Unified Collaboration Portal

1.0       Overview

 The Sirona Unified Collaboration Portal framework (UCP) is a modular platform that helps health care providers communicate and collaborate with their patients on health care matters. It provides access to clinical data, documents, diagnostic guidance, risk analysis, decision support, and planning tools that help providers assess their patients' medical data, their relative risk for specific diseases and to leverage rules and workflows during their diagnostic workups. Medical facility administrators can use a resource-capacity simulator to optimize resources (staff, rooms, equipment, and so on) needed to care for their patients. Such optimization increases capacity and improves access to care.

Sirona allows patients to access many of the same tools and clinical resources used by providers. Sirona also provides a range of opportunities to educate patients on a broad spectrum of health care topics, and through its collaboration services, facilitates active participation in their treatment and recovery. Through use of the Sirona patient tools, patients can better understand their conditions, their treatment plans, and can collaborate with their health care providers to fashion and implement a coordinated plan for achieving and sustaining health.

1.1       System Description

Sirona is a web-based application divided into three groups of general functionality, accessible to both providers and patients according to their status and role.

•  General Education: Both unauthenticated and authenticated users can access certain portal resources without logging in. Users can browse general help topics and news, request an account, take a feature tour, and other tasks appropriate to site navigation.

•  Patient Functionality: Only authenticated patients can access this layer of Sirona, which provides access to their medical record (PMR), a Patient Inbox for receiving and sending messages related to their health care, and management tools, such as a unified calendar and health care address book.

•  Provider Functionality: Only authenticated health care providers can access this layer. It contains tools to review patient medical records through the Electronic Medical Record (EMR) application, send emails/alerts/documents to patients and colleagues, and receive Clinical Decision Support alerts. Additional clinical tools include capabilities to assess a patient risk for disease and determine a diagnosis. The portal allows authorized providers to access a CDS workbench to author rules that support clinical decision-making, and a simulator to optimize resources at their medical facilities.

Both providers and patients log in on the same page. Sirona, based on user type, directs the user to the appropriate portal application, Patient Portal (PMR) or Provider Portal (EMR). While each application has its own theme colors, layout, and functionality, the intent behind the common login is to re-enforce that patient and providers are a team collaborating on a common goal.

This document describes the functional requirements for the Sirona portal framework. It provides a high-level understanding of the features available to all users, both authenticated and unauthenticated.

1.3.1    Audience

The following stakeholders are the audience for this document:

•  Business analysts and users

•  Architects looking for a broad description of the Sirona Unified Care Portal and its applications

•  Developers

1.3.2    Document Organization

Section 1.0 describes the audience, scope, relevant terminology, reference documents, and documentation for the Unified Collaboration Portal.

Section 2.0 provides a description of the Sirona Home and site navigation pages that introduce the main portal application and the other modules comprising the system. It also describes the functional requirements defining account access and site navigation.

Section 3.0 describes the Patient Portal and the functional requirements governing the patient Universal Inbox and Patient Medical Record, as well as patient organizing tools, such as the Calendar and Personal Info features.

Section 4.0 describes the Provider Portal and the tools that authenticated providers can use to monitor patient medical records, analyze risk for disease, support clinical decision-making, and run disease probability and diagnostic processes. This section provides functional requirements for the Medical Records, Clinical Analytics, and Diagnostic Guide tools. The tools that facilitate clinical decision support and resource capacity optimization, also accessed through the Provider Portal, are described in separate documents referenced below.

1.3.3    Reference Documents

•  Resource Capacity Simulator functional requirements are described in Requirements - Resource

Capacity Simulator

•  Clinical Decision Support Workbench functional requirements are described in Requirements - Clinical Decision Support Workbench

•  The functional scenarios that provide examples of how to use the Sirona Unified Care Portal are described in Requirements – Scenarios

2.0       General Portal Functionality

A major goal of the Sirona system is to create a collaborative health care team that includes the patient and his or her circle of medical professionals. To that end, the Sirona Unified Collaboration Portal platform provides a broad base of general information on treating disease and establishing a healthy lifestyle that unauthenticated users can access. After perusing the information provided on general health and well being, users can request that accounts with greater access and functionality be established for them.

