participating in a webinar, attending an in-person information session, or by completing the computerbased training. Questions? Contact the Rochester RHIO Support Center at 1-877-865-7446, or email info@grrhio.org. Thank you, Rochester RHIO Team EXPLORE Access (Post-Training) Congratulations Email: Congratulations! You have successfully completed Explore training course and have access to RHIO services. Rochester RHIO's security and privacy policies require that users reset their password every 90 days. In addition, user accounts will lock after 60 days of inactivity, or failure to participate in Rochester RHIO s Last Update: 5/31/2018 11:58 AM Page 11 of 83
required annual refresher training. This required training can be completed by participating in a webinar, attending an information session in person, or by completing computer-based training. Questions? Contact the Rochester RHIO Support Center at 1.877.865.7446, or email info@grrhio.org. Thanks! Rochester RHIO Team Attestation Requirement: Users are required to attest to confirm participation in a training event. This is done by clicking the training event attended and then on the attestation language in red. Training Events Attestation Last Update: 5/31/2018 11:58 AM Page 12 of 83
1.10 Support Request How to Submit a Support Request 1. Login to the Provider Portal at http://providerportal.grrhio.org/ 2. Click on Support Request tab, fill in the fields and click Submit. Last Update: 5/31/2018 11:58 AM Page 13 of 83
Reasons to submit a Support Request: Deactivate Staff for RHIO service (24 hr notice) Patient merge EXPLORE inquiry MyResults Delivered issue(s)* * When submitting Support Request with MyResults Delivered issue(s): As Support Requests are a secure mechanism for transporting PHI, provide a brief explanation of the issue in the Description field and include the following: Patient Name Patient Date of Birth Name of Test Date of Service Data Source Name (Hospital, Lab, etc.) Ordering Provider & Practice Name Use the File Attachment field to attach a scanned copy of the paper result, or securely fax to 585-410-6801, if available. All Users can create a Support Request; skip the RHIO User Name field if not applicable. Support Requests containing examples over 14 days old or incomplete requests may be more difficult for the Rochester RHIO to troubleshoot thoroughly. Support Line Call 1-877-865-7446 with the pertinent information (see above) for RHIO to investigate issue. Last Update: 5/31/2018 11:58 AM Page 14 of 83
1.11 My Community Profile Rochester RHIO User Guide In this tab, users can update their basic information and / or verify email address. Clinical users have an enhanced My Community Profile with additional privileges through a self-service portal. This allows users to review and update their community profile information and preferred contact methods. The profile and the contact preferences are used to help other community providers / users when they need to contact the provider. In order to review and make updates, clinical users click the Update My Community Profile button on the My Community Profile tab. This launches access to the Provider Registry; a component module of Patient Care Network. Any updates made are submitted to the RHIO team for review and confirmation. The necessary changes are confirmed with the organization s RHIO Administrator before updating user information. The following categories are available for users to update information: Summary, General, Locations, Communications, Specialties and Identifiers. All categories display a header including Provider Name, Gender, Office Phone, and Address. Last Update: 5/31/2018 11:58 AM Page 15 of 83
Summary Tab: Includes Provider demographics, contact information, specialties and identifiers in one view. Last Update: 5/31/2018 11:58 AM Page 16 of 83
General Tab: Includes First, Middle and Last Name, Suffix, Honor (credential), DOB, Gender and NPI. Locations Tab: Includes Location Type, Facility Type, Business Name, Address, City, State, Zip, County by Source. Last Update: 5/31/2018 11:58 AM Page 17 of 83
Communications Tab: Includes Location Type, Details, Purpose, Additional Info, Location by Source. To modify a communication preference, click the edit icon for pop-up window to display. Select the type of communication, update the detail and communication purpose and select submit. Last Update: 5/31/2018 11:58 AM Page 18 of 83
Specialties Tab: Displays two sections, Specialty and Coded Specialty. Coded Specialty section includes Coded Specialty like Taxonomy or State Specialty Classification, Primary Specialty, and Board Status. Users can designate specialty by location. First preference to make modifications is the Coded Specialty Section. If a coded specialty is unavailable, use the Specialty Section which allows users to free text specialty information by location. Identifiers Tab: Displays Provider NPI number. * This information is only editable in the General Tab. Last Update: 5/31/2018 11:58 AM Page 19 of 83
2 RHIO Support The Rochester RHIO provides around the clock service to our customers. We have dedicated staff managing our Customer Support Center phone lines, email inquiries, and website Technical Support Requests. Our Customer Support Center s regular business hours are Monday through Friday from 8:00am - 5:00pm. For after-hours support, users with non-critical inquiries are prompted to leave a message for return call back the following business day. For urgent matters requiring immediate assistance, users can hold to be connected to a representative on-call. Three ways to contact the RHIO Customer Support Center and Regional Account Team: Support Email: support@grrhio.org Tel: 585.410.6800 Toll Free: 877.865.RHIO (7446) Fax: 585.410.6801 General Email Inquiries: info@grrhio.org Provider Portal: https://providerportal.grrhio.org Mailing Address: Greater Rochester Regional Health Information Organization 200 Canal View Blvd., Ste. 200 Rochester, NY 14623 Our Regional Account Team consists of five Regional Account Representatives assigned by territory and zip code. For more information on programs, data, resources and services, contact your Regional Account Representative. If you need to identify your Regional Account Representative, click the Look-up your Account Representative link located on the Provider Portal homepage. Last Update: 5/31/2018 11:58 AM Page 20 of 83
3 Participant Responsibilities 3.1 Data Sharing Agreement Health information exchange policies and operating procedures continue to evolve. To assist our Participants, the Rochester RHIO has designed a legal and policy framework that supports a changing landscape with the least amount of process disruption and is consistent with the New York Privacy and Security Policies. The Rochester RHIO s Data Sharing Agreement governs the use and obligations of all services related to our health information exchange. The agreement addresses all relevant Federal and State regulatory and policy requirements. This framework helps maintain a consistent and reliable approach to statewide health information exchange. There are three pieces of documentation that comprise the Rochester RHIO Data Sharing Agreement: Participation Agreement (signing document) Terms & Conditions NY Privacy and Security Policies and Procedures for NYS Qualified Entity (QE) and Participants See: https://rhioportal.grrhio.org/pages/getmediafile.aspx?fileid=733487 Last Update: 5/31/2018 11:58 AM Page 21 of 83
