Topics Letters Out Search:  
Providers may often want to send letters containing patient Assessment and Plan information to Referring Providers. Similarly, they may engage in various communication tasks with patients, Insurance Companies, and specialists, among others.

The Letters Out feature streamlines the process of generating letters efficiently by utilizing predefined templates. These templates are tailored to the current encounter, ensuring that all relevant details are readily available.

Field Descriptions:

Add: Click on this button to open a blank Letters Out screen and create a new letter.

Search: Click on this button to view all existing letters for the selected Patient. The search popup displays details of letter such as date, subject, status, and the recipient(s).

To: The dropdown list displays a selection of recipients to whom the letter can be sent. The recipients are determined based on specified conditions, which include:
  1. Referring Provider:
    1. If the Billing module is available for the clinic then the name of Referring Provider at the Billing side is displayed.
    2. If the Billing module is available for the clinic then name of the Referring Provider of the current encounter at EMR side is displayed.
    3. If the Referring Provider is not present in the encounter, then the one associated to the patient on the Patient Registration screen is displayed.
  2. Referred to Provider: Visible if there is a Referred to Provider set from the Edit Existing Encounter screen.
  3. Patient: The default value displayed in the dropdown list is the name of the currently selected patient.
  4. Others
  5. Employer: Visible if the Employer details have been entered for the Patient on the Patient Registration screen. Employer name could either be selected from the search or be added manually.
  6. Patient’s Primary Insurance: Visible if Patient’s Primary Insurance details are available on the Patient Insurance popup.
  7. Patient’s Secondary Insurance: Visible if Patient’s Secondary Insurance details are available on Insurance popup.
  8. Patient’s Tertiary Insurance: Visible if Patient’s Tertiary Insurance details are available on Insurance popup.
  9. Emergency Contact: Visible if the patient’s Emergency contact details have been entered in the system (i.e. on Patient Registration screen à section: Emergency Contact Details).
  10. Spouse/ Parent/ Legal Guardian (SPL): Visible if any of the patient’s relation details have entered in the system (from Patient Registration screen à section: Spouse/Parent/Legal Guardian details).
  11. Subscriber Primary Insurance: Visible if the name of the policy holder or Subscriber of Patient’s Primary Insurance is other than self as entered in the system via the Insurance popup.
  12. Subscriber Secondary Insurance: Visible if the name of the policy holder or Subscriber of Patient’s Secondary Insurance is other than self as entered in the system via the Insurance popup.
  13. Subscriber Tertiary Insurance: Visible if the name of the policy holder or Subscriber of Patient’s Tertiary Insurance is other than self as entered in the system via the Insurance popup.
  14. Primary Care Physician 1: Visible if the name of the first Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
  15. Primary Care Physician 2: Visible if the name of the second Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
  16. Primary Care Physician 3: Visible if the name of the third Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
  17. Primary Care Physician 4: Visible if the name of the fourth Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
  18. Primary Care Physician 5: Visible if the name of the fifth Primary Care Physician has been entered from Physician tab on the Patient Registration screen.
  19. Responsible Person: Visible if the patient’s Responsible Person entered is NOT equal to self. Responsible Person is added from the Billing tab on Patient Registration screen.
  20. Primary Insurance Attorney: Visible if the Primary Insurance of the Patient has the Attorney details entered from the Insurance popup.
  21. Secondary Insurance Attorney: Visible if the Secondary Insurance of the Patient has the Attorney details entered from the Insurance popup.
  22. Tertiary Insurance Attorney: Visible if the Tertiary Insurance of the Patient has the Attorney details entered from the Insurance popup.
  23. Primary Insurance Adjustor: Visible if the Primary Insurance of the Patient has the Adjustor details entered from the Insurance popup.
  24. Secondary Insurance Adjustor: Visible if the Secondary Insurance of the Patient has the Adjustor details entered from the Insurance popup.
  25. Tertiary Insurance Adjustor:T Visible if the Tertiary Insurance of the Patient has the Adjustor details entered from the Insurance popup.
  26. Patient Attorney: Visible if patient’s attorney’s name has been entered in the Billing Info tab on the Patient Registration screen
  27. Patient Adjustor: Visible if Patient Adjustor’s name is entered in any Case associated to the patient from the Case Management popup.
  28. Case Manager 1: Visible if the first Case Manager’s name has been added from Case Management popup.
  29. Case Manager 2: Visible if the second Case Manager’s name has been added from Case Management popup.
  30. Case Manager 3: Visible if the third Case Manager’s name has been added from Case Management popup.
  31. Rendering Provider (Billing): Visible if Billing module is ON and Rendering Provider’s details is available with Patient’s Claim details.
  32. Attending Provider (Billing): Visible if Billing module is ON and Attending Provider’s details is available on the Patient’s Registration screen.
  33. Operating Provider: Visible if Billing module is ON and the UB04 form details have Operating Provider’s name or details entered.
  34. Operating Assistant Provider 1: Visible if Billing module is ON and the UB04 form details have the first Operating Assistant Provider’s name or details entered.
  35. Operating Assistant Provider 2: Visible if Billing module is ON and the UB04 form details have the second Operating Assistant Provider’s name or details entered.
  36. Case Insurance Company: Visible if a case is present for the patient and if Insurance has been assigned to this case from the ‘Insurance/Employer/Patient’ Section on the Case Management popup.
  37. Case Insurance Attorney: Visible if an Attorney has been assigned for the case from the Case Management popup.
  38. Case Insurance Adjustor: Visible if an Adjustor’s detail has been entered for the Insurance in the case from the Case Management popup.
  39. Case Patient Attorney: Visible if an Attorney has been assigned for the patient from the Case Management popup.
  40. Case Patient Adjustor: Visible if an Adjustor’s detail has been entered for the patient in the case from the Case Management popup.
  41. Collection Agency: Visible if a Claim has been sent to a collection agency.
  42. Encounter Case Employer: Visible if a case has been assigned specifically to an Encounter via Edit Encounter.
  43. Encounter Case Employer Job: Visible if Employer Job has been associated to a case from the Insurance popup.
  44. Claim Case Employer: Visible if Employer Job has been associated to a case from the Insurance popup.
  45. Claim TPA (Third Party Agency): Visible on process of Claim having Employer details and also the third-party agency details associated (from the Employer’s TPA Master screen).
  46. Claim Employer TPA Contact: Visible if the associated TPA agency has a contact person’s name entered in records.
TOC: Select the checkbox if the user is sending the Transition of Care and it gets counted in the Health Information Exchange (Send Summary Of Care Records) measure.