Accounts require specific security measures and access-control procedures. Although a potential user can request an account online, actual account creation typically requires an in-person meeting with a System Administrator at the relevant medical facility. Patients requesting access must have been enrolled in the Healthcare Plan and must have a Primary Care Manager who serves as guide and mentor when patients have questions or concerns regarding the data they can now access.

This section describes the functional requirements for account creation and access, and for unauthenticated site navigation. The following figure provides a screenshot of the home login page, showing the three main tabs and the site navigation footer: Log In, About, and Medical News:

2.2       Log In Tab

The Sirona Unified Collaboration Portal platform is a controlled environment that meets HIPAA security and privacy regulations. New users must establish accounts in person, using any administrative process approved by their medical facility. Once enrolled in the Sirona system, patients and providers both use the standard user name /password log-in procedure on the Portal Home Page, or for convenience, a Common Access Card (CAC). Although the enrollment process must be completed in person, patients and providers can request an account online using the UCP user interface to expedite the onsite enrollment process. For authenticated users who lose their password, UCP provides a tool for resetting passwords.

The Log In tab contains the UCP user interface that allows patients and providers to request accounts, reset passwords, and log in.

2.2.1    Account Access

Accounts require security measures and specific access procedures. New users must establish accounts in person. Once a user has established an account, he or she can access the Sirona system by entering the authenticated account user name and password and clicking Log In, or using a Common Access Card. All users log in at the same page.

2.2.2    Request Account

To ensure HIPAA security and privacy regulations, new account registration typically follows these, or similar, steps:

1.  User requests account online using the Sirona interface.

2.  System Administrator of user's medical facility contacts user to schedule time to enroll in person.

3.  Following in person identity confirmation, the System Administrator creates the account.

4.  System Administrator notifies user of completion and availability of account via email.

Users can begin the enrollment process by requesting an account online via the Home Log In Page. They click Request An Account, and submit the initial account information, which includes first and last name, email address, complete street address, Social Security number, username, and policy number (the ID associated with the chosen health care facility). The Request Account button allows users to send their requests to the specified medical facility. By clicking Request Account, the user agrees that he or she has read the Terms of Service available on that screen.

New users must complete the enrollment process in person at their medical facility. System Administrator specifies roles and access level at time of manual account creation.

2.2.3    Request New Password

If users forget their password or wish a new one, they click Request New Password on the Home Log In page. On the screen that appears, they enter their full email address that they use to sign into their account, and click Submit. Sirona subsequently sends a temporary system-generated password to the user's email address.

2.3       About Tab

Sirona currently includes four main applications, described in general terms on the About navigation tab, with more detail provided in application-specific information pages:

•  Patient Portal is a patient-focused application that improves collaboration between patients and health care professionals by providing patients with their personal medical records, a patient inbox for receiving communications, articles, and documents that educate a patient on health concerns, and other health care management tools.

•  Provider Portal similarly is focused on the professional, who needs less education. Provider Portal tools are more sophisticated, designed to facilitate the health care provider's decision-making process. Provider Portal provides clinical analytics and diagnosis tools, in addition to EMR.

•  Resource Capacity Simulator provides tools for the health care administrator to optimize the allocation of resources for treatment.

•  Clinical Decision Support (CDS) Workbench provides tools that help the enterprise expert or health care provider to write CDS rules and interact with Sirona rule engine to execute decision support.

2.3.1    Patient Portal Page

This page contains introductory information about the Patient Portal application, similar to the following: “Patient Portal is a patient-focused application that improves collaboration between patients and health care professionals by providing patients with their personal medical records, a patient inbox for receiving communications, articles, and documents that educate a patient on health concerns, and other health care management tools. Also called the Patient Medical Record component, Patient Portal enables patients to participate actively in their treatment through email and scheduling tools. It allows them to review their medical data, with item-specific supporting material appropriate for the layperson, and manage their health care much as they now manage their business affairs through other online resources. It provides patients with tools to exchange emails with their providers, receive recommendations and alerts related to their care, and complete the tasks requested by their health care provider team. Sirona decision support and workflow capabilities provide additional personalized services and guide patients in making better choices about their health and well-being. As informed partners collaborating dynamically with their health care providers, patients have the opportunity to engage fully in a lifelong educational program that empowers them to control their own health care actively.”

