Appendix E_HSWLSCTD 2021-004_MHS Genesis Procedural Guidance.pdf

HSWLSCTD 2021-004

HEALTH, SAFETY AND WORK-LIFE SERVICE CENTER TECHNICAL DIRECTIVE 2021-004

Subj: MHS GENESIS PROCEDURAL GUIDANCE

Ref: (a) Coast Guard Medical Manual, COMDTINST M6000.1 (series)

(b) Disposition of Health Records, COMDTINST 6150.4 (series)

(c) ACN 097/20 Health Record Transition to MHS GENESIS

(d) Physical Disability Evaluation System COMDTINST M1850.2 (series)

(e) Coast Guard Occupational Medicine Manual, COMDTINST M6260.32 (series)

(f) Coast Guard Periodic Health Assessment, COMDTINST 6450.3 (series)

(g) DoD Health Record Lifecycle Management, DODI 6040.45

(h) Information and Lifecycle Management Manual, COMDTINST M5212.12A

(i) Memorandum of Understanding among the DOD, VA, and U.S. Coast Guard, “Electronic

Storage, Access, and Retrieval of Military Service Treatment Records,” April 30, 2017

(j) MHS GENESIS Information Portal MilSuite Website:

https://www.milsuite.mil/book/community/spaces/mhs-genesis-mtf

(k) DHA Patient Administration Division MilSuite Website:

https://www.milsuite.mil/book/community/spaces/dha-pad

(l) Coast Guard Aviation Medical Manual, COMDTINST M6410.3 (series)

(m) Telemedicine, COMDTINST 6300.32 (series)

(n) Memorandum of Agreement between the Defense Health Agency and the Veterans Health

Administration (VHA) and the United States Coast Guard (USCG) for Accessing Health

Record Information Through the Joint Legacy Viewer,” June 15, 2017

(o) DHA Interim Procedures Memorandum 18-001, “Standard Appointing Processes, Procedures, Hours of Operation, Productivity, Performance Measures and Appointment

Types in Primary, Specialty, and Behavioral Health Care in Medical Treatment Facilities

(MTFs)”

(p) Military Health System Specific Coding Guidelines Version effective 01Jul2017 found at: https://info.health.mil/bus/brm/mcpo/SitePages/Home.aspx or https://www.milsuite.mil/book/community/spaces/dha-pad/coding-work-group

DISTRIBUTION – SDL No. 170

A

B

C

D

E

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G

H

Commanding Officer United States Coast Guard Health, Safety & Work-Life Service Center

300 E. Main Street Suite 1000 Norfolk, Va. 23510-9109 Staff Symbol: (h) Phone: (757) 628-4328 a b c d e f g h i j k l m n o p q r s t u v w x y z https://www.milsuite.mil/book/community/spaces/mhs-genesis-mtf https://www.milsuite.mil/book/community/spaces/dha-pad https://info.health.mil/bus/brm/mcpo/SitePages/Home.aspx https://www.milsuite.mil/book/community/spaces/dha-pad/coding-work-group

NON-STANDARD DISTRIBUTION:

1. PURPOSE. As per the authority in references (a) – (c), this publication provides standardized technical directives (TD) issued by the Health, Safety, and Work-Life Service Center (HSWL SC) that address the roles, responsibilities, procedures, and guidelines for Coast Guard (CG) clinics and sick-bays that have implemented the Electronic Health Record (EHR), MHS GENESIS.

2. ACTION. This TD publication applies to all the HSWL SC organizational elements at all types of

CG units. HSWL SC retains the authority to provide technical direction over all HSWL SC organizational elements. This TD is used to clarify policy that falls under the responsibilities and authorities of the HSWL SC. Internet release is authorized.