SOC Req: Select the checkbox if the user is requesting for the Summary of Care and it gets counted in the Receive Incorporate measure of MU3.

Sender: Displays the Patient's Attending Provider name by default. Clicking on the Providers Search icon invokes Providers Search popup which displays all the medics with DR Type. On selecting a Provider from the popup, the selected Provider gets displayed in front of the Sender label.
Note:
  • For every new Letter on the Letters-Out screen, the Attending Provider of the last encounter is displayed as the Sender by default whereas manually selected Sender is restricted only to that particular Letter.
  • If the Sender has been changed to someone other than the Attending Provider of the last encounter and the Letter has been saved and sent, then the Search icon becomes unclickable.
Patient: Displays the Patient's name. To select another Patient, click the Patient search icon . A click on Patient Info icon: displays the selected Patient's demographic details.

DOS: This field shows the date of the encounter i.e. the date of service of the selected patient. By default, the date of the latest encounter is shown. A Select Encounter search icon is present next to the DOS field. By clicking on the Select Encounter search icon the Patient Encounter List popup gets invoked that shows the list of all the encounters of the patient (including Zero duration encounters) irrespective of their encounter status i.e. Open or Closed. If the value of the letter.use.associate.options property is set to On, the Associate Letter To icon is displayed on the Letters-Out screen instead of the DOS field. The User can click on this icon to invoke the Associate Letter To popup.

Patient Encounter List Popup: The Patient Encounter List popup displays the following columns which can be configured:
  • Date: This column shows the date of the encounter in MM DD YYYY format.
  • Type: This column shows the type of encounter including Zero duration encounter types.
  • Person: This column shows the first and last name of the provider associated with the respective encounter of the patient.
  • Reason of Visit: This column shows the reason for the visit of the patient which gets auto-populated from the reason added in the Reason field on the Start/Edit Encounter screen.
  • Status: This column shows the encounter status of the patient such as Open and Close.
  • Case No.: This column shows the Case No. associated with the encounter of the patient.
Note:
  • In order to accommodate the DOS field and the Search Encounter icon, the Sender and the Patient fields have been truncated and only 15 characters are displayed. The tooltip displays the full name of the Sender and the Patient respectively.
  • In case a letter was created for an incorrect encounter and then the User clicks on the Search Encounter icon to select the correct encounter the letter that was displayed for the previous encounter gets blanked out. The user has to now create a new letter.
  • In case an encounter is deleted then the letter sent with that DOS remains still be available under Letters Out or the Letter Search.
  • After creating the letter if another patient is selected from the Select Patient popup invoked by clicking on the Search icon in the Patient field, then the letter gets blanked out and a new letter has to be created. The Date of Service, DOS field displays the last encounter date for the selected patient.
Date: Is set to run date.