2.3.2    Provider Portal Page

This page contains introductory information about the Provider Portal application, similar to the following: "Provider Portal similarly is focused on the professional, who needs less education. Provider Portal tools are more sophisticated, designed to facilitate the health care provider's decision-making process. Provider Portal provides clinical analytics and diagnosis tools, in addition to EMR. Through the Provider Portal web-based user interface, health care professionals manage their patients’ care and to collaborate with patients in deciding the best course of treatment. Provider Portal provides a wealth of advanced, state-of-the- art tools that support health care professionals in risk assessment, disease probability analysis and diagnosis, and creation of rules and workflows to store in the rule engine for clinical decision support. This version of the product focuses on improving health care outcomes for patients diagnosed with PTSD.

Provider Portal provides clinical analytics and predictive models to support the clinician's decision-making process in managing risk, diagnosing, and treating patients. Sirona, via its rule engines, decides what to do, its dynamic and iterative diagnostic capabilities automate the needed tasks, and its notification capabilities communicate with patients and providers to result in the most efficient and timely use of resources."

2.3.3    Resource Capacity Simulator Page

This page contains introductory information about the Resource Capacity Simulator application, similar to the following:

"The Resource Capacity Simulator provides tools for the health care administrator to optimize the allocation of re- sources for treatment. It helps health care administrators to predict the number of new cases of a particular disease to expect when a specified population deploys. The application determines the maximum number of patients that the cur- rent health care facility resources can accommodate, based on definitions contained in a specified constraint set. The Resource Capacity Simulator adjusts schedule, resources, and other variables to provide the best recommendation for resource allocation, including staff, hospital beds, and equipment. It determines additional resources required to care for new patients after available resources have been optimized. This version of the product focuses on optimizing re- sources in the treatment of post-traumatic stress disorder (PTSD)."

2.4.4    CDS Workbench Page (Future Addition)

A future version of Sirona incorporates the Clinical Decision Support Workbench, which is currently a standalone application. Once integrated, a page with introductory information about the workbench will include text similar to the following:

"The Clinical Decision Support (CDS) Workbench provides tools that help the enterprise domain expert or health care provider to write CDS rules and interact with the Sirona rule engine to execute decision support. This web-based Sirona interface provides the clinical domain expert and other authenticated health care professionals with an intuitive graphical tool to author knowledge modules containing rules, guidelines, and other logic. Once created, this logic can be saved along with its defining metadata to the knowledge module repository to allow a diverse community of medical groups or individuals to share their expertise and standards of excellence with others."

2.4       Medical News Tab

The Medical News navigation tab provides ready access to general and summary information on fitness, exercise, nutrition and other topics, allowing Sirona to guide and inform patients about topics important to well being and recovery. Patients may select topic-specific pages to access detailed information in each area. The goal is to provide a holistic approach to educating patients and providers.

2.4.1    Wellness Page

The Wellness detail page provides patients and health care professionals with resources and services that in- spire physical, social, and psychological health. On this page, users find articles on physical wellness and how to achieve and maintain it through better hygiene, sleep patterns, and environmental safety. This page addresses social and psychological wellness, including educational information on stress management, building friendships and social alliances, and problem-solving and time management skills. It also lists educational programs and services available in neighborhood centers or at medical facilities. Information on education classes and services might include volunteer groups, behavioral health specialists, animal therapy programs, and social networking organizations. All articles include publishing dates. Available services and classes are described with location and schedule information.