3.2 Guidance Document for Participants As part of the New York Department of Health s State Health Information Network of New York (SHIN-NY), there are policies and requirements for RHIOs and their Participants. Under this framework, RHIOs are referred to as Qualified Entities or QEs and the users participating in the RHIOs or QEs are referred to as Participants. SHIN-NY policies address how QEs provide services and how Participants can use these services. Requirements and policies that specifically relate to Participants are sometimes referred to as Flow-Down Requirements. By participating with the SHIN-NY, each user and organization is required to adhere to these specific policies. The current version of the New York Policies is 3.4. The policies include definitions of many of the terms frequently used in each version of the Data Sharing Agreement. According to the New York Policies: Qualified Health IT Entities ( QEs ) and their Participants must comply with the Policies and Procedures and other Statewide Policy Guidance. QEs must require their Participants to comply with the Policies and Procedures through the terms of the Participant Agreement that a QE enters into with a Participant. Please see the Provider Portal s Information tab in the Data Sharing Agreement section for specific Flow-Down obligations for all Participants accessing the SHIN-NY through a RHIO or Qualified Entity (QE). 3.3 HIPAA Compliance The Rochester RHIO and Participants are mandated and pursuant to comply with all relevant Federal HIPAA Privacy and Compliance guidelines, as well as the NYS Regulations and the Privacy and Security policies for Qualified Entities and their participants. Participants are required to attest to annual participation in HIPAA training. (See privacy and security policies link below, SECTION 4: ACCESS, 4.7 Training) This can be done independently or through participation in one of the Rochester RHIO s HIPAA Compliance Seminars. For more specific information regarding HIPAA Compliance please see: https://www.health.ny.gov/technology/regulations/shin-ny/docs/privacy_and_security_policies.pdf https://regs.health.ny.gov/sites/default/files/pdf/recently_adopted_regulations/2016-03-09_shin_ny.pdf https://www.healthit.gov/policy-researchers-implementers/hipaa-and-health-it https://www.hhs.gov/hipaa/index.html For information on the Rochester RHIO s HIPAA Compliance Seminars, go to the Training Tab after logging into the Provider Portal. 3.4 Role as RHIO Administrator Each Participant is required to assign at least one staff member to be the RHIO Administrator for their organization. This representative verifies the identity of prospective RHIO users, authorizes user access, and notifies RHIO Community Services staff when access should be updated and/or terminated. Last Update: 5/31/2018 11:58 AM Page 22 of 83
The RHIO Administrator has the responsibility to ensure proper training has been provided and documented for all employees regarding annual HIPAA Compliance. The RHIO Administrator is the primary contact for their organization and is responsible for information sharing within their organization/practice. RHIO Administrators have enhanced portal capabilities via: Applications Applications are available to RHIO Administrators through Applications located in the green toolbar are the top of the page layout. After selecting Applications, RHIO Administrators can complete and submit applications on behalf of users within their organization. By signing-off on applications, the RHIO Administrator certifies the identity of the user. RHIO Administrator User ID paper applications are available in the Information tab under Applications. User Access This tab allows RHIO Administrators access to a full list of their organization s users. RHIO Administrators can filter this data and/or export to excel. User Access tab provides valuable information on individual user account status allowing RHIO Administrators of organizations the ability to see when user accounts are created, disabled, and modified and via filter options, which users have completed training and single sign-on services they have been enabled. Reports Reports are available to RHIO Administrators through the red Reports link located at the top of the page layout. After clicking Reports, RHIO Administrators have access to a left menu that allows view and export capabilities of those reports on behalf of users within their organization. The left menu selections are Logins, RHIO Explore Access, DIRECT Access and Training Course. Examples below: Last Update: 5/31/2018 11:58 AM Page 23 of 83
Logins Report: Last Update: 5/31/2018 11:58 AM Page 24 of 83
Training Course Report: Rochester RHIO User Guide 3.5 Access Roles Provider Portal Access Users with Provider Portal access are given a unique username and password. Password setting requirements and annual refresher training rules apply to all Provider Portal users. Users with additional RHIO services, for example Explore and/or DIRECT, default to these tabs on the portal. RHIO Administrators & HISP Administrators: Currently, users with this role have additional access to roster files for their organization and online applications for staff access. Explore Access Roles Interested applicants will work with their RHIO Administrator and RHIO Community Services staff to designate the type of access appropriate for their entity and users. Access for all users is routinely audited by the RHIO Privacy and Compliance Department. This is done through a random selection Last Update: 5/31/2018 11:58 AM Page 25 of 83
process. Below are the RHIO Explore categories and types of data available for each user role: Medical Doctor Full access for consented patients (all test results, available patient information and demographics, insurance information). Can set consent preference for patient. Advanced Practitioner Full access for consented patients (all test results, available patient information and demographics, insurance information). Can set consent preference for patient. Licensed Health Professional Full access for consented patients (all test results, available patient information and demographics, insurance information). Can set consent preference for patient. Public Health Professional If the user is authorized under New York s Public Health Law, sections 2220-2231, they may be given access to RHIO Explore under the Public Health user role. This law, together with the New York Sanitation Code regulations (i.e. 10NYCRR 2.17; 2.7) allows local district/public Health Departments access to PHI without patient consent. Some job responsibilities associated with public health departments are related to clinic services and therefore do not fall under the above law. Public health users whose access is authorized by the New York Public Health Laws are audited on a monthly basis to ensure appropriate access. (SPS 1.2.1) Staff-I Access to all test results, available patient information, demographics and insurance information. Can set consent preference for patient. Staff-II No access to clinical data. Can set consent preference for patient and access to insurance and demographic information. Data Source (IT) - This access is commonly given to IT Staff for organizations and only allows access to their organization s information. Access provided is for data validation, MPI management, testing / troubleshooting, and similar operational and technical support purposes. Pharmacist Full access for consented patients (all test results, available patient information and demographics, insurance information). Can set consent preference for patient. DIRECT Access Roles Individual Account: All Direct users are given an individual Direct inbox via Provider Portal SSO. Sharing of individual user accounts is prohibited. Last Update: 5/31/2018 11:58 AM Page 26 of 83
