1. New Hampshire Health Information Organization Healthcare Provider Directory Please note that all participants are MUTED upon entry to the audio portion of the webinar. For the best audio experience, please use your phone line and individual Audio Pin provided upon logging into the webinar. Participants will be able to UN-MUTE their own lines as needed using the microphone/phone icon on the participant panel. If you have difficulty, please utilize the Questions Panel to type in any questions that will be reviewed and answered at the end of the presentation. The webinar will begin shortly. Thank you.!

2. New Hampshire Health Information Organization Healthcare Provider Directory

3. - 3 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Definition of Terms NHHIO Architecture and HISP Services EHR Integration Options What is the Healthcare Provider Directory? What is the Direct email address? Who should be listed in the Healthcare Provider Directory? Accessing and Sharing the Healthcare Provider Directory Review of Required Documents Next Steps Questions Comments

4. - 4 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Definitions ONC: Office of the National Coordinator - Oversees the HIE grant and certifies EHRs DSM: Direct Secure Messaging – Encrypted exchange of information between providers and organizations without using a centralized repository HPD: The healthcare provider directory is a “phone book” of providers using DSM HISP: Health Information Service Provider – Assigns Direct addresses and provides the network for providers listed in the HPD to utilize DSM. Direct: A national standard for interoperability using specific email type addresses, defined message formats and transport protocols XDR-SOAP (optional of ONC certification) SMTP-S/MIME (required for ONC certification) CCD: Continuity of Care Document – A medical summary of patient information CCDA: Consolidated Clinical Document Architecture – A standard for message formats under the Direct protocols CEHRT: Certified Electronic Health Record Technology

5. - 5 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Definition of Terms NHHIO Architecture and HISP Services EHR Integration Options What is the Healthcare Provider Directory? What is the Direct email address? Who should be listed in the Healthcare Provider Directory? Accessing and Sharing the Healthcare Provider Directory Review of Required Documents Next Steps Questions Comments

6. - 6 - New Hampshire Health Information Organization © NHHIO. All rights reserved. NHHIO Mission As healthcare organizations look to transform healthcare by providing better healthcare, improving the health of their patients, and reducing costs, the need to more effectively and efficiently coordinate the care of patients has never been more important. The electronic transmission of patient health information between health care providers in a timely, secure, and confidential manner is an important next step in the evolution of health care delivery in the Granite State.

7. - 7 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Health Information Service Provider (HISP) An organization that manages security and transport for health information exchange among health care entities or individuals using the Direct standard for transport. There is no specific legal designation for a HISP, nor are HISPs specifically regulated by Meaningful Use certification rules. Functions can be performed by existing organizations (such as EHR vendors or HIE organizations) or by standalone organizations specializing in HISP services. HISPs perform two key functions that support scalability of exchange using the Direct standard. Issue security certificates. HISPs establish trust networks by defining policies for network participation and issuing security certificates tied to a HISP anchor certificate to enforce such policiesIssue security certificates. Issue direct addresses. HISPs issue direct addresses tied to the HISP anchor certificate in accordance with conventions defined by the Direct standardIssue direct addresses.

8. - 8 - New Hampshire Health Information Organization © NHHIO. All rights reserved. NHHIO Architecture and HISP Services NH Statewide Network – “Backbone” CHAN Provider Practices Hospital Public Health (DHHS) Security Node addressing Provider addressing Audit MD Relationship Listing Service (EMPI) Long-term care SNFs Phase I: Direct Secure Messaging (DSM) Inter-state / HISP gateway Phase II: Relationship Listing Service (RLS) – Electronic Master Person Index (EMPI) Health Centers Behavioral Health Diagnostic testing NH Hospital VNA / Homecare MD ASCC Inter-state / HISP communications

9. - 9 - New Hampshire Health Information Organization © NHHIO. All rights reserved. 3 rd Party HISP Connections

10. - 10 - New Hampshire Health Information Organization © NHHIO. All rights reserved. DSM Direct – XDR (NHHIO HISP) Pending ONC 2014 Certification

11. - 11 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Definition of Terms NHHIO Architecture and HISP Services EHR Integration Options What is the Healthcare Provider Directory? What is the Direct email address? Who should be listed in the Healthcare Provider Directory? Accessing and Sharing the Healthcare Provider Directory Review of Required Documents Next Steps Questions Comments

12. - 12 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Electronic Health Record (EHR) Integration DSM Web DSM Direct DSM Connect Basic Direct Secure Messaging Web-based access Email client access Direct Secure Messaging with EHR System integration Encrypted S/MIME access HISP-HISP Capability Encrypted XDR access Managed Direct Secure Messaging Client-deployed hardware device (LAND Appliance) Monitored by OH Managed Services HPD CERT MSG NHHIO Trust Network