2.4.2    Exercise & Fitness Page

The Exercise and Fitness detail page provides articles on the latest in exercise and fitness news. Articles support the user in beginning an exercise program and maintaining fitness while limiting risk of injury. This page lists educational programs and services available in the vicinity or at medical facilities. Popular educational and article topics might include Back Pain and Stretching, Dog-Walking and Fitness, Cardiovascular Training Through Community Sports, and Dance and Fitness. Services might include local gyms, yoga centers, physical therapists, personal trainers, walking clubs, and community centers offering enjoyable classes and activities. All articles include publishing dates. Available services and classes are described with location and schedule information.

2.4.3    Diet & Nutrition Page

The Diet and Nutrition detail page provides the latest news on diet and nutrition and how they impact the development of major diseases such as diabetes, high blood pressure, and cancer. This page lists educational programs and services available in neighborhood centers or at medical facilities. Popular educational and article topics might include Foods and Supplements to Reduce Depression, Healthy Diets for Weight Loss, Gluten-Free Cooking, Diet for Improved Energy and Motivation, Effects of Alcohol on Health, and Managing Low Blood Sugar. Local services might include nutritionists, dieticians, health food stores, alternative medicine, and support groups for weight loss or gain and addictive substance behaviors. All articles include publishing dates. Available services and classes are described with location and schedule information.

2.4.4    Your Provider Page

The Your Provider detail page contains background information on the providers available at the medical facility, their areas of specialization and subspecialties, and the services that they provide. This page also includes the programs and services offered at the medical facility.

2.4.5    Family Page

The Family detail page provides articles related to building strong family ties, and involving all family members in the creation of wellness in the family. This page addresses the challenges that family members manage when one member is physically ill, or suffering from mental and psychological stress and lists educational programs and services available n neighborhood centers or at medical facilities. Popular educational topics might include Health Issues of Caregivers, When Your Loved One Returns From Deployment, How to Integrate Back Into the Family After Deployment, and the Importance of Family Life in Health. Family services might include family therapists and child counselors, community centers offering family activities, after-school programs for children, support services at local churches, and 12-step support groups. All articles include publishing dates. Available services and classes are described with location and schedule information.

2.4.6    Veterans Page

The Veterans detail page provides articles that help returning veterans adjust to civilian life and reintegrate with their loved ones and community. Articles on this page might cover topics such as Reintegration Into Civilian Life, Returning Veterans and the Job Market, Managing Mixed Feelings Upon Educational Re- Entry, and Physical and Emotional Challenges of Returning Vets. This page also describes the services available to returning military personnel, including financial aid, special programs, educational re-entry, and support in many areas of daily living. These services are available at the medical facility, in the local community, at the Veterans Administration, and other appropriate venues. All articles include publishing dates. Available services and classes are described with location and schedule information.

2.5       Navigation Footer

The Sirona Navigation Footer displayed at the bottom of the portal for unauthenticated users provides access to the functionality available in the Log In, About, and Medical News tab navigation bar. It also pro- vides additional, less commonly accessed information. The Support/Help component provides various ways of getting answers to the questions that patients and providers may have. A Getting Started feature includes frequently asked questions and their answers; a Preferences feature provides a way to configure and personalize the portal experience; a Feedback tool allows users to contact the proper personnel and provide feed- back on their experience of the product.

As with all organizations and products, information on terms of service, copyright, security, and privacy must be provided to users. The Sirona Legal/Security feature provides this information. Finally, the Sirona Site Navigation Footer provides a Contact Us page with company contact information.

2.5.1    Get Started Page

The Get Started page of the Support/Help feature provides some introductory tips to using the Unified Collaboration Portal and answers frequently asked questions, including how to get account, who might find Sirona helpful, and how health is achieved collaboratively within a patient and provider team.

2.5.2    Preferences Page

The Preferences page of the Support/Help feature provides ideas about how the user can personalize his or her experience of the Unified Collaboration Portal. This page is available only after a user has logged in.

2.5.3    Help Page

The Help page of the Support/Help feature shows how to search through the broad base of Sirona help topics. This page provides a Search field that allows the user to enter help keywords. A Search Results box displays the resulting information available on the specified topic.

2.5.4    Feedback Page

The Feedback page of the Support/Help feature shows how to submit written suggestions and comments to Sirona support. On this page, authenticated or unauthenticated users can enter their email address in the specified field and then write their suggestions or comments in the text box provided. A Submit button sends the information to Sirona Support.