Group Account: At least one individual Direct account is required before issuing a group account. These accounts are shared by multiple users through a delegation process. All users accessing group accounts can only do so through individual account access. Sharing of individual Direct accounts is prohibited. Organizations are defined by HIPAA Covered Entity. A digital certificate is required for each organization before access is granted. In addition to a digital certificate, each organization is required to go through an identity proofing process prior to gaining full access to their addresses. This includes: Representative of organization completes a declaration of identity. This representative is often the GRRHIO Administrator, but can also be a Privacy and Compliance Officer or Director. The representative is charged with granting employee access to Direct and managing users for appropriate use. They are required to notify Rochester RHIO within one business day upon employee separation and when employee demographics change. This declaration document requires notary signature. Organizational Policy on identity proofing practices. This is often an HR policy, but can also be an onboarding policy or a privacy/compliance policy, depending on organization type. The document needs to include a statement on how the organization confirms the identity of their employees prior to allowing access to PHI. NON-HIPAA Covered Entity: With Organizations that do not fall under the HIPAA Covered Entity or Business Associate definition, DIRECT messaging is a service option allowed with the following requirements: Duly signed Rochester RHIO HISP Agreement and Digicert Agreements. Digital certificate for each organization before access is granted. o Each organization and its users are required to go through an identity proofing process prior to gaining full access to their DIRECT addresses. This declaration document requires notary signature. Identified HISP Administrator(s) 3.6 Viewing Patient Information: Disclaimer Messages The following is a list of disclaimer messages that are posted on the Provider Portal prior to launching clinical viewer and accessing patient health information. Affirmative Consent Requirement. You are being permitted access to Protected Health Information via the SHIN-NY. You may only access this information with Affirmative Consent or as otherwise permitted by the SHIN-NY Policies and Procedures. You may only access portions Last Update: 5/31/2018 11:58 AM Page 27 of 83
of a patient s record that are directly related to your reason for accessing a patient s Protected Health Information ( minimum necessary ). SAMHSA Information. The records that you are about to access may contain information from federally-assisted alcohol or drug abuse programs. If such information is present, then the following federally mandated warning applies: This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written authorization of the person to whom it pertains or as otherwise permitted by 42 CFR part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient. HIV/AIDS Information. The records that you are about to access may contain HIV/AIDS Information, which is protected under the Article 27-F of the NY Public Health Law. Redisclosure of this information is subject to all relevant Federal and New York State laws and regulations. Compliance is mandatory. Mental Health/Developmental Disabilities. The records that you are about to access may contain information from facilities licensed or operated by the New York State Office of Mental Health or the New York State Office for People with Developmental Disabilities. Re-disclosure of this information is subject to all relevant Federal and NY State Mental Hygiene Section 33.13. Compliance is mandatory. Genetic Information. The records that you are about to access may contain genetic information (including information containing results from genetic testing, genetic profiling, genetic counseling and information pertaining to the family medical history of a patient) that is subject to confidentiality restrictions under the Genetic Information Non-Discrimination Act of 2008 and implementing regulations. Re-disclosure of this information to employers and payers may be limited or prohibited. 4 Patient Consent Policies & Procedures In order for users to view patient information through RHIO, the patient must sign a RHIO consent form. This form gives a practice or health system permission to view patient records. Patient verbal consent is not sufficient. RHIO services gated by patient consent are RHIO Explore, Alerts and Subscription. Key Points Last Update: 5/31/2018 11:58 AM Page 28 of 83
Consent is considered durable: A signed consent will remain in effect until the patient changes his/her mind. When or if this occurs, the patient is required to complete a new consent form. Consents are audited: Practices are required to retain original (or copy of) signed consent documents and may be asked to provide them during a random audit. Consents are based on HIPAA Covered Entities: When a patient signs a consent form in a care setting, their consent decision applies to all users of the HIPAA covered entity. Consent forms are approved by State & Federal Government and cannot be altered. Any alterations will nullify any consent decision made and use of altered forms may result in termination of services. Consent forms missing information or illegible are considered invalid and are sent back to the practice. If a consent form was signed by the patient but missing required information, write Incomplete at the top and fax to the RHIO at 585-410-6801. The consent will be entered as a No until a new consent form is obtained from the patient. 4.1 Consent Choices Standard Unknown: This is the default consent option and will be listed for all patients where no consent decision has been made. When minors turn age 18, their consent for all HIPAA covered entities defaults back to this status. Users are allowed emergency access (break the glass) for this consent indicator when directed by a medical professional. Yes: This consent indicator allows access for all users of HIPAA covered entity. No: This consent indicator denies access for all users of HIPAA covered entity. This denial also prohibits access in emergency settings. Minor Minor Consent: This consent indicator overrides any prior consent decisions made by parent or legal guardian. Access associated with an emergency event is granted even when a minor s consent decision was to deny access. See Minor Consent guidelines in Section 4.3 for additional detail. RHIO-Wide Last Update: 5/31/2018 11:58 AM Page 29 of 83
