Direct SMIME can be a very complicated process if not done correctly. We have created a step-by-step process to meet Meaningful Use Stage 2. In the event that you would like to send to a 3rd party vendor for practicing purposes, a similar process will take place outside of the NIST environment which will require MicroFour to get in contact with the desired 3rd party vendor so that trust anchors can be exchanged.
Registering within the EHR-Randomizer
- First, navigate to the ehr-randomizer NIST website: https://ehr-randomizer.nist.gov/ehr-randomizer-app/#/matches.
- If you have not yet registered on this site, then you will need to register by clicking the “Register” link at the top of the page.
- When prompted, enter your company (clinic) name and other requested basic information. When done, click “Create Account.”
- Once this is done, you are ready to login.
Login to EHR-Randomizer with New Account
- Click on the Login link at the top right of the page.
- Once logged in, there will be some new menu options at the top left of the screen. Click on My CEHRTs.
Create the PracticeStudio CEHRT Record
- Click the “Add CEHRT” link under My CEHRTs
- Fill out the page content with the following information:
- CEHRT Label: PracticeStudio
- Direct Email Address: This is the email address assigned to you when you created your account. If you do not remember, it is an easy formula. If your email address is firstname.lastname@example.org then your direct email is email@example.com. The @portalmaildirect.com will always be the same. Just replace the “@” in your email address with a period and add the @portalmaildirect.com to the end and that will be your direct email address. If that doesn’t work for you, contact MicroFour support and we will look up your address and send it to you.
- Time Zone: Your local time zone
- Developer: Drop down and choose “MicroFour, Inc.” from the list.
- Direct Trust Membership?: No
- Click the “Save” button to add the CEHRT record. The record should look something like this when completed.
Create a Match Request
This is the process that will match you with another vendor for sending your Direct SMIME and effectively start your test. However, this process DOES REQUIRE interaction with MicroFour support/development staff to make work. When doing this step, we will provide same day turnarounds to load the anchor if it is for a company not already in our direct trust network.
- Click My Matches link on the menu
- Click the “Request New Match” button
- When prompted, choose the PracticeStudio CEHRT created from earlier steps as the EHR that will be tested. Then click Request Match.
- This will create a match which will show up in the list below.
- Now, click on the name of the vendor with whom you have been matched.
- The details will expand below.
- Important Step – Downloading and Forwarding Trust Anchors to MicroFour
If you are matched with a vendor that is not in the list below, proceed to step 8. If the matched vendor is in the list, proceed to next section.
Currently Supported EHR-Randomizer Vendors
- If you were not matched with a currently supported vendor, scroll down to the Trust Anchor area of the page and download all certificates that are available. Once downloaded, create a PracticeStudio support ticket and attach the downloaded certificates. You may also send them via email once contacted by a MicroFour support technician. Once we have the certificates, we will add these anchors to our DIRECT servers and notify you. This is a quick process once the anchors are in hand.
- You will most likely receive an email from the company with whom you have been matched asking for the anchor key. That key can be downloaded here and then given to the vendor with whom you have been matched. If MicroFour can handle this step for you we will. If you will provide the contact information given to you on the site, MicroFour will contact the vendor and send them the link for the anchor.
You Are Now Ready to Send the CCD via DIRECT SMIME
- At this point, the trusts are in place and a CCD can be sent to the specified email address.
- First, make sure that you have been in contact with the vendor in question so that they are expecting your CCD. There is an email and phone number in the contact section of the My Matches for the vendor.
- Open PracticeStudio, login, and navigate to Medical Records.
- Choose the patient for which you are going to send the CCD.
- Click “Create Care Document” link on the left side of the screen
- You will need the DIRECT SMIME email address give to you from the NIST site for this vendor for the next step.
- Now, in PracticeStudio, fill out the Create Care Document dialog.
- Choose the most recent encounter, entire patient record, or a date range. Whatever is most appropriate for this patient. If you don’t know, just choose Entire Patient Record.
- Purpose: Transfer of Care
- Output: Direct SMIME, then enter the email address gathered in step 6.
- Click Save
- This will present the Portal Upload dialog. Make sure that the “From” user is the user that was given to the receiving vendor so that they know who to be looking for. They will have approved this email. This is your direct email address.
- Click Send.
- At this point, you should be finished.
Wasn’t that a piece of cake! At this point, the receiving vendor should be awaiting receipt of the DIRECT SMIME message. Once they have received it, you should receive notification by them through standard email or a phone call letting you know. At this point, you have fulfilled this portion of Meaningful Use.