2.5.5    Terms of Service Page

The Terms of Service page of the Legal/Security feature provides a text description of the conditions governing use of the Sirona website. This page gives information about site content and how users are and are not permitted to use it. The conditions described on the Terms of Service page address how to protect the site and sets the expectations for user participation.

2.5.6    Privacy Policy Page

The Privacy page of the Legal/Security feature provides the Sirona privacy practices, including policies on information collection, use, and sharing, as well as access to and control over information.

2.5.7    Copyright Page

The Copyright page of the Legal/Security feature Sirona provides the year(s) of deployment of the Sirona system and includes the name of the owner of the copyright, not necessarily the author or creators of the system. It includes the conditions under which parts of the Sirona site can be copied and used in various environments and how to acknowledge the legal owner of the copyright and the Sirona creators.

2.5.8    Security Page

The Security page of the Legal/Security feature describes the precautions taken to protect information and prevent unauthorized access to the Sirona system. It describes how links to other websites and cookies are managed to protect the personal information that a user may provide.

2.5.9    Contact Us Page

The Contact Us page of the Sirona website contains public contact information for the medical facility's public facilitators, patient representatives, legal department, and portal administrative help and support teams, including street addresses, phone numbers, and email addresses. This page provides the capability to determine public email addresses, street addresses, and phone numbers for common services.

3.0       Patient Portal

The Patient Portal application provides additional web-based functionality for authenticated patients.

Patient Portal continues the general education that the patient began with the UCP Navigation tool. It allows patients to review their medical data, with item-specific supporting material appropriate for the layperson, and manage their health care much as they now manage their business affairs through other online resources. It provides patients with tools to exchange emails with their providers, receive recommendations and alerts related to their care, and complete the tasks requested by their health care provider team. Sirona decision support and workflow capabilities provide additional personalized services and guide patients in making better choices about their health and well being. As informed partners collaborating dynamically with their health care providers, patients have the opportunity to engage fully in a lifelong educational program that empowers them to control their own health care.

3.1       Patient Application Menu

The Portal Application Menu provides access to functionality within the portal. It is common to both the Patient Portal and the Provider Portal described in Section 4. User role and privilege defines the degree and depth of each portal capability. Access to the following general functions is provided:

3.2       Organizer

Patient Portal provides patients with several organizational aides that help them manage their health-related tasks and remain accountable to the health care team to which they belong.

•  Messages provides general emailing functionality, the ability to receive and respond to CDS alerts, and to request NwHIN documents.

•  Calendar allows the patient to view and change medical appointments using a standard calendar tool that lays out the month and its commitments. This feature also allows the patient to learn the available education times and learn details on the curriculum of all education classes.

•  Contacts provides the medical address book, a directory of contact information for health care entities committed to the progress of the authenticated patient.

•  Personal Info contains the database of information on a patient's circle of family and legal support and contains information that the patient has provided the medical facility.

Each of these organizing tools is described in detail in the subsections below.

3.2.1    Messages

The Unified Collaboration Portal platform uses the Universal Inbox as its mailbox. The Universal Inbox is similar to other well-known email clients, and is able to manage more than just email. In the current version of Sirona, messages include CDS alerts, with or without associated tasks, or NwHIN documents from other health care organizations. The Universal Inbox is used to display and manage patient and provider messages throughout the Unified Collaboration Portal. In Provider Portal, two inboxes are available to a provider: a Desktop Inbox for messages sent directly to or from the provider, and an EMR inbox, for messages sent to or from a selected patient to health care providers contributing to his or her care. In Patient Portal, only one mailbox is supported, the Messages Inbox; it provides a patient with a dedicated client for communicating only with their health care providers.

3.2.1.1 Email

The Messages Inbox can receive standard email correspondence and alerts from contacts listed in the Medical Address Book accessed via Organizer > Contacts, described later.