RHIO-Wide Denial: This consent indicator denies all Rochester RHIO users access to patient health information available through patient consent (Explore, Subscription, Alert Notification), even in case of an emergency. See RHIO-Wide Denial forms in Section 4.3 for additional detail. 4.2 Consent Forms Who Can Sign the RHIO Patient Consent Form? Criteria below is intended as an informational guide for health care organizations. PATIENT CRITERIA 18 YRS AND OLDER Patient Health Proxy Power of Attorney DISABLED / HANDICAPPED Patient (if deemed appropriate) Health Proxy Power of Attorney Legal Guardian State Official (if one has been appointed) UNDER 18 Patient (during emancipating event) Parent or Guardian* *Under 18 Parent or Guardian: exclusions apply; see Minor Consent guidelines in Section 4.3 for additional detail. RHIO Consent Form Examples Standard Consent example: Required fields indicated in red. For Minors under age 18, Standard Consent Form should be completed by parent/ guardian. The consent delegation expires when minor turns 18, standard form is stored at the practice site and not required to be submitted directly to the Rochester RHIO (Exclusions apply; see Minor Consent guidelines for additional detail). Last Update: 5/31/2018 11:58 AM Page 30 of 83
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RHIO-Wide Denial forms: The RHIO-Wide Denial of Access and Change Denial of Access forms must be notarized and submitted directly to the Rochester RHIO by patients choosing to deny all providers access to their clinical information through RHIO Services gated by patient consent. This form prevents user access even in the event of an emergency. In order for Rochester RHIO to process this request, the patient must contact the Rochester RHIO s Customer Support Center. Please note, currently this form cannot be submitted by a provider on a patient s behalf. RHIO-Wide Denial example: (Required fields indicated in red). Last Update: 5/31/2018 11:58 AM Page 33 of 83
RHIO-Wide Change Denial of Access example: (Required fields indicated in red). Last Update: 5/31/2018 11:58 AM Page 34 of 83
Minor Consent Specially Protected Services example: (Required fields indicated in red). Providers should follow the Minor Consent process when minors (up to age 18) are receiving treatment for emancipating events. The Minor Consent form overrides any prior parental consent. The minor signs this form during a private discussion with a Provider and the form is submitted directly to the Rochester RHIO. Emergency access is granted even when a minor s consent decision was to deny access. Any emergency access is audited by RHIO. Emancipating events include: Sexually transmitted disease/ HIV AIDS Reproductive health services Substance abuse Mental health When a patient turns 18, all prior consent decisions expire and are null and void. Consent status for all HIPAA covered entities defaults back to unknown thereby granting the patient an opportunity to provide consent to treating HIPAA covered entities. Last Update: 5/31/2018 11:58 AM Page 35 of 83
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4.3 Managing Patient Consent Patient consent can be managed in several ways. Rochester RHIO supports collecting consent through an automated consent feed (sent by the covered entities from their registration systems) through Explore, and through the Provider Portal for multi-entity consent (Care Zones). Minor Consent forms must be submitted directly to the RHIO, where RHIO staff manually sets the consent preference. RHIO-Wide Denial forms are initiated, completed and notarized by patient and submitted to RHIO for processing. 4.4 Automated Consents At the time of registering a patient, health systems and other larger institutions record the patient consent in their EHR or registration system and send an electronic consent feed to Rochester RHIO. Each covered entity must still have the patient physically sign and keep record of the consent form for auditing purposes. 4.5 Setting & Updating Consent through Explore Explore users have the option to set patient consent at the time of visit thereby allowing immediate access to patient clinical data (See Logging Consent Section for instructions). Each covered entity must still have the patient physically sign and keep a record of the consent form for auditing purposes (exclusions apply; see Emergency Access Guidelines for additional detail) 4.6 Emergency Access (Break The Glass) Emergency access is allowed in cases where the Provider deems it necessary under the New York Public Health Law. This access is commonly called Break the Glass and is audited 100% of the time for appropriate utilization. This access is only available to users where a patient consent status is emergency only, unknown, or in the event the patient is a minor. For patients who have denied consent and/or opted out of RHIO, emergency access is not allowed. This access would not be provided and is therefore not applicable to the following user access roles: Staff II users and Data Source IT Administrators. (SPS 1.2.3) See RHIO Auditing Policies & Procedures Section 5. 4.7 Setting Multi-Entity Consents through RHIO Provider Portal Certain RHIO Provider Portal users can set consent for multiple entities when they are members of a Care Zone. This multi-entity consent is used in scenarios when more than one entity is involved in managing patient s care (Ex: Perinatal Network of Monroe County). Organizations who are part of this multi-entity consent model must use a separate consent form for each entity when collecting consents from the patient. Patients have the choice to set different consent decisions for each organization within the network. See Section 1.6 for Care Zone Enrollment. See Information tab on Provider Portal for additional resources on Patient Consent. Last Update: 5/31/2018 11:58 AM Page 37 of 83
5 Rochester RHIO Auditing Policies & Procedures 5.1 Audits Audits assure compliance with Federal and State Regulations as well as RHIO Policies and Procedures. The following audits are routinely completed by the RHIO Privacy and Compliance Department: Monthly Rochester RHIO Consent Form Compliance Audit Emergency Access Audit Public Health Access Audit Patient Audit Requests Minor Consent Audit Identity Proofing Audit HIPAA Compliance When receiving an audit request, Participants are asked to provide documentation regarding patient consent, including RHIO Consent Forms, Consent Management Procedures and details regarding Emergency Access/Break the Glass Access. In addition, the RHIO audits identity verification procedures and requests Participants to provide identity verification documentation to assure compliance with Authentication requirements prior to access being granted to PHI using RHIO services. Participants are asked to provide audit responses within 30 days. Sanctions, including, but not limited to: suspension of access to RHIO services may be placed upon users or Participants for failure to comply with RHIO Policies and Procedures. 6 Rochester RHIO Services The Rochester RHIO provides a range of service offerings that promote and support the movement towards a patient-centric view of clinical information. The RHIO employs the most advanced information safeguards and has established policies and procedures to protect patient privacy and security. A statewide-wide Master Patient Index (MPI) and Record Locator Service (RLS) is used to identify, locate, and present medical information including lab results, radiology reports and images for patients who choose to participate. Rochester RHIO services support both a query-based approach to requesting clinical information and a clinical messaging model where results are directly and securely routed to ordering, referring and copied or included physicians. Last Update: 5/31/2018 11:58 AM Page 38 of 83
