RPMS Direct Messaging - Indian Health Service

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RPMS DIRECT MessagingGlenn Janzen, Chief Enterprise Architect - IHSChris Lamer, Clinical Informatics Consultant - IHSMeghna Patel, Business Analyst - DNCDuane Rozsnyai, Application System Analyst - DNC

Meaningful UseSecure Messaging Is a Meaningful Use RequirementObjective: Use secure electronic messaging to communicate withpatients on relevant health information (for EPs only)Measure: A secure message was sent using the electronic messagingfunction of Certified EHR Technology by more than five percent ofunique patients (or their authorized representatives) seen by the EPduring the EHR reporting period §495.6(j)(17)(ii)2

RPMS DIRECT Messaging RPMS DIRECT Messaging is the name of the secureemail system. RPMS DIRECT Messaging is separate from your otheremail account. You can access RPMS DIRECT Messaging within theEHR. Patients can access RPMS DIRECT Messaging withinthe PHR. RPMS DIRECT Messaging is used for health-relatedmessages only. RPMS DIRECT Messaging messages can be sent to andreceived from other trusted DIRECT addresses only.3

RPMS DIRECT Applications RPMS DIRECT Messaging: Accessed by healthcare providers and other professionalswithin the RPMS EHR (to be configured by facility CAC) Personal Health Record (PHR): Used to connect patients and/or their personal representativesto the RPMS DIRECT Messaging using PHR My Messagesmenu Patients and/or their personal representatives manage theiraccounts through the PHR RPMS DIRECT Messaging Administrator Portal: Used to set up domains and manage users’ access forhealthcare providers and other professionals4

Integration with EHR5

Integration with PHR6

Health Information Exchange (HIE)7

Health Information Exchange (HIE)8

Certificates Users with an RPMS DIRECT Messaging account will beassociated with an organizational certificate. A certificate is attached to your organization’s domain name Proves the identity of the organization to which you belong Proves that your address is a valid, trusted address under thatorganization Ensures email messages are secure9

RPMS DIRECT Messaging Domain: Domain name is dedicated to your organization Domain name must be the organization’s legal name or theIHS D1 domain name Domain name will be assigned an organizational-boundcertificate Example: claremoreindianhospital.directihs.net RPMS DIRECT Messaging Addresses: Assigned toindividual providers, Message Agents, and other staff RPMS DIRECT Messaging addresses under organization willbe linked to the organization’s domain name and certificate Address format: firstname.lastname Example: 10

Roles and Responsibilities11

Roles and Responsibilities (cont.)12

Roles Service Unit/Facility Administrator Facility ManagerManage and grant RPMS DIRECT Messaging user access andcomplete identity vetting at LoA 3 for healthcare providers and otherprofessionals, including Message Agents and PHR Registrars PHR Registrar Patient Registrar or Front DeskPerform patients’ PHR and RPMS DIRECT Messaging registration byfollowing PHR registration procedure (i.e., Identity Vetting, IHS-810Form) Message Agent Front Desk or Patient Check-inInitial responder and distributer of the secure messages for assignedpatient and/or patient group13

Message Agents The person(s) assigned to receive secure messages Similar to the person assigned to answer the phone in theclinic, they get the call and take action as appropriate Sample use cases of patient-sent secure messages: Cancels appointment - Message Agent alerts schedule clerk tomake appropriate change. Requests medication renewal - Message Agent alerts provider ofrequest (sends notification in EHR, tells the provider, writes a note whatever you do now when you get a call); Message Agent repliesto the patient with an updated status regarding the message. Shares health information (e.g., Recent home blood sugar results,information from another provider, experiences that they think couldbe an adverse reaction to a new medication) - Message Agentforwards to provider; message is stored into the VistA Imaging in thepatient’s medical record. Providers may respond to patient directlyor through the Message Agents.14

Assigning Message Agents How to assign Message Agents Small sites may only need one Larger sites may need more than one Consider having at least one backup to cover leave, sick days,etc. Patients can be assigned to a Message Agent in theDesignated Primary Provider package Message Agents are a new provider typeCan assign individual patients to a Message AgentCan assign all of a provider’s patients to a Message AgentA provider can be a message agent, but we recommend usingsomeone else on your team while you are starting out15

Identity VettingLevel of Assurance (LoA):Level of Assurance (LoA) is one’s ability to determine, with some level of certainty, thatthe electronic credential representing an entity (machine or human) can be trusted tobelong to the entity (they are who they say they are). There are four levels ofassurance ranging in confidence level from low to very high (LoA1 to LoA 4), which ismeasured by the strength and rigor of the identity vetting process. Level of Assurance 3 (LoA 3): Individual vetted at LoA 3 provides high confidence in the asserted identity’svalidityMust present a current, non-expired Personal Identity Verification (PIV) Card ORTwo forms of picture identifications, where one is a Federal Government issuedpicture identification, and the other is REAL ID Act compliant picture identification,such as a state driver’s license or state identification cardHealthcare providers and other professionals, including Message Agents and PHRRegistrars, MUST have their identity vetted at LoA 316

Implementation Phase 1: Send messages internally Indian, Tribal, and Urban RPMS DIRECT Messaginghealthcare providers and other professionals Patients and patients’ personal representatives with PHRaccess Phase 2: Send messages internally and externally Participating internal partners (Indian, Tribal, and Urbanfacilities) Trusted external partners Part of the same Trust bundle/Trust framework to ensure securityand policy requirement align17

Policies and AgreementsRPMS DIRECT Messaging Business Associate Agreement (BAA) End-User Agreement RPMS DIRECT Messaging Privacy Policy RPMS DIRECT Messaging Terms and Conditions Access to the RPMS DIRECT Messaging System: End Users Administrators18

Policies and Agreements (cont.)Personal Health Record Processing Patient Access to their PHR Policy Personal Health Record Privacy Policy Personal Health Record Terms and Conditions Personal Health Record System Audit Process Policy19

Preparing for RPMS DIRECT Messaging Start thinking about: Service Unit/Facility Administrator(s) PHR Registrar(s) Message Agent(s) Complete and submit Data Call Develop an RPMS Direct Messaging Awareness Plan20


RPMS DIRECT Messaging 3 RPMS DIRECT Messaging is the name of the secure email system. RPMS DIRECT Messaging is separate from your other email account. You can access RPMS DIRECT Messaging within the EHR. Patients can access RPMS DIRECT Messaging within the PHR. RPMS DIRECT Messaging is used for health-related messages only.

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