3.2.1.2 Alerts

The Messages Inbox can display alerts. An alert is any message that the Clinical Decision Support system sends, and can be a simple notification of information of interest, or an important reminder to complete a survey or schedule a visit with the patient's Primary Care Manager. An Alert may be associated with a task that the patient is asked to perform; common tasks include scheduling appointments, filling out surveys, and delivering documents. Alerts can have different priority levels, currently the following: Normal, HIGH, or Critical.

Because Sirona emphasizes collaboration between patient and provider, Inbox alerts may ask a patient to perform associated tasks. Tasks include scheduling appointments, filling out surveys, and delivering documents. As timely completion of tasks is critical to the collaborative delivery of health care services, the Universal Inbox provides a mechanism for completing these tasks from within the tool, allowing patients to respond to, discard, or reject an alert message. Sirona then sends the patient's decision or response to the appropriate provider or system responsible for executing the task.

3.2.1.3 NwHIN Documents

To ensure patients have access to all their health information, regardless of the custodial organization, patients can request that NwHIN Summary of Care documents be forwarded to them. NwHIN provides standards, services, and policies enabling health information exchange over the Internet and provides the security the confidentiality required for the transfer of medical information. Sirona provides the capability of broadcasting a patient request to all NwHIN affiliated institutions and automatically submits document requests to any facility with new data not previously downloaded. Through the Sirona Patient Portal inter- face, patients and providers can request that NwHIN send pertinent documentation to them, receive them in their Inbox, and review them. A copy of that document is automatically included in the patient's Sirona Medical Record.

Currently, this document is self-contained. Future iterations of the tool will parse the in- formation and seamlessly integrate it with the local organization's data into a single comprehensive view so that distributed health information can be aggregated and is readily available for clinical decision making. Sirona also sends the received document to its rule engine for analysis.

3.2.2    Calendar

Calendars in the patient Organizer help patients keep track of their medical appointments, such as checkups with their Primary Care Manager, consults with medical specialists, and their scheduled diagnostic tests. Each patient has a medical calendar that aggregates all his or her booked appointments throughout the system, regardless of clinic or specialty. This integrated view ensures that they have a comprehensive collection of all their scheduled clinic visits. In addition, the patient may elect to register any iCal-based (for example, Google) personal calendar with the Sirona portal and automatically import their private appointments into their Organizer. These calendars can be individually viewed or super-imposed on top of their medical calendar, thereby ensuring that they can efficiently review both their private and clinical obligations. In addition to standard booked appointments, Sirona can display a configurable list of general calendars such as the schedule for available education classes, common screening services, or meetings of community interest.

The Sirona calendars are currently read only. Future versions allow patients to book or reschedule appointments. The standard calendars also are supplemented by additional schedules exposed by the CDS engine. Based on patient diagnoses, consult orders, and so on, additional calendars might be appropriate for a given patient. For example, if a patient has an un-booked neurology consult request, the CDS engine can make the clinic's open appointment schedule visible to patients, allowing them to book a convenient time slot themselves. Once the order is booked, the view is automatically removed, and the booked appointment is displayed in the patient's standard medical calendar.  Rule-based calendar exposure ensures a highly individualized and personal patient experience, while at the same time providing for the appropriate degree of control by the responsible clinic.

3.2.3    Contacts

The Contacts option of the Organizer menu provides a Medical Address Book for patients. The Contacts list includes the title, first and last names, and organizational affiliation of every health care professional that have contributed to the patient's recent medical care. Patients can search for a health care contact, select one, review public telephone numbers, and send a corresponding email if desired, among other functions. To maintain an accurate and useful list of the health care professionals involved in the patient's treatment, while not exposing contact information unnecessarily, Sirona does not allow patients to delete, add, or change entries in their Contacts list. Instead, Sirona always displays the current Primary Care Manager, the contact information of any provider seen within the past two years, and will automatically include information for any provider with which the patient has a future booked appointment; Sirona automatically re- moves that entry if the appointment is subsequently cancelled or the patient does not keep the appointment. Patients can access the Contacts medical address book through the Organizer menu or when composing email in the Messages Inbox tool.