6.1 Explore Explore is Rochester RHIO s secure clinical query portal service that provides users access to patient health information which supports the delivery of efficient, quality healthcare. Patient information available through Explore is extensive and continues to grow. Currently, patient health data includes: lab results, radiology reports and images, clinical reports, admission/discharge notification, deceased notification, encounters, health home, skilled nursing facility and Continuity of Care Documents (CCDs). For a complete listing of Data Sources see: http://providerportal.grrhio.org/en/data%20providers.aspx Using Explore: Log into the Provider Portal and see RHIO Explore tab: Last Update: 5/31/2018 11:58 AM Page 39 of 83
Users who have access to RHIO Explore through multiple organizations will be prompted to select the organization they are logging in under. If necessary, these users can change organization names during the same session by choosing change organization located in the upper right hand corner after login. After login, users are taken directly to a patient search screen. Patient Search: Users need, at minimum, the patient s Last Name, Date of Birth (or Patient ID/MRN Number) and a Search Reason to submit a search. Reason codes: Last Update: 5/31/2018 11:58 AM Page 40 of 83
Community User Security Roles EVENT REASON EMERGENCY EVENT Description Medical Doctor Mid-Level Provider Licensed Health Professional Pharmacist Staff-I Staff-II 000 - Break the Glass Emergency Access X X X X X Bypass Consent Data Public Source Health Admin TREATMENT 100 - Treatment Default Default Default Default Default PUBLICHEALTH PUBLICHEALTH1 PUBLICHEALTH2 PUBLICHEALTH3 PUBLICHEALTH4 PUBLICHEALTH5 DONATION PUBLICHEALTH7 OPERATIONS SYSADMIN 200 - Public Health: Investigate Communicable Disease 201 - Public Health: Ascertain Sources of Infection 202 - Public Health: Reduce Morbidity and Mortality 203 - Public Health: Investigate Lead Poisoning 204 - Public Health: Reporting 205 - Public Health: Emergencies 206 - Public Health: Facilitate Organ Donation 207 - Public Health: Approved Medical Examiner Duties 300 - Healthcare Operations X X X X X X X 400 - System Administration All available patient records matching search criteria will display. Active Consent status is shown on the Patient Search result screen. X X X X X X X X X Last Update: 5/31/2018 11:58 AM Page 41 of 83
Patient Duplicates: On occasion, users may see duplicate patients listed in their search results as shown above. This occurs when there has been some variation in patient data entered at the time of registration at one or more testing sites. To notify RHIO of duplicate patient entries, contact RHIO Customer Support Center or create an online Support Request to be researched by RHIO staff. Note: To research a duplicates patients request, the Rochester RHIO needs the following information: patient name, date of birth, and gender. Any other demographic information you can provide will help us ensure a correct match. Logging Consent: After locating a patient through Patient Search, users are required to log patient consent if not previously recorded. This consent is logged on the initial search or in the event that the patient changes their consent decision. To log patient consent, choose Add Consent on the Patient Consent page. Indicate the patient consent decision and click submit. (NOTE: The effective date defaults to the date the user registers the patient s consent decision). Patient consent decision is recorded on the page. Last Update: 5/31/2018 11:58 AM Page 42 of 83
When patient has given consent, a user must go Back to List to pull up Patient Summary screen and select the patient name. In order to update patient consent, a new consent form must be signed by the patient indicating their updated consent decision. To change patient consent, search for and locate patient in RHIO Explore. Click Add Consent, on the Patient Consent page. Indicate patient consent decision and click submit. (NOTE: The effective date defaults to the date that the user registers the patient s consent decision.) Last Update: 5/31/2018 11:58 AM Page 43 of 83
To record a change of patient s consent decision for patients who initially gave consent, a user must search for and locate patient in RHIO Explore. Once patient is located, users default to Patient Summary page. Choose the More Patient Information tab and click on Consent. To update consent status, choose Add Consent. Update the consent type and then submit. NOTE: This will alter access to users on future patient search attempts. Emergency Access (Break the Glass): Emergency access is allowed in cases where the Provider deems it necessary under the New York Public Health Law and is only available to users where a patient consent status is emergency only, unknown, or in the event Last Update: 5/31/2018 11:58 AM Page 44 of 83
the patient is a minor. For patients who have denied consent and/or opted out of RHIO, emergency access is not allowed. This access would not be provided and is therefore not applicable to the following user access roles: Staff II users and Data Source IT Administrators. For emergency access, users click the Break the Glass icon on the Patient Consent screen. Users are required to choose a reason code for emergency access. Note: For acronym definitions, refer to the glossary at the end of this guide. Last Update: 5/31/2018 11:58 AM Page 45 of 83
Explore Patient Summary: Patient information is displayed first on the Summary page. From here users can access different reports or results available for patients. Users can filter information in each quadrant by date, and data elements; for example Date or Source, etc. See indicator under left Patient Actions Menu (see RHIO Explore Settings section below) to know when information is available in a hidden quadrant. The Patient Summary page consists of nine quadrants. RHIO Explore will be set with default recommendations. Users can change these settings or rearrange them on their personal page layout depending on personal preferences. To customize the Patient Summary page, choose Configure Layout in the Patient Actions menu to enable Quadrant All Clinical Items or Other Encounters. RHIO recommends: Click / drag Other Encounters into Ambulatory Encounter Quadrant, Submit. All Clinical Items is best placed in an empty Quadrant. All Clinical Items: Allows user to show all clinical events, including encounters, labs, transcriptions, and imaging in one consolidated list. Last Update: 5/31/2018 11:58 AM Page 46 of 83