13. - 13 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Definition of Terms NHHIO Architecture and HISP Services EHR Integration Options What is the Healthcare Provider Directory? What is the Direct email address? Who should be listed in the Healthcare Provider Directory? Accessing and Sharing the Healthcare Provider Directory Review of Required Documents Next Steps Questions Comments

14. - 14 - New Hampshire Health Information Organization © NHHIO. All rights reserved. What is the Healthcare Provider Directory? The Healthcare Provider Directory (HPD) is a searchable directory of individual and organizational healthcare providersHealthcare Provider Directory (HPD) Individual Provider – A person who provides healthcare services, such as a physician, nurse practitioner, physician assistant or nurse Organizational Provider – An organization that provides or supports healthcare services such as hospitals, health centers, or practices It allows discovery of a provider's electronic messaging details, in particular, the Direct email address It stores demographics, contact information, specialties, organizational relationships, and other information for delivery of messages

15. - 15 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Definition of Terms NHHIO Architecture and HISP Services EHR Integration Options What is the Healthcare Provider Directory? What is the Direct email address? Who should be listed in the Healthcare Provider Directory? Accessing and Sharing the Healthcare Provider Directory Review of Required Documents Next Steps Questions Comments

16. - 16 - New Hampshire Health Information Organization © NHHIO. All rights reserved. What is the Direct email address? The Direct email address allows for: Discovery of the provider or organization for electronic delivery Provides their location on the HISP network Provides security certificate information NHHIO example: Organization Direct Address: exeter@direct.exeterhospital.nhhio.comexeter@direct.exeterhospital.nhhio.com Provider Direct Address: John.smith@direct.exeterhospital.nhhio.comJohn.smith@direct.exeterhospital.nhhio.com

17. - 17 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Direct email address components Domain: The domain of the address is used for location of delivery, and transport method of delivery if any conversion is required.(XDR-SMTP) DSM Connect (LAND Appliance) DSM Direct DSM Web (email product) HISP-HISP (ie. Surescripts, eClinicalworks) Endpoint: The final destination for delivery within the EHR application or other DSM product John.smith@direct.exeterhospital.nhhio.com Domain Endpoint Direct Address

18. - 18 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Direct email address examples

19. - 19 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Why use Direct email address?

20. - 20 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Definition of Terms NHHIO Architecture and HISP Services EHR Integration Options What is the Healthcare Provider Directory? What is the Direct email address? Who should be listed in the Healthcare Provider Directory? Accessing and Sharing the Healthcare Provider Directory Review of Required Documents Next Steps Questions Comments

21. - 21 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Who should be listed in the Healthcare Provider Directory? Direct Secure Messaging (DSM) Direct Secure Messaging (DSM) is the encrypted exchange of information between providers and is generalized as the replacement for current faxing and paper based transmission of information The Healthcare Provider Directory (HPD) is the “phonebook” that would replace the contact fax numbers or mailing address of your individual and organizational providers The HPD is the “phonebook” presented to the NHHIO community for referral provider information – How do you want to be seen in the directory? All providers? All departments? A consolidated view?

22. - 22 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Can a provider have multiple Direct addresses? Yes: Although the endpoint (provider) may be the same, the provider may work in multiple domains (organizations). Domain: The domain for the endpoint (provider) could exist in multiple organizations and may be using multiple methods of connectivity based on local EHR capabilities. DSM Connect (LAND Appliance) DSM Direct (connect through EHR) DSM Web (email product) HISP-HISP (ie. Surescripts, eClinicalworks, Greenway) Example: John.smith@direct.exeterhospital.nhhio.com John.smith@direct.surescripts.com

23. - 23 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Can a provider have multiple Direct addresses? Dr. Smith #3 Dr.Smith #1 Dr. Smith DSM Connect HPD Dr. Smith DSM Web Dr. Smith DSM Direct Dr.Smith #2 Dr. Smith works in 3 facilities in the State. He connects through his EHR at site #1 (XDR) and site #2 (S/MIME) but uses Webmail at site 3.