To/Cc: Select the desired option from the list i.e. either To or Cc. The first row is always saved as To.

Name, e-mail, Fax and Address: Name is a mandatory field. If the check boxes for Referring Provider or Referred to Provider or Patient were checked, these text fields are automatically populated. If one or more Medics or Patients were selected using the search button, their names along with the stored fields in the database are populated. User can also enter an adhoc name with the email and/or fax and/or address fields.

Email Type: This column displays two dropdown values: Secured and Non-Secured and is displayed only if the property, prognocis.n2n.enable is turned On from the Properties Master screen. If any of the email recipient's email address (selected either from the Email Type dropdown list, or by click of the Email icon, or entered directly in the field) is non N2N secured, then a warning message popup is displayed with the message: Sending patient health data over email is not advisable for HIPAA compliance reasons. Do you want to Continue?.

A secure email is sent from this screen only when Clinical Messaging (N2N Messaging) is turned On for the clinic and both the sender and recipient's email addresses are N2N secure. If a user (sender) selects Secure from this dropdown but enters a recipient email address which is not N2N secure in the Email Address field, then an error message popup is displayed when an attempt is made to save the letter. The message popup prompts the user to change the Email Type to Non-Secure or to enter an N2N secure email address for the recipient. The row number for the non N2N secure email address is mentioned in the message for the user to easily identify and change the email address. The letter cannot be saved and sent until the Email Type or email address is changed.

Note:: If the property mail.attachment.password.protect is turned ON, then it allows the user to send a non-secure mail in the following two ways with password protected attachment.
  • CCD Attachment: If the Email contains a CCD attachment, then the consolidated PDF and CCD files (XML and HTML files) are zipped together,and this zip file is applied a password protection and sent to the Recipient Email Address/Addresses. Once the Email is sent, a trailing Email is also fired to the respective Email address/addresses which contains a 10 character alphanumeric (first five characters are random alphabets and next five characters are random numbers) password for zipped PDF and CCD attachment along with the subject name of the previous Email for identification.
  • Other Attachment: If the Email contains attachment(s) without CCD, then the consolidated PDF file has a password protection.
Send: The checkbox Send is automatically checked for all the rows when any information (like Name, Email, Fax or Address) is entered.

Subject: Enter Subject for the Letter in this box. By default, Subject will be set to Template Name selected.

Note: When Clinical messaging is enabled in a Clinic, in the Letters-Out screen a warning is displayed, “Do NOT include private or sensitive information (PHI) in the subject line. It will be displayed in the recipient's personal non-secure email inbox”. Also, option of “Sure scripts Directory” is available to Users from wherein it is possible to select Clinical messaging recipients.

Fax Coversheet: If a coversheet template is defined in the property, bizfax.LT.coversheet.template then the option, Fax Coversheet is displayed on the Letters-Out screen and if the Fax Coversheet option is selected then the fax is sent with the coversheet else the fax is sent without the coversheet.

Status: This is set by the system as:
  • Entered: on clicking Save by a user who has been assigned entry rights only.
  • Approved on clicking Save by a user who has been assigned approval rights.
  • Sent on clicking Send.
Attach Button: Click on this button to attach additional file(s) with this letter. Checking the "Sel" Checkbox in the view, allows user to make multiple selections to be attached. On selection, the program displays a row of icons, one for each selected Document. User can click on any icon to view the contents in a pop up Or to Detach it.