3. DIRECTIVES AFFECTED. HSWLSCTD 2020-013 MHS GENESIS Procedural Guidance is hereby cancelled.

4. DISCUSSION. The Coast Guard has joined forces with the Department of Defense (DOD) in using

MHS GENESIS, the new electronic health record for the Military Health System (MHS). MHS

GENESIS will minimize the need for paper records and allow for interoperability with DOD and

Department of Veterans Affairs (VA). MHS GENESIS connects medical and dental information across the continuum of care. Once fully deployed, MHS GENESIS will provide a modern health record for the Coast Guard’s eligible beneficiaries that facilitates care, meets records management and security requirements, and interoperates with care-giving partners, maximizing patient safety and care continuity. The health record is media neutral for Service member records and for federal civilian employee records that receive occupational health care as per reference (c). Therefore, the health record may be comprised of both electronic and paper formats that will be consolidated when required and upon disposition. All other eligible beneficiaries’ records are paper-based as per the current Records Schedule identified in reference (c), however may be maintained in an electronic format until disposed of in accordance with reference (h). All sites shall continue to manage paper records as per reference (a), (b), and (g) until such time as all paper records have been appropriately disposed of.

5. DISCLAIMER. This TD is not a substitute for applicable legal guidance, nor is it itself a rule. It is intended to provide operational guidance for CG personnel and is not intended to nor does it impose legally-binding requirements on any party outside the CG.

6. ENVIRONMENTAL ASPECT AND IMPACT CONSIDERATIONS.

a. The development of this TD and the general policies contained within it have been thoroughly reviewed by the originating office in conjunction with the Office of Environmental Management, and are categorically excluded (CE) under current USCG CE #33 from further environmental analysis, in accordance with Section 2.B.2 and Figure 2-1 of the National Environmental Policy

Act Implementing Procedures and Policy for Considering Environmental Impacts, COMDTINST

M16475.1 (series).

b. This TD will not have any of the following: significant cumulative impacts on the human environment; substantial controversy or substantial change to existing environmental conditions;

or inconsistencies with any Federal, State, or local laws or administrative determinations relating to the environment. All future specific actions resulting from the general policies in this TD must be individually evaluated for compliance with the National Environmental Policy Act (NEPA), Council on Environmental Policy NEPA Regulations at 40 CFR Parts 1500-1508, DHS and CG

NEPA policy, and compliance with all other environmental mandates.

7. DISTRIBUTION. No paper distribution will be made of this TD. An electronic version will be located on the CGPortal: https://cgportal2.uscg.mil/units/hswlsc/SitePages/Unit%20Directives.aspx.

8. PROCEDURE. See MHS GENESIS Procedural Guidance.

9. RECORDS MANAGEMENT CONSIDERATIONS. This TD has been thoroughly reviewed during the directives clearance process and it has been determined there are no further records scheduling requirements, in accordance with Federal Records Act, 44 U.S.C. 3101 et seq., National Archives and Records Administration (NARA) requirements, and the Information and Life Cycle Management

Manual, COMDTINST M5212.12 (series). This policy does not have any significant or substantial changes to existing records management requirements.

10. FORMS/REPORTS. None.

11. REQUEST FOR CHANGES. Recommendations for improvements to this TD are encouraged and should be submitted to HSWL SC (ma); 300 East Main Street; Suite 1000; Norfolk, VA 23510-

9109, D05-SMB-CGHealthRecords@uscg.mil.

P. J. KREMER

Captain, U. S. Coast Guard

Coast Guard Health, Safety, and

Work-Life Service Center mailto:D05-SMB-HSWLSC-OPMED@uscg.mil mailto:D05-SMB-CGHealthRecords@uscg.mil

Table of Contents

Chapter 1 Introduction Pg. 5

Chapter 2 Roles and Responsibilities Pg. 5

Chapter 3 MHS GENESIS System Access, Training, and Use Pg. 9

Chapter 4 Patient Administration Pg. 14

Chapter 5 Health Record Management Pg. 22

Chapter 6 Medical Pg. 28

Chapter 7 Dental Pg. 34

Chapter 8 Pharmacy Pg. 42

Chapter 9 Laboratory Pg. 44

Chapter 10 Sickbays Pg. 44

Chapter 11 Coding and Charge Services Pg. 46

Chapter 12 Communications Pg. 49

Chapter 13 Reporting Pg. 49

Encl: (1) Health Records Document and Scanning Crosswalk

(2) Paper to MHS GENESIS Health Record Transition Checklist

(3) Coding Tips

(4) Paper Record MHS GENESIS Notification Cover Sheet

MHS GENESIS PROCEDURAL GUIDANCE

CHAPTER 1. INTRODUCTION.