3.2.4    Personal Info

The Personal Info option of the Organizer menu allows patients to provide demographic information to their health care provider and update it, when necessary. The organization's subsequent processing and validation of this information is not specifically configured in Sirona, but can be managed by the Rule and Workflow engines as appropriate for each facility. This information includes photos and demographic information, data on members of the family, emergency contact information, HIPAA releases, powers of attorney, and address and contact information.

3.3       Medical Records

The Patient Portal provides authenticated patients access to their entire medical record created and stored by their primary health care organization. It includes information on admissions, allergies, documentation and encounters, immunizations, medications, problems, vital signs, and diagnostic test results. PMR pro- vides exactly the same information that is accessible to the patient's health care professionals, who access the patient record through the Electronic Medical Record (EMR) in the Provider Portal.

The Sirona PMR module provides valuable health care education content integrated directly into the portal. When a patient is reviewing a lab, for example, they can optionally access additional information on the test, how it is done, and what the results may mean. Most of the information is textual, although the system can optionally include images, podcasts, and videos related to the topic if the organization has the appropriate license. This integrated information capability is called the Educational Content Service and is optimally configured to display its information in the user-specified language and reading level.

3.3.1    General Functionality

The following subsections describe the general and specific display requirements for the main medical record modules supported by Sirona, including Admissions, Allergies, Demographics, Documentation (including encounters), Immunizations, Medications, Problems, Results, and Vital Signs.

3.3.2    Admissions

The Admissions Module of the medical record contains the patient's history of admissions into the hospital. This record includes admitting and discharge dates, admitting, discharge, and follow-up doctors, diagnosis, and data source (organization) providing the information.

3.3.3    Allergies

The Allergies Module of the medical record contains the patient's history of allergies and drug sensitivities. This record includes the allergy or intolerance conditions, severity, and any associated adverse conditions that the patient has experienced. An adverse condition might be in relation to food, medication, environment, or a product.

3.3.4    Documents

The Documents Module of the medical record includes documents related to encounters and interactions between the patient and health care providers. Interactions include in-person visits and other forms of communication, such as faxes or telephone consults (Telcons). This module might also include copies of consents, advanced directives, progress notes, summaries of communications, letters and other documents related to the treatment of the patient, such as the existence of a living will, health care proxies, and CPR and resuscitation status.

3.3.5    Immunizations

The Immunizations Module of the medical record provides a history of the patient's immunizations, and whether the patient was offered but refused a specific vaccine. Data include vaccine name, date and time of administration, facility, administering provider, dosage, dose number, any reactions, date to re-administer, lot number, route and anatomic site of administration. This module also includes educational content on the vaccine and the diseases that the immunization is intended to prevent.

3.4.6    Medications

The Medications Module of the medical record contains information on the prescription and non-prescription medications that the patient is now taking or has taken in the past and educational content on the medication and its side effects. It includes a history of prescriptions, fulfillment, and medication administration activities, such as locations where the prescriptions were filled and the managing pharmacist. Side effects noted might include reactions to medications, such as rash, nausea, or increased heart rate.

3.4.7    Problems

The Problems Module of the record contains information on relevant clinical problems, complaints, and conditions for which the patient is receiving care. Data include onset, severity, and names of providers treating the problem. This module also includes educational content on each disease, its treatment, prevention, and long-term outcomes.

3.4.8    Results

The Results Module of the medical record contains the results of the laboratory and other diagnostic tests performed on the patient. Test data are organized according to micro, cytology, pathology, imaging, surgical, and procedures, among others. This module of the medical record reports historical and current result observations for the patient and also includes educational content on each test, risks, and so on.

3.4.9    Vital Signs

The Vital Signs module of the medical record contains historical and current data on vital signs for the patient. Vital signs are considered a subset of results, but are displayed separately to follow the clinical conventions of the medical facility recording them. Clinical context determines the vital signs recorded, which include temperature, height, weight, blood pressure, and so on.

