1 Direct Messaging with OpenEMR and EMR Direct phiMail(TM)
2 Version 1.1, 22 Feb 2013
5 To provide a secure method from within OpenEMR for sending/receiving protected health
6 information to/from another Direct address using the Direct Project messaging
7 standard, as a step toward the goal of satisfying the three MU2 criteria
8 requiring the use of Direct messaging. (For general information about Direct messaging,
9 see http://www.emrdirect.com/about-directed-exchange-and-secure-direct-messaging.html)
12 EMR Direct currently considers the OpenEMR Direct Messaging features to be in test-mode
13 and not ready for use with real PHI. Some known limitations include:
14 a. the current code only supports a single shared "group" Direct Address for each OpenEMR
15 installation. Note that this trust model is fully compliant with the Direct Project
16 requirements for Direct messaging, but we may add additional trust models in the future
17 should we determine that doing so would provide a higher degree of interoperability for
19 b. the current code only sends the CCD XML data that was already available in OpenEMR;
20 these CDA files as currently generated by existing OpenEMR code do not meet the requirements
21 of the MU2 criteria; MU2 does require, however, that other systems be able to receive valid
25 1. Patient-initiated transmission of CCDA data from the Report section of the Patient Portal
27 2. Provider-initiated transmission of CCDA data from the Report section of the Patient pane
28 in the main OpenEMR interface.
29 3. Log all CCDA data transmissions including date/time, patient, and whether transmission
30 was initiated by the patient through the Patient Portal or by an OpenEMR user through the
32 4. Receive Direct messages from other sources.
35 Once configured, OpenEMR will interface with a phiMail Direct messaging server to complete the
36 required message transactions. The phiMail platform is described on the EMR Direct website,
37 http://www.emrdirect.com and http://www.emrdirect.com/phimail-faq.html.
39 What you need before enabling Direct Messaging in OpenEMR:
40 1. Test Mode: Developers may contact EMR Direct to request complimentary test address and
41 digital certificate provisioning, as well as API documentation, at support@emrdirect.com.
42 Access to a sandbox server is available for preliminary testing.
43 2. Production Mode: Healthcare provider users should begin by signing up for a Direct message
44 account with EMR Direct.
45 Subscribers will receive the username, password, and server address information with which to
46 configure OpenEMR. Applicants may visit https://www.emrdirect.com/subscribe.html to begin the
49 How to enable the Direct Messaging Features in OpenEMR:
50 Setup of phimail Direct messaging Service is done in the Administration::Globals::Connectors
52 1. Check the "Enable phiMail Direct Messaging Service" checkbox.
53 2. Enter the Server Address, Username, and Password provided to you.
54 3. Specify the interval for automatic message checking; we suggest 5 or 10 minutes as a
55 starting point, but installations processing a large number of Direct messages may want a
56 shorter interval. By setting the interval to 0 (zero), automatic message checking through
57 OpenEMR's background service manager will be suppressed. (This would be appropriate if message
58 checking is managed through another mechanism, such as a system cron job.)
59 4. Specify the OpenEMR user who will receive notification of new incoming Direct messages.
60 Enter the username in the field.
61 5. Click the "Save" button.
62 6. Confirm that a valid Notification Email Address is set in the Administration::
63 Globals::Notifications tab to receive error notifications from the Direct Messaging service.
65 Checking the status and history of the Direct Messaging Service in OpenEMR:
66 Administrators may view the status of the service by Selecting Reports::Services::Background
67 Services from the main OpenEMR left navigation bar. The "View Log" link on this page or
68 Reports::Services::Direct Message Log will open the messaging history log showing each message
69 sent or received and the current status of that message (Received, Sent, Delivery Confirmed,
72 Note of message status messages: Receiving message status updates requires that Direct message
73 checking be enabled. When receiving messages, the phiMail back-end is fully compliant with the
74 Direct messaging protocols to notify the sender and provide final delivery confirmation, but
75 please note that many other Direct providers do not yet support these features. If a message
76 is sent to a recipient using one of these other systems, OpenEMR probably won't ever receive a
77 final delivery confirmation for that message.
79 How to use the Direct Messaging Features in OpenEMR:
81 When the phiMail Direct Messaging service is enabled, an additional "Transmit" button will
82 appear in the Continuity of Care Document (CCD) section of the Reports section in both the
83 Patient Portal and the Patient pane of the main provider interface.
85 To transmit a CCD, first click the "Transmit" button. This will open a small dialog immediately
86 below the button with a form field to enter the intended recipient's Direct Address. Clicking
87 "Transmit" again will hide the dialog.
89 A Direct Address should have the same form as a regular email address, e.g.
90 jonesclinic@direct.example.com. Enter the address in the field and click the "Send" button
91 immediately to the right of the field. Only a single recipient may be specified in the field.
92 The Send button will be temporarily disabled while OpenEMR is communicating with the phiMail
93 server. This will only work for properly-configured Direct addresses. Attempts to send to a
94 regular email address or Direct address outside of our test mode "trust sandbox" will fail
97 OpenEMR will then display a status message immediately below the Address field, the
98 success or failure of the message transmission, or an error message. If the message is
99 successfully submitted to the server, the Address field will be cleared to prevent accidental
100 re-transmission. If multiple recipients are required, the next recipient can now be entered.
103 When the phiMail Direct Messaging service is enabled, and message checking is enabled either
104 through the background services manager of another mechanism, OpenEMR will automatically process
105 message status updates and new messages. Status updates will be reflected immediately in the
106 Direct Messaging log. Additionally, if a "Failed" notification is received for a previously sent
107 message, a regular email message will be generated to the Notification Email Address specified
108 in the Notifications tab of the Global Settings panel (accessed by selecting Administration::
109 Globals from the main left navigation menu).
111 New Direct messages will be processed as follows. A new "Patient Note" will be generated and
112 sent to the phiMail notification user specified in the Connectors tab of the Global settings.
113 The patient note will contain information about the message, including any text at the beginning
114 of the message from the sender. Any attachments (and any non-text content) will be automatically
115 converted to separate OpenEMR Documents, which will be referenced in the new Patient Note.
116 The Documents and the Patient Note are initially created without an assigned patient.
118 At this time, the envisioned workflow is that the notification user will review the message text
119 and any included Documents to determine which patient the content belongs to and will then set the
120 patient using the existing Patient Note interface for choosing a patient. Once the patient is sent,
121 the Patient Note can be forwarded to another provider or staff member as appropriate using the
122 existing forwarding mechanism for Patient Notes. The unassigned Documents can be viewed by Selecting
123 Miscellaneous::New Documents from the main left navigation menu, which opens a Documents list. Once
124 the specified document is opened, the user can optionally categorize the document and, when
125 appropriate, assign the document to a specific patient using the "Move to Patient #" feature in the
129 Trademark Notice: phiMail is a trademark of EMR Direct.
131 Copyright (c) 2013 EMR Direct.