a. This guidance, based on the authority in reference (c), establishes standardized procedures for clinics and sickbays that have implemented MHS GENESIS (MHS GENESIS).

b. MHS GENESIS is part of the Federal Electronic Health Record Modernization project and it is an enterprise system that is standardized for all organizational users (Department of Defense

(DOD), Coast Guard (CG), and, Department of Veterans Affairs (VA)). CG Military Treatment

Facility (MTF) personnel will utilize the system analogous to that of DOD MTFs. When the term enterprise is used, it means considerations that effect all three agencies.

c. All health services personnel shall follow the MHS GENESIS guidance and workflows established by Defense Healthcare Management System Modernization (DHMSM) Program Management

Office which are populated in reference (j). Additionally staff shall follow CG-specific standardized workflows that are posted the MHS GENESIS portal site. The information in this TD is meant to provide guidance on CG specific procedures unique to CG health services operations or requirements not covered within the enterprise guidance and workflows.

d. In instances where MHS GENESIS workflows conflict with legacy policy or procedural guidance, personnel shall follow enterprise MHS GENESIS direction. If a specific MHS

GENESIS workflow conflicts with legacy CG policy/ procedural guidance such that it creates an adverse operational circumstance, staff shall request guidance from HSWL SC, via D05-SMB-

CGHealthRecords@uscg.mil, on the appropriate course of action.

e. Staff will be trained on specific elements during clinic roll-out. Lessons learned from each roll out will be incorporated in future updates of this procedural guidance.

CHAPTER 2. ROLES AND RESPONSIBILITIES.

a. COMDT (CG-112) Chief Medical Informatics Officer (CMIO).

(1) Serve as the CG representative and liaison to Defense Health Agency Health Informatics

(DHA/HI).

(2) Chair USCG Electronic Health Record (EHR) Acquisition Functional Steering Committee

(FSC).

(3) Co-chair Health Services Information Technology Configuration Control Board (IT CCB).

(4) Oversees MHS GENESIS interface with other health information technology.

(5) Oversees overall CG Health Information Systems selection and adoption.

b. Electronic Health Record Acquisition (eHRa) Program Management Office (PMO).

(1) Serve as the planning forum for all decisions required in planning, acquiring, and implementing MHS GENESIS.

(2) Serve as the integrating body representing all CG stakeholders during the acquisition mailto:CGHealthRecords@uscg.mil mailto:CGHealthRecords@uscg.mil and deployment phase.

c. Electronic Health Record Functional Steering Committee (EHR FSC).

(1) Serve as the health services functional community Health Information System (HIS)

EHR governance body that acts as the single voice to CG-11 leadership and federal partners.

(2) Shall act as the primary functional decision-making body regarding the implementation and the utilization of the Electronic Health Record and associated information systems. In this role, the FSC shall:

(a) Maintain clear and concise documentation of all functional decision requests and business process re-engineering change requests and resulting decisions (note: Electronic

Health Record Acquisition Program Management Office (eHRA PMO).

(b) Provide senior oversight and coordination of end user system utilization.

(c) Report to the eHRA PMO and/or DHA/HI any functional challenges, successes, and enterprise system change requests.

(d) Identify, manage, and ameliorate risks associated with MHS GENESIS utilization within

CG health services delivery.

d. Health Services Information Technology Control Configuration Board (IT CCB).

(1) Provides technical and administrative direction and oversight to control the functional and physical configuration characteristics of Health information technology (IT), integrated biomedical systems or sensors, and applicable support infrastructure and control changes to those characteristics, and report/record change processing and implementation.

(2) Decision-making authority for configuration approval for all Class I (affecting safety, form, fit, function, or logistics support) engineering change proposals and all critical and major deviations from baseline. The Health Services IT CCB will have change authority over the following general categories:

(3) Electronic Health Record Acquisition Program and all associated changes impacting

Coast Guard legacy IT (i.e. interfaces, helpdesk, legacy enterprise IT systems).

(4) Medical & Dental Radiology Information Technology (MDRIT).

(5) Health Services End User Devices (i.e. Standard Workstations, Printers, Barcode

Scanners, video cameras, etc.).Health Services IT Enabled Medical Devices.

