Health information exchange

Health information exchange: turn it on

Health information exchange sends and receives patients’ health record files (a summary of care, a referral note, or a care plan) with other practices by Direct secure messaging. A secure address (Direct address) is like an email address that only health care organizations can use, so practices can send each other patients’ records safely. Files you receive are checked for problems, shown section by section, matched to the patient, and their medications, allergies and problems can be reviewed side by side with the chart and added in one step.

1. Get a Direct provider account. Your practice needs an account with a Direct provider (a HISP). They give you the server details and the secure addresses you enter in Hero.
2. Turn the feature on. A practice administrator opens Admin → Additional Features, finds Health information exchange, switches it on and presses Save Changes. It is off for every practice until you turn it on.
3. Connect Direct messaging and add your addresses. See Connect Direct messaging and Secure addresses.

While the feature is off, the Health records folder, the Send health record buttons, the Direct messaging tab and the Direct address field for outside doctors are all hidden.

Connect your Direct provider

1. Open the tab. Admin → External Providers, then Direct messaging under Clinical integrations. The badge at the top reads Not set up, Turned off, Needs attention or Connected.
2. Enter what your Direct provider gave you. In the Connection card switch on Enable Direct messaging, then fill in Sending (SMTP) (server, port, security SSL/TLS or STARTTLS), Receiving (IMAP) (server, port, security, and the Inbox folder, usually INBOX), and the Username and Password. A saved password is never shown again; leave it blank to keep it.
3. Choose the delivery options. Ask recipients to confirm delivery (on by default) lets you see when a record arrived. Under Advanced, turn on Send as XDM package only if a recipient’s system asks for it.
4. Press Save, then Test connection. The test checks Sending (SMTP), Receiving (IMAP) and Secure addresses and reads “Connected. Hero can send and receive health records with these settings.” or “Something isn’t working yet. See each check below.” You can run up to 10 tests in 10 minutes.
5. Add your secure addresses in the card below (see Secure addresses).

The Status card shows the connection, the Last connection test and the Last inbox check. While Direct messaging is on, Hero checks your secure inbox every few minutes for records sent to you.

Your secure addresses, and outside doctors’

Your practice’s and your providers’ addresses

In Your secure addresses (on the Direct messaging tab) press Add address:

• Secure address — exactly as your Direct provider gave it, for example frontdesk@direct.yourpractice.org. An address can belong to only one practice.
• Display name (optional) — shown to recipients as the sender’s name.
• Belongs to — The practice (used for everything else, and where other practices send you records) or A provider (records that provider sends go out from this address); then choose the provider.
• Use as the practice's default sending address — ticked for your first address.

Each address can be made the Default, or set to Deactivate / Activate; addresses are never deleted. Make an address active before making it the default. When you send, the From address is your own provider address if you have one, otherwise the practice default; the dialog shows a From choice only when the practice has more than one active address.

Outside doctors’ addresses

Save the receiving office’s secure address on their record in Admin → Referring providers: edit the doctor and, under How to reach them, fill in Direct address (secure email for health records). Ask their office for it. It then shows on the doctor’s detail panel and fills in Send health record for you (see Referring providers).

Send a health record to another practice

You can send from two places:

• A sent referral. Inbox → Referrals, the Sent list, open the referral, then Send health record (not on cancelled referrals). Sending never changes the referral’s status.
• A care-team doctor. In the chart’s Care team or a visit’s Communications section, the doctor’s actions include Send health record (next to Secure message), with their secure address filled in (see Contacting providers).

1. Check who it goes to. Send to (secure address) is required. Suggestions offer the referral’s recipient (From the referral), the doctor’s saved address (Referring provider) and care-team doctors with an address (Care team). A doctor with no address on file shows “… has no secure address on file. Type it above, or add it to their record in Referring providers.”
2. Choose Send as. Summary of care, Referral note or Care plan. From a referral it starts on Referral note; otherwise on Summary of care.
3. Add the details for that kind of file. Reason for referral is filled in from the referral and required for a referral note (“Included in the record so the receiving provider knows why they’re getting it.”). For a care plan, Outcomes so far takes one outcome per line (up to 20), for example A1c down to 7.2%; they are saved to the patient’s care plan as soon as you preview or send.
4. Add an optional Note to the recipient. It goes with the file as the cover message. Keep patient details in the file itself: the subject line (Referral note from …) and the default cover text name your practice, never the patient.
5. Preview, then Send. Preview shows the file before it goes. If Hero notices formatting problems the receiving system may flag, it says so, but they never stop you sending.

Did it arrive? Delivery status and what to do

After Send the dialog follows the delivery; you can close it at any time, and the referral’s Health record line keeps the latest status for people who may send.

When secure sending isn’t ready

If Direct messaging isn’t set up, is turned off, or the practice has no secure address yet, the dialog reads “Secure sending isn’t ready yet.” with the reason, and explains that an administrator sets it up in Admin → External providers → Direct messaging. It offers Fax the referral instead (from a referral) or Fax it instead (from a care-team doctor with a fax number).