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Updated readme for Direct Messaging; added receive info

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1 parent d574b8c commit 85de59d04627b1e681018364ef63b5744022b4bb @lcmaas lcmaas committed with bradymiller Feb 24, 2013
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  1. +81 −21 Documentation/Direct_Messaging_README.txt
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102 Documentation/Direct_Messaging_README.txt
@@ -1,51 +1,83 @@
Direct Messaging with OpenEMR and EMR Direct phiMail(TM)
-Version 1.0, 1 Feb 2013
+Version 1.1, 22 Feb 2013
Purpose:
-To provide a secure method from within OpenEMR for sending protected health
-information to another Direct address using the Direct Project messaging
-standard, as a first step toward the goal of satisfying the three MU2 criteria
+To provide a secure method from within OpenEMR for sending/receiving protected health
+information to/from another Direct address using the Direct Project messaging
+standard, as a step toward the goal of satisfying the three MU2 criteria
requiring the use of Direct messaging. (For general information about Direct messaging,
see http://www.emrdirect.com/about-directed-exchange-and-secure-direct-messaging.html)
IMPORTANT:
EMR Direct currently considers the OpenEMR Direct Messaging features to be in test-mode
-and not ready for use with real PHI. Some known limitations include:
-a. the current code does not have the ability to query for delayed failure or final delivery
-notifications from the phiMail server, and
-b. the current code only supports a single shared "group" Direct Address for each OpenEMR
-installation.
+and not ready for use with real PHI. Some known limitations include:
+a. the current code only supports a single shared "group" Direct Address for each OpenEMR
+installation. Note that this trust model is fully compliant with the Direct Project
+requirements for Direct messaging, but we may add additional trust models in the future
+should we determine that doing so would provide a higher degree of interoperability for
+OpenEMR users.
+b. the current code only sends the CCD XML data that was already available in OpenEMR;
+these CDA files as currently generated by existing OpenEMR code do not meet the requirements
+of the MU2 criteria; MU2 does require, however, that other systems be able to receive valid
+CCD files.
Problems Solved:
-1. Patient initiated transmission of CCDA data from the Report section of the Patient Portal
+1. Patient-initiated transmission of CCDA data from the Report section of the Patient Portal
interface.
-2. Provider initiated transmission of CCDA data from the Report section of the Patient pane
+2. Provider-initiated transmission of CCDA data from the Report section of the Patient pane
in the main OpenEMR interface.
3. Log all CCDA data transmissions including date/time, patient, and whether transmission
was initiated by the patient through the Patient Portal or by an OpenEMR user through the
main interface.
+4. Receive Direct messages from other sources.
How it Works:
Once configured, OpenEMR will interface with a phiMail Direct messaging server to complete the
required message transactions. The phiMail platform is described on the EMR Direct website,
http://www.emrdirect.com and http://www.emrdirect.com/phimail-faq.html.
What you need before enabling Direct Messaging in OpenEMR:
-1. Test-Mode: Developers may contact EMR Direct to request complimentary test address and
-digital certificate provisioning, as well as API documentation, at support@emrdirect.com.
-2. Production-Mode: Healthcare provider users should begin by signing up for a Direct message
+1. Test Mode: Developers may contact EMR Direct to request complimentary test address and
+digital certificate provisioning, as well as API documentation, at support@emrdirect.com.
+Access to a sandbox server is available for preliminary testing.
+2. Production Mode: Healthcare provider users should begin by signing up for a Direct message
account with EMR Direct.
Subscribers will receive the username, password, and server address information with which to
-configure OpenEMR. Applicants may visit http://www.emrdirect.com/subscribe.html to begin the
+configure OpenEMR. Applicants may visit https://www.emrdirect.com/subscribe.html to begin the
process.
How to enable the Direct Messaging Features in OpenEMR:
-Setup of phimail Direct messaging Service is done in the Administration::Globals::Connectors tab
+Setup of phimail Direct messaging Service is done in the Administration::Globals::Connectors
+tab
1. Check the "Enable phiMail Direct Messaging Service" checkbox.
-2. Enter the Server Address, Username, and Password provided to you by EMR Direct.
-3. Click the "Save" button.
+2. Enter the Server Address, Username, and Password provided to you.
+3. Specify the interval for automatic message checking; we suggest 5 or 10 minutes as a
+starting point, but installations processing a large number of Direct messages may want a
+shorter interval. By setting the interval to 0 (zero), automatic message checking through
+OpenEMR's background service manager will be suppressed. (This would be appropriate if message
+checking is managed through another mechanism, such as a system cron job.)
+4. Specify the OpenEMR user who will receive notification of new incoming Direct messages.
+Enter the username in the field.
+5. Click the "Save" button.
+6. Confirm that a valid Notification Email Address is set in the Administration::
+Globals::Notifications tab to receive error notifications from the Direct Messaging service.
+
+Checking the status and history of the Direct Messaging Service in OpenEMR:
+Administrators may view the status of the service by Selecting Reports::Services::Background
+Services from the main OpenEMR left navigation bar. The "View Log" link on this page or
+Reports::Services::Direct Message Log will open the messaging history log showing each message
+sent or received and the current status of that message (Received, Sent, Delivery Confirmed,
+or Failed).
+
+Note of message status messages: Receiving message status updates requires that Direct message
+checking be enabled. When receiving messages, the phiMail back-end is fully compliant with the
+Direct messaging protocols to notify the sender and provide final delivery confirmation, but
+please note that many other Direct providers do not yet support these features. If a message
+is sent to a recipient using one of these other systems, OpenEMR probably won't ever receive a
+final delivery confirmation for that message.
How to use the Direct Messaging Features in OpenEMR:
+Sending:
When the phiMail Direct Messaging service is enabled, an additional "Transmit" button will
appear in the Continuity of Care Document (CCD) section of the Reports section in both the
Patient Portal and the Patient pane of the main provider interface.
@@ -57,16 +89,44 @@ below the button with a form field to enter the intended recipient's Direct Addr
A Direct Address should have the same form as a regular email address, e.g.
jonesclinic@direct.example.com. Enter the address in the field and click the "Send" button
immediately to the right of the field. Only a single recipient may be specified in the field.
-The Send button will be temporarily disabled while OpenEMR is communicating with the phiMail server.
-This will only work for properly-configured Direct addresses. Attempts to send to a regular
-email address or Direct address outside of our test mode "trust sandbox" will fail.
+The Send button will be temporarily disabled while OpenEMR is communicating with the phiMail
+server. This will only work for properly-configured Direct addresses. Attempts to send to a
+regular email address or Direct address outside of our test mode "trust sandbox" will fail
+during testing.
OpenEMR will then display a status message immediately below the Address field, the
success or failure of the message transmission, or an error message. If the message is
successfully submitted to the server, the Address field will be cleared to prevent accidental
re-transmission. If multiple recipients are required, the next recipient can now be entered.
+Receiving:
+When the phiMail Direct Messaging service is enabled, and message checking is enabled either
+through the background services manager of another mechanism, OpenEMR will automatically process
+message status updates and new messages. Status updates will be reflected immediately in the
+Direct Messaging log. Additionally, if a "Failed" notification is received for a previously sent
+message, a regular email message will be generated to the Notification Email Address specified
+in the Notifications tab of the Global Settings panel (accessed by selecting Administration::
+Globals from the main left navigation menu).
+
+New Direct messages will be processed as follows. A new "Patient Note" will be generated and
+sent to the phiMail notification user specified in the Connectors tab of the Global settings.
+The patient note will contain information about the message, including any text at the beginning
+of the message from the sender. Any attachments (and any non-text content) will be automatically
+converted to separate OpenEMR Documents, which will be referenced in the new Patient Note.
+The Documents and the Patient Note are initially created without an assigned patient.
+
+At this time, the envisioned workflow is that the notification user will review the message text
+and any included Documents to determine which patient the content belongs to and will then set the
+patient using the existing Patient Note interface for choosing a patient. Once the patient is sent,
+the Patient Note can be forwarded to another provider or staff member as appropriate using the
+existing forwarding mechanism for Patient Notes. The unassigned Documents can be viewed by Selecting
+Miscellaneous::New Documents from the main left navigation menu, which opens a Documents list. Once
+the specified document is opened, the user can optionally categorize the document and, when
+appropriate, assign the document to a specific patient using the "Move to Patient #" feature in the
+Documents interface.
+
Trademark Notice: phiMail is a trademark of EMR Direct.
Copyright (c) 2013 EMR Direct.
+

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