(6) Clinic & Sickbay IT Infrastructure (i.e. network cable/wiring, telecom closet, local area network configuration).

e. HSWL SC.

(1) Liaison w/ eHRa PMO, C5I Health Systems Asset Line and Centralized Service Desk.

(2) Serve as voting member on the EHR FSC, IT CCB, and other governance bodies.

(3) Coordinate and update MHS GENESIS procedural guidance.

(4) Serve as the User Role Assignment Coordinator (URAC) and training liaison during sustainment. URAC are responsible for account management oversight including provisioning, modification, and account reset.

(5) Monitor and respond to policy interpretation and procedural questions via shared mailbox:

D05-SMB-CGHealthRecords@uscg.mil.

(6) Maintain MHS GENESIS functional community intranet portal site at:

https://cg.portal.uscg.mil/units/hswlsc/cg.portal.uscg.milunitshwslscmhsgenesis/SitePages/H ome.aspx.

f. HSWL Regional Practice (RP) leadership (i.e. RD, RM, SME, SDE, RPE, SIDHS). Descriptions of acronyms can be found in reference (a).

(1) Ensure adherence with MHS GENESIS guidance.

(2) Validate and submit system change requests as per established help desk workflows.

(3) Report system utilization challenges and successes to EHR FSC.

g. Health Services Administrator (HSA).

(1) Verify and validate user role assignments within the clinic’s area of responsibility, to include assigned Independent Duty Health Services (IDHS) Technicians.

(2) Assign and ensure appropriate training for at least one MHS GENESIS Super User per clinic.

(3) Ensures local compliance with MHS GENESIS use.

h. Clinic Training Coordinator. Every clinic shall assign a local site Training Coordinator (TC) to support the end-users, to include sickbay staff, under that clinic’s responsibility. The TC

(1) Local subject matter expert with regards to assignment of User Roles and associated training requirements and help-desk ticketing processes.

(2) Established local official responsible for approving all requests for training for that site. The key responsibility of this individual in support of MHS GENESIS CBT training will be to validate/endorse the USCG MHS GENESIS Access/Training Request Form, which notifies the

URAC of end users who need new or modified MHS GENESIS roles and/or permissions.

(3) With regards to instructor led training, responsible for communicating and coordinating in-processing and local computer system access status (capabilities) of end user, establishing end user’s physical training location room, training room set up and materials preparation, and ensuring training and communications needs of end users are met based on requirements of the virtual training platform.

(4) Communicate needs for supplemental training to the USCG Training Managers, URAC, and the Sustainment Training Team.

mailto:D05-SMB-CGHealthRecords@uscg.mil https://cg.portal.uscg.mil/units/hswlsc/cg.portal.uscg.milunitshwslscmhsgenesis/SitePages/Home.aspx https://cg.portal.uscg.mil/units/hswlsc/cg.portal.uscg.milunitshwslscmhsgenesis/SitePages/Home.aspx https://cg.portal.uscg.mil/units/hswlsc/cg.portal.uscg.milunitshwslscmhsgenesis/SitePages/Home.aspx

(5) With regards to Super Users, identifying super users and communicating this information to the

URACs, Government Training Manager, and Sustainment Training Team, directing end users and super users, and communicating feedback on super user performance (strengths and gaps) to Government Training Manager and Sustainment Training Team.

i. MHS GENESIS Super User. Target volume of Super Users is 1 for every 10 end users during the pilot and 1 for every 20 users during the following waves in in sustainment (post go-live). The volume of Super Users for MHS GENESIS in sustainment will be determined based on experience during the pilot phase.

(1) Maintain knowledge in the use of MHS GENESIS to facilitate the provision of expert functional support. The volume of super users will be established in future iterations of this document.

(2) Support clinical workflow review discussions, end user training, other adoption activities.

(3) Serve as the primary facilitator for site specific change management activities. Super Users are the conduit for system change information sharing between and among end users, site leadership, the eHRa PMO (during implementation) and HSWL SC.

(4) Active supporters of the new system, communicating its many benefits and encouraging end user adoption.

(5) Serve as the first point of contact for end users to answer questions and provide peer-to-peer

MHS GENESIS support.

(6) Guide personnel on training requirements required for MHS GENESIS access.

(7) Maintain familiarity and