Note:
  • Selecting an earlier Letter-Out, will Not select its Attachments. Fax of the letter will include all Attachments selected (provided the Letter template is PDF enabled). Letter template will be printed equal to the number of recipients.
  • Delete of the Letter will fail if it has been attached to some other Letter-Out.
  • In case CCD file is attached then it prints the HTML of CCD file along with combined single PDF; In case CCD file is attached then it downloads XML and HTML both discretely. When a User clicks on download then the CCD HTML file and CCD XML file is downloaded separately in the same folder. In case it's a non secured email and if user is attaching CCD file while sending letter then both XML and the HTML are sent discretely; In case CCD is attached while sending the letter then the HTML of CCD file (after converting to PDF) is sent.
  • If the property mail.attachment.password.protect is turned ON, then it allows the user to send a non-secure mail in the following two ways with password protected attachment:
    • CCD Attachment: If the Email contains a CCD attachment, then the consolidated PDF and CCD files (XML and HTML files) are zipped together, and this zip file is applied a password protection and sent to the Recipient Email Address/Addresses. Once the Email is sent, a trailing Email is also fired to the respective Email address/addresses which contains a 10 character alphanumeric (first five characters are random alphabets and next five characters are random numbers) password for zipped PDF and CCD attachment along with the subject name of the previous Email for identification.
    • Other Attachment: If the Email contains attachment(s) without CCD, then the consolidated PDF file has a password protection.
Billing Docs: Click on this button to attach Billing documents with this letter. This button is present only on the Letters Out screen accessed via Patient → Letters Out and visible to only those users who have been assigned the LetterBillDocs role from the User Role screen. A popup is invoked on clicking this button which has two options: Patient Ledger and Patient Statement with checkboxes for both options. Select the required type of document and click on the OK button on the popup to save the selection and close the popup or click on the CANCEL button to close the popup without saving the changes. The selected documents appear as icons between the Billing Docs button and the Set Sequence icon. The tooltip for the icon displays the type of document. On clicking the icon, a popup is invoked which displays the details of the Patient Statement or Patient Ledger documents along with two buttons: detach and close. Users can click on the detach button to delete the attached document and remove the icon for that document. On clicking the close button, the popup closes, and the user is redirected to the Letters Out screen. All the Billing documents attached via the Billing Docs button as well as EMR documents attached via Attach button are detached from the letter.

Select Tags : To add new contents at any position, move the cursor to that position and click there. Now select any Tag from the List Box. The program selects the tag, generates the relevant contents and inserts them at the cursor position. The generated contents can be a small string (like a Patient Name) or could be a multiple line string like (List of Current Medication).
The cc list and subject can be printed as part of the Letter by using special Tags.
Use [LETTER_SUBJECT] to print Subject and [LETTER_CC] to print CC.

Letter dropdown list: Displays a list of all letters for the current Patient in reverse order of date.

Append: The feature Append on the Letters- Out screen enables the user to send multiple letters at a time. Here,
  • Select a template from the list 'Letter'. This will be the default template.
  • Click on next to 'Append'.
  • A new window will display a list of the available templates, from which the user can select multiple templates by clicking on the checkboxes against each template name.
  • Click ok to append these selected templates to the default template selected from the list in 'Letter'.
  • The multiple letters are separated by Page Break in the body. The user can edit these letters.
Note:
  1. The letters would be displayed in the order that they were selected.
  2. The default template is selected fromt he list 'Letter'.
  3. If any other default template is selected, the existing contents are overwritten.
 Select Tags and Template will be disabled in case the selected Patient does not have a single encounter.

Letter Contents: The Text of the letter generated based on the template and the Tags used is shown here. The user can add / delete / change the contents. The text editor tool bar provides a wide range of functionality, with standard buttons, tool tips and functionality.
User is also allowed to save and send a letter without any content having only attachment(s) and/or Fax Coversheet. While carrying out Print, Fax, E-mail and Download operations only the Fax Coversheet and/or the attachment(s) content will be available to the User.

Send: A letter cannot be send until it is approved by the Provider. Once the letter status is ‘sent’, the user will not be allowed to edit the letter or add the attachments, but only view the attachments. If the letter is sent out to multiple people, then users are able to see multiple entries in ‘Letter To’ column of the search available on letters out screen.

save: Click on this button to save the changes of the Letter-Out screen. In order to save the letter mandatory fields such as 'To','Name' and any one of the 'Email Address/Fax/Address' is required.

delete: Click on this button to delete the letter which are in 'Sent' status. Only the user with ‘DeleteSentLetterOut’ role access will be allowed to delete the letter.

reset: Click on this button to reset the recently entered changes in the record to before it was saved.

save as: Click on this button to create a copy of the Letter with same Subject as defined for the original letter. If the original letter have some attachments then all the attachments will also be copied to the new letter. The 'save as' button is enabled after the first 'save' action on the Letter Out screen and for all users who have access rights for Letters-Out screen.

Depending on the user having Approve right for Letter out, when a copy of letter is created in Approved status, the new letter is also in the Approved status. However, if user does not have Approve right, new letter will be created with Entered status.

Action icons on Letters Out screen:

There are 5 action icons on the top right corner of the screen. These icons offer different ways of sharing the selected letters and documents from this screen via print, fax, email, download and directly on all the Portals of PrognoCIS.