Other Encounters: Allows user to see events that are not categorized or do not meet the traditional categorization of Inpatient, Emergency or Outpatient Events. As more connections are established with Health Homes, Community Based Agencies, etc., RHIO will begin to display event notifications in this Other Encounters section. Some data sources that appear in this Clinical Section include Outpatient Radiology visits. RHIO Explore Settings: Default recommendations are set in Explore as follows: Inpatient Encounters Ambulatory Encounters Emergency Encounters Transcriptions Laboratories Imaging Optional configuration additions to the default recommendations are as follows. All Clinical Items Allergies Problems Vitals Documents Care Management Functional Status Immunizations Medications Procedures Social History Other Orders Other Encounters Last Update: 5/31/2018 11:58 AM Page 47 of 83
Note: Click Reset to Default button to go back to default settings at any time. See indicator under left Patient Action Menu to know when information is available in a hidden quadrant. To view a document, locate, and click on the file from the Patient Summary page. Users can download a CCD, CCDA, and a Summary PDF. Select any or all 18 data sets to add or remove from the Summary page. There are additional downloading options available in the heading of each report. With the required Start & End Date entry, users can select multiple clinical items to print in PDF format. Each page produced includes the Patient s Name and Date of Birth (DOB) within a header. Under the Summary tab, users can select various items they need to print. After more than one item is selected, an option to Download Selected Items as PDF appears under the Patient Actions menu. Download options include checkbox to Include Clinical Items without Dates Last Update: 5/31/2018 11:58 AM Page 48 of 83
Ambulatory, Emergency and Inpatient Encounters: These encounters or events are often admission, discharge, and transfer notifications. However, they can also populate information based on a specific test by a data provider. If indicated by data provider, results associated with an encounter can be listed and linked to the encounter for easy access. Last Update: 5/31/2018 11:58 AM Page 49 of 83
Patient Care Network: Rochester RHIO User Guide A global chronology of a patient s clinical encounters with physicians and healthcare providers as well as organizational networks across the region. The Patient Care Network (PCN) also provides contact information for a patient s care team and how to reach them. User access to PCN is controlled in the same manner as viewing patient information in RHIO Explore. After launching the Patient Care Network (PCN), users can select an event and see available care team information such as referring, attending, and PCP of record. Users can also search events by year. Last Update: 5/31/2018 11:58 AM Page 50 of 83
Important notes regarding PCN: End dates on encounters are not always provided Re-occurring visit numbers for extended periods (Ex. rehabilitation) may be used thus impacting the calculated duration of days connected to some events Associated providers may not always be included Last Update: 5/31/2018 11:58 AM Page 51 of 83
Some past and future dates for appointments may be included due to certain hospital-generated messages. The data sources displayed in the Patient Care Network were enabled beginning winter 2017. In addition, some data sources provide encounter information further back in time and/or send future scheduled appointment dates. For a complete list of data sources with encounter timeframes displayed in the Patient Care Network see: the PCN Data Sources. Encounters: Encounter information varies by data source and may include: Basic Information Facility Name Start/End Dates Duration Admit/ Encounter Reason Diagnosis Codes Encounter Description Location Contact Information Care Team Providers Attending Consulting Referring Admitting PCP of Record Encounter (or visits) are classified in 4 categories: Emergency, Outpatient, Inpatient and Unspecified (indicates the encounter type was not specified). Last Update: 5/31/2018 11:58 AM Page 52 of 83
Encounter examples: Emergency: Outpatient: Inpatient: Unspecified: Last Update: 5/31/2018 11:58 AM Page 53 of 83
After selecting a specific encounter, additional detail displays along with associated providers. User can view available contact information for each provider within the encounter by choosing the provider in the drop down menu located on the left side of screen. Care Team Contact Information Includes: Provider Name, NPI, Provider Contact Information, Communication Preferences, Service Location and Specialties. Last Update: 5/31/2018 11:58 AM Page 54 of 83
Transcribed Reports: Clinical documents are listed in the Transcriptions category of RHIO Explore. Some examples are discharge summaries, cardiology reports, or operative notes. Any provider that has been copied or included will be located at the lower left hand corner of the report. This information is not included in the Providers on Order section at the top center of the page. Last Update: 5/31/2018 11:58 AM Page 55 of 83
Laboratories: This section includes all laboratory data available for the patient. Users can view laboratory results related to an encounter or by selecting the Laboratories quadrant on the Patient Summary Page. Users can also sort or open a laboratory result for additional information. Explore includes and flags STAT preliminary reports in addition to finals and amended reports. For a current list of Laboratory data providers, see list of Data Sources located on the Information tab of the Provider Portal. The top of the result includes the order information, including ordering provider. See Below: Last Update: 5/31/2018 11:58 AM Page 56 of 83
Imaging: Explore is equipped with an Image Viewer that allows users to view images associated with radiology and cardiology reports. After opening an imaging report, click the View Image button to launch the Image Viewer. Clicking on this button will launch the Image Viewer in a new window. Once the study is cached (loaded and available for viewing), the user will see a blue button indicating that the image is ready for viewing. Last Update: 5/31/2018 11:58 AM Page 57 of 83
The HIE Viewer will open and display the image. If the study is cached, the Image Viewer will open in a new window and the image will load. By double clicking on any series or image pane expands the viewing window (in a 1x1 layout) A standard Viewer Toolbar at the top of the window allows users to perform a number of functions while viewing an image (for example: rotate, zoom, measure, etc.). For a complete description of all HIE image viewer functions, click on the question mark in the upper righthand corner of the window. If the study image is not in cache, the user will see the progress of their ad-hoc request in a new tab. For icon definitions, see Section 7 for Glossary of Terms. Important Note Regarding Export and Print tools: Ensure Adobe Flash is installed on browser and enabled by default. If the Export and Print buttons are missing, your browser settings need to be changed to use Flash by default. Chrome Troubleshooting Steps: 1. Right click on green lock icon in browser URL window. 2. Select Site Settings Last Update: 5/31/2018 11:58 AM Page 58 of 83