4.0    Provider Portal

The Provider Portal application provides a web-based user interface that health care professionals use to manage their patients’ care and to collaborate with patients in deciding the best course of treatment. In addition to standard EMR functionality, the Provider Portal provides a wealth of advanced, state-of-the-art tools that support the clinician's decision-making process in managing risk, diagnosis, and treatment. Although this version of the product focuses on improving health care outcomes for patients diagnosed with PTSD, the Sirona platform provides generalized capabilities that are equally applicable to other diseases and conditions.

4.1       Portal Navigation Menu

The Portal Navigation Menu provides access to individual applications within the portal. It is common to both the Provider Portal and the Patient Portal described in Section 3. User role and privileges define what tabs are visible for a given user. The navigation tabs for a fully-privileged provider include the following:

•  Desktop

•  Patient Records

•  Simulator

•  Workbench (future version)

Note: The Resource Capacity Simulator and the Clinical Decision Support Workbench are advanced stand- alone clinical decision support and resource optimization tools accessed from the Provider Portal interface and described in other documents.

4.2       Provider Desktop

Provider Portal Desktop provides health care providers with several organizational aides that help them manage their health-related tasks and remain accountable to the health care team to which they belong:

•  Messages provides general emailing functionality and the ability to receive and respond to CDS alerts.

•  Calendar allows the provider to view and change medical and personal appointments using a standard calendar tool that lays out the month and its commitments.

•  Contacts provides the personal address book and a complete directory of contact information for all organizational entities.

•  Personal Info contains the database of information on a provider's circle of family and legal support and contains information that the provider has at the medical facility.

Each of these tools is accessible form the Organizer Menu and is described in detail in the subsections below.

4.2.1    Messages

The Provider Desktop Organizer uses the Universal Inbox as its mailbox that can be access by the link Messages in the Desktop navigation menu. It is similar to other well-known email clients, but manages more than email. In the current version of Sirona, messages can be also be CDS alerts, with or without associated tasks, or NwHIN documents from other health care organizations.

The following figure shows how health care professionals access their Organizer Messages from the

Provider Desktop:

4.2.2    Email

The Desktop Inbox can receive standard email correspondence and alerts from contacts listed in the Medical Address Book accessed via Organizer > Contacts, described later. When viewing messages in the Desktop, all emails sent directly to or from the provider are displayed, regardless of the patient they concern. In contrast to the Patient Portal, the NwHIN document request functionality is not available at the desktop level and can only be accessed from within a patient record as described below.

4.2.3    Alerts

The Desktop Inbox can display alerts. An alert is any message that the Clinical Decision Support system sends, and can be a simple notification of information of interest, or an important reminder to complete a survey or schedule a visit, or review a critical lab result. An alert may be associated with a task that the provider is asked to perform. Alerts can have different priority levels, currently: Normal, Important or Critical.

Because Sirona emphasizes collaboration between patient and provider, Desktop Inbox alerts may ask a provider to perform an associated task, including scheduling appointments, filling out surveys, and reviewing critical lab results. As timely completion of tasks is critical to the collaborative delivery of health care services, the Desktop Inbox provides a mechanism for completing these tasks from within the tool, allowing providers to respond to, discard, or reject an alert message. Sirona then sends the decision or response to the appropriate system responsible for executing the task.

4.2.5    Calendar

Calendars in the Provider Desktop Organizer help providers keep track of their medical appointments. Each provider has one or more medical calendars that display all their booked appointments throughout the sys- tem, regardless of clinic or specialty. This integrated view ensures that they have a comprehensive collection of all their scheduled clinic visits. In addition, the provider may elect to register any iCal-based (such as Google) personal calendar with the Sirona portal and automatically import their private appointments into their Organizer. These calendars can be individually viewed or super-imposed on top of their medical calendar, thereby ensuring that they can efficiently review both their private and clinical obligations. In addition to standard booked appointments, Sirona can display a configurable list of general calendars such as the schedule for available education classes, common screening services, or meetings of community inter- est. The Sirona calendars are currently read only, but future versions allow providers to book or reschedule patient clinic appointments, manage clinic appointment templates for future schedules, and change appointment slot duration, type, or both. Provider or clinic rule-managed calendars can display a configurable list of general calendars, such as the schedule for available education classes, common screening services, or meetings of community interest.