Print: Click on this icon to print the selected letters. On closing the print window, the Status changes from Approved to Sent which is displayed in a hyperlink. On clicking the hyperlink, the Message Events popup is invoked that displays the Send Type as Print.

Fax: Click on this icon to fax the selected letters, ensuring that both the sender's and receiver's fax numbers are provided. If the fax number for the selected receiver is absent, an error message will appear stating: Fax number is not present for the selected receiver. After sending the fax, the status transitions from Approved to Sent, which is displayed as a hyperlink. Clicking on this hyperlink invokes the Message Events popup, which shows the Send Type as Fax.

Password protected documents cannot be sent via fax from this screen. On clicking this icon for such documents, an alert message stating: Document attached is password protected, Hence cannot fax the document. Share the encrypted document via Email is displayed.

Email: Click on this icon to email the selected Letters to the recipients (Provider, Insurance, Employers, Attorney, Adjuster etc.). If the Email Type is selected as Non-Secured, then on clicking this icon, a warning message: Sending patient health data over email is not advisable for HIPAA compliance reasons. Do you want to continue? is displayed along with the email addresses. On clicking the OK button on this popup, the recipient receives 2 emails. One contains the letters in the form of a password-protected attachment and the other contains the password to open the attachment. If the Email address of the sender/receiver is missing, then on clicking this icon, an error message, Cannot send as the Email ID of the sender/receiver is missing is displayed. On successfully sending the email, a message: Letter Sent Successfully is displayed in green and bold font on the screen, and the status changes from Approved to Sent which is displayed in a hyperlink. On clicking the hyperlink, the Message Events popup is invoked that displays the Send Type as Email.

When a secure N2N email is sent from the Letters Out screen, it first goes from the sender to SureScripts and then to the receiver. On successfully sending the email, a message: Accepted and Delivered to Surescripts. is displayed in green and bold font on the screen, and the status changes from Approved to Sent which is displayed in a hyperlink. The Message Events popup invoked on clicking on this hyperlink displays the date and timestamp at which the letter was sent in the Date Time column, the Email column remains blank (as messages are not pertaining to any email ID) and the Event Desc column displays the status of the message such as Delivered to Surescripts, Delivered to Receiver, etc. This message is updated as per the type of response received from Surescripts.

Download: Click on this icon to download the PDF of the selected letters. The downloaded letters can be found in the Downloads folder of the machine. However it also depends on the settings of the machine that’s being used. On downloading the letters, the Status changes from Approved to Send which is displayed in a hyperlink. On clicking the hyperlink, the Message Events popup is invoked that displays the Send Type as Download.

Share on Portal: On clicking this icon, Select Portal popup is invoked. This popup displays the Portal names that are configured for the client. In Front of every Portal name, a toggle button is provided. Users can turn the button On for the Portals where the selected documents need to be shared and click on the Save button on the popup to share the documents. After selecting the documents that need to be shared, it is necessary to save them by clicking on the Save button displayed at the bottom of the screen. If a User tries to share the documents without saving them, then on clicking the Share on Portal icon, “Cannot be shared to portals without saving” message is displayed. If there are no portals configured for the User, then on clicking the Share on Portal icon, the popup displays a message “Not applicable for sharing.” On successfully sharing the letters on portals, the Status changes from Approved to Send which is displayed in a hyperlink. On clicking the hyperlink, the Message Events popup is invoked that displays the Send Type as Portal.

Note: If the HylaFAX property prognocis.fax.hylafaxapi is turned On from the Properties Master screen, then the documents are sent via the HylaFAX functionality. In this case, the status of the document can be seen by clicking on the Sent hyperlink, which invokes the Status popup.

Hint:
  • When Clinical messaging is enabled in a Clinic, in the Letters-Out screen a warning is displayed, “Do NOT include private or sensitive information (PHI) in the subject line. It will be displayed in the recipient's personal non-secure email inbox”. Also, option of “Sure scripts Directory” is available to Users from wherein it is possible to select Clinical messaging recipients.
  • Consider the following conditions with regard to the CCD file:
    • In case CCD file is attached then on print, it prints the HTML of CCD file along with combined single PDF.
    • In case CCD file is attached then on download, it downloads XML and HTML both discretely. When a User clicks on download then the CCD HTML file and CCD XML file is downloaded separately in the same folder.
    • In case it's a non secured email and if user is attaching CCD file then while sending letter then both XML and the HTML are sent discretely.
    • Fax: In case CCD is attached while sending the letter then the HTML of CCD file (after converting to PDF) is sent.