3. Change Flash setting to Allow (default) 4. Close the browser window and relaunch the Image Viewer. HIE Worklist: This application can be launched from the Patient Actions menu or from within an imaging report. With one click, users can review a list of all diagnostic images available for a patient, with the option to instantly view these studies. HIE Worklist without filters: Last Update: 5/31/2018 11:58 AM Page 59 of 83
HIE Worklist with filters: Rochester RHIO User Guide Access to the HIE Worklist allows users to view all images associated with a patient without having to click though each corresponding report. The Worklist opens in a separate tab allowing users to toggle back and forth to Explore. From the Worklist, users can view all images associated with a patient and select up to 4 images to view at one time. Last Update: 5/31/2018 11:58 AM Page 60 of 83
Transfer to PACS A cutting-edge solution that provides a universal image, which can be viewed on any PACS system. Image providers that use Transfer to PACS will experience more efficient workflows and faster image viewing, leading to reduced costs associated with viewing patient images. Available only for users that request the service and install the add-on. For more information regarding Transfer to PACs, contact your Regional Account Rep to provide an onsite demonstration. Last Update: 5/31/2018 11:58 AM Page 61 of 83
Statewide Patient Record Lookup (SPRL) Rochester RHIO User Guide Use Explore as normal to search for a patient. If patient consent is affirmative, go into the Explore record. After an Explore user has entered the record for their patient, click Statewide Data to begin a statewide data query for clinical data on a patient. This begins the statewide data search. Our Statewide Data query allows a care manager or provider access to clinical data for patient encounters in Albany, Binghamton, Buffalo, Syracuse and New York City regions. After several minutes and the data is retrieved, the clocking will stop and a message appears at the top of the screen: Statewide data load completed successfully. Please click here to View Results. Users can perform other tasks while waiting for data to load. Notes: Document retrieval can take up to five (5) minutes. Users can view other Explore reports or search for a new patient while waiting. If users log out before retrieval, the user must query for the data again. Any documents retrieved will be available for a 15-minute period. Not all patients have data available statewide. Last Update: 5/31/2018 11:58 AM Page 62 of 83
Here s an example of a statewide data screen. Click on a document to view it. Each line item above represents clinical data provide by each qualified entity (QE) in New York State. Each QE, or community health information exchange, will only provide one document, similar to a Continuity of Care Document (CCD). Example: Last Update: 5/31/2018 11:58 AM Page 63 of 83
SPRL Support For users who receive an error message, or believe their query did not provide sufficient patient data and should have, please submit an online Support Request. For example, the user knows a patient had tests performed at a health system outside of the Rochester RHIO s 13-county area, or the user has access to another Qualified Entity s Query Portal and can see clinical data in a separate database. When submitting a Support Request, provide the Rochester RHIO with the following information: Patient s Community ID number (from both RHIOs, if available) Error message (be as specific as possible or attach screenshot) Patient s full name, data of birth, and gender If known, where other testing may have taken place (include date and name of test) Note: Do not send information via email unless using a secure email channel. The email address info@grrhio.org is not a secure means of transmitting PHI. RHIO Repository A central location to view, download and print C-CDAs (Continuity of Care Documents). These document summaries include medication history, diagnoses, immunizations, allergies and more. For additional information on data contribution in our community see: https://providerportal.grrhio.org/datasources. To learn more about data elements review Common Clinical Data Set standards on www.healthit.gov. From the Patient Summary Page, a pop-up notifies user when information is available in the RHIO Repository. Last Update: 5/31/2018 11:58 AM Page 64 of 83
Click on RHIO Repository. New window opens that narrows search by date range or source. Click Filter and Document List displays. Last Update: 5/31/2018 11:58 AM Page 65 of 83
Select a document to view, download or print and the Re-disclosure Warning appears. This only displays on the first document selection during the login session. Users will not continue to see this pop-up with further searches and document selections for additional patients in the same login session. Select OK to see Re-disclosure Warning in the heading of the C-CDA. This re-disclosure appears on all C-CDA headings and on all exports. It cannot be removed or stripped from the message. Message Header Components: Created Time Service Start Date Document Source Classification Service End Date Document Author Document Type Facility Type Unique ID Confidentiality Practice Setting Code Last Update: 5/31/2018 11:58 AM Page 66 of 83
User options with C-CDAs once in the C-CDA viewer: Display Toggle Sidebar Search Go to Specific Page Zoom Change View Open File Print Download Copy to New Window Rotate Page Layout To Print, Save, or Download (located in the lower left of the viewer) To return to the Document List, users can click the back arrow More Patient Information Tab: Information available through the More Patient Information tab comes from patient demographics on reports received, additional data included in ADT messages, and an MPI (Master Patient Index) tool. The Rochester RHIO populates these fields when the information is provided to us from our Data Sources. 6.2 Contribute Contribute is a simple tool to share patient data (Continuity of Care Documents, or CCDs) with the Rochester RHIO through an EHR vendor. With this additional data, the RHIO will be able to provide more complete patient health records, enabling the highest quality patient care effectively transforming the healthcare system. Contributed data will be fed into the Repository, which will be a feature in RHIO Explore. See Explore Service: RHIO Repository for an example of how this information displays in the RHIO Query Portal. Last Update: 5/31/2018 11:58 AM Page 67 of 83
6.3 DIRECT Overview: DIRECT is a form of secure messaging allowing users to exchange PHI with other trusted health care entities. These services are provided by Health Information Service Providers (HISPs). Rochester RHIO is a Direct Trust EHNAC (Electronic Healthcare Network Accreditation Commission) Certified HISP. For more information on EHNAC, Accredited Organizations, or Direct Trust participants please see https://www.ehnac.org/ After logging onto the Provider Portal, users who have access to RHIO Direct can first click on the DIRECT tab and next, click on the "Continue to DIRECT" button. Users default to their individual inbox. From here, users have all the features of standard email messaging (for example: compose, reply, forward, etc.) Attach a File: Users can attach a variety of file types to their messages, for example: CCDs, images, Microsoft Word or Excel files, referrals, care plans, etc. Maximum size of attachments cannot exceed 50 MB per DIRECT Last Update: 5/31/2018 11:58 AM Page 68 of 83