24. - 24 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Can an organization have multiple domains? Yes: Based on the integration methods of the EHR systems, an organization may have an inpatient and outpatient domain, or may be using the domain provided by another HISP: Example: Inpatient system is connected by DSM Connect (LAND Appliance) and NHHIO provides HISP services: snhmc@direct.snhmc.nhhio.comLAND Appliancesnhmc@direct.snhmc.nhhio.com Outpatient system (GE) is connected to Surescripts HISP: John.smith@direct.surescripts.com John.smith@direct.surescripts.com

25. - 25 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Can an organization have multiple domains? Specialist PCP MR Specialist PCP MR HPD Provider Practices EHR Vendor HISP LAND Appliance Parent Organization

26. - 26 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Can multiple providers use a single Direct address? Yes: The endpoint of the address is used by the local EHR to determine the final delivery location of the information. Based upon the functionality of your EHR vendor, or based upon your current staff resources and workflows, multiple providers can use the same Direct address to centralize delivery of information Example: System is connected by DSM Connect (LAND Appliance) and NHHIO provides HISP services: Dr. John Smith: orthopedics@direct.dartmouthhitchcock.nhhio.comorthopedics@direct.dartmouthhitchcock.nhhio.com Dr. Sue Jones: orthopedics@direct.dartmouthhitchcock.nhhio.comorthopedics@direct.dartmouthhitchcock.nhhio.com

27. - 27 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Can multiple providers use a single Direct address? Specialist PCP MR Specialist PCP MR HPD *message details in clinical documentation will determine final destination*

28. - 28 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Definition of Terms NHHIO Architecture and HISP Services EHR Integration Options What is the Healthcare Provider Directory? What is the Direct email address? Who should be listed in the Healthcare Provider Directory? Accessing and Sharing the Healthcare Provider Directory Review of Required Documents Next Steps Questions Comments

29. - 29 - New Hampshire Health Information Organization © NHHIO. All rights reserved. How do I access the HPD? The HPD will reside at the NHHIO central site and can be accessed in several ways: Organizations using DSM Web will have the HPD automatically incorporated and will work just like a MS Outlook directoryDSM Web Organizations using an EHR application: Receive a.CSV file periodically to update their internal directory or manually enter updated information View full HPD through NHHIO portal (to be implemented) Receive or query against an HPD+ formatted file that can be presented within the EHR applicationHPD+ formatted file

30. - 30 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Will other HISP HPDs be available to NHHIO? Yes: Organizations who have enrolled as NHHO participants, but are also connecting to another HISP, will provide NHHIO with the same HPD information as all participants Direct address field information will be populated with previously assigned addresses (can export HPD from current vendor) Organizations who join a vendor HISP, but do not participate with NHHIO will not be able to access NHHIO HPD through the portal Only vendor HISP address information for participating providers and organizations will be viewable or available in the NHHIO HPD

31. - 31 - New Hampshire Health Information Organization © NHHIO. All rights reserved. How do I update the HPD? Currently, NHHIO is working with Orion Health to determine the most effective and efficient method for updating: The NHHIO web-portal and access administrator documentation is designed to allow participants to manually update the HPD as needed To start, participants will send additional.CSV files with new providers, or email notification of terminated providers Updated HPD information will be distributed to participants (access administrators) based on volume and timing of changes

32. - 32 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Definition of Terms NHHIO Architecture and HISP Services EHR Integration Options What is the Healthcare Provider Directory? What is the Direct email address? Who should be listed in the Healthcare Provider Directory? Accessing and Sharing the Healthcare Provider Directory Review of Required Documents Next Steps Questions Comments

33. - 33 - New Hampshire Health Information Organization © NHHIO. All rights reserved. How do I submit the HPD?

34. - 34 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Required Documents Appendix C – Provider Directory Upload File Format

35. - 35 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Definition of Terms NHHIO Architecture and HISP Services EHR Integration Options What is the Healthcare Provider Directory? What is the Direct email address? Who should be listed in the Healthcare Provider Directory? Accessing and Sharing the Healthcare Provider Directory Review of Required Documents Next Steps Questions Comments

36. - 36 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Next Steps Complete and return Appendix C – Provider Directory Upload File FormatAppendix C – Provider Directory Upload File Format Complete Declaration of Identify Form (Contact NHHIO for form)NHHIO Exploration of EHR functionality

37. - 37 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Agenda Definition of Terms NHHIO Architecture and HISP Services EHR Integration Options What is the Healthcare Provider Directory? What is the Direct email address? Who should be listed in the Healthcare Provider Directory? Accessing and Sharing the Healthcare Provider Directory Review of Required Documents Next Steps Questions Comments

38. www.nhhio.org NHHIO Resources

39. - 39 - New Hampshire Health Information Organization © NHHIO. All rights reserved. Project Contact Information 125 Airport Road, Concord, New Hampshire, 03301 Office. (603) 219-0184 Fax. (603) 218-6126 www.NHHIO.org Jeff Loughlin Executive Director c: (508) 326-3944 o: (781) 434-7751 jloughlin@maehc.org Jackie Baldaro Project Manager c: (339) 223-0888 o: (781) 434-7553 jbaldaro@maehc.org