message. In message, click on Attach File icon at the right hand side and upload attachments. Larger attachments may take a few seconds longer to process and send. DIRECT Settings: Users can customize their account in several ways. To customize, users click on the drop down arrow next to their DIRECT address in the upper right hand corner of the page. Click Webmail (located in the upper left hand corner of the page) to go back to inbox from settings. Available Settings: Choose Settings 1. Preferences: Customize page layout, message font and other mailbox settings. 2. Folders: Organize mailbox by creating new folders or editing existing older formats. 3. Identity: Set default settings and create a signature for messages. 4. Notifications: Elect to have a message sent to an email account notifying when a DIRECT message has been delivered. This limits logging into account unnecessarily to check for messages. In settings, users can update their notification email address on file. For users with notification email addresses affiliated with group/shared inboxes, please contact Rochester RHIO Customer Support Center or RHIO Administrator in order to update those addresses. 5. Delegations: This section should not be used on individual accounts. Users reference this list on group/shared accounts, however, delegations cannot be updated without contacting Rochester RHIO Customer Support Center, RHIO Administrator, or HISP Administrator. Access Shared Account: Although users default to their individual inbox after logging in, alternate accounts can be accessed by clicking on the drop down arrow next to their DIRECT address in the upper right hand corner of the page. Choose Alternate Address Last Update: 5/31/2018 11:58 AM Page 69 of 83
Users with more than one alternate address, will view those addresses under the Delegations. Users can go back to their individual account or to a different alternate account by clicking the dropdown arrow again and selecting the intended address destination. DIRECT Address Search: Users can locate their recipient s DIRECT address in several ways as follows: Compose Message. When user begins typing in their recipient s address, the system will automatically provide available selections for prefilling address. Address Book Provider Directory (located in the upper left hand corner of the page) 6.4 Alerts & MyAlerts Rochester RHIO Alerts notify users of critical patient events in real time through our Alerts service. These notifications are currently delivered through DIRECT messaging. Using the Alerts service, care managers, and other health professionals receive automatic notifications when their patients are admitted or discharged from a participating regional hospital or emergency department. Each notification message includes essential information such as the patient name, date of birth, event date, type of event, and the hospital(s) involved in the patient care. In some cases, messages include additional details, for example, patient diagnosis. MyAlerts Value-added service developed to meet specific clinical use cases and allows for customization of clinical workflows. MyAlerts is a list-based alerts feed, giving participants the ability to select alerts received based upon the needs of both the care provider and patient. MyAlerts is an enhancement of the core RHIO Alerts service, and can be delivered through DIRECT messaging, or integrated through an EHR vendor or system. Last Update: 5/31/2018 11:58 AM Page 70 of 83
Examples: Health Home, Home Care, Skilled Nursing Facility with 30-day hospital readmit Other Custom Alerts: Contact the Rochester RHIO for information about further customization. Statewide Alerts: Notification of patients admitted or discharged to an emergency department or hospital in New York State. 6.5 MyResults Delivered The Rochester RHIO delivers electronic results directly to a practice s EHR. This service both replaces fax/mail result delivery and eliminates the need for additional costs incurred on interfaces with multiple data providers. No more phoning and waiting for lab results or sending patients for additional tests when results are not readily available. The Rochester RHIO works with EHR vendors to facilitate integration. MyResults Delivered mirrors the existing exchange of information in a medical practice, so patients do not need to sign the RHIO Patient Consent Form for results to be sent through the RHIO. Providers can receive reports, forward reports to referring physicians, and save reports into their EHR. The RHIO staff is dedicated to supporting our community s clinicians who rely on MyResults Delivered. Click on the Support Request Tab inside the Provider Portal to securely submit a request for support. You can also call the RHIO at 1-877-865-RHIO. If a provider has multiple affiliations, specific information is requested on the application to ensure that results are delivered appropriately. MyResults Delivered - Paper: Paper Off Contact data source directly to turn the paper service off. Go to the Data Source page on the Provider Portal for available contact information at https://providerportal.grrhio.org/datasources Enhancements to Results Delivery Image Enabled Result Delivery (IERD) Physician practices can opt to include images in their results delivery data. Image Enabled Results Delivery (IERD) provides instant access to images by embedding a secure link to the image associated with a radiology report. Filtering Physician practices can opt to filter results delivered via the RHIO to support more efficient practice workflow options for filters including: preliminary results, inpatient results and CCD results. Last Update: 5/31/2018 11:58 AM Page 71 of 83
6.6 Subscribe/Forward Rochester RHIO can provide organizations a data feed of clinical data associated with consented patients (subscription) or a data feed based on a contractual relationship between RHIO participants (forwarding). These services are a powerful tool for participants to gather a more complete clinical record of their patients. 6.7 emolst emolst is a secure, web-based application that allows users to complete the NYS emolst application. This tab offers Single Sign on, and takes RHIO users directly to the website without the need for a second login. 6.8 Custom Orders Rochester RHIO's health information exchange services can be customized to meet the needs of participating organizations. The RHIO employs a highly experienced technical team, who can evaluate clinical and business requirements of healthcare organizations, identify technical solutions, and deliver services to solve identified information and workflow needs. RHIO custom projects have included but are not limited to building interfaces, inbound lab order for a closed loop electronic results delivery solution, public health connectivity, single sign-on, user authentication services, and data analysis for health research. Last Update: 5/31/2018 11:58 AM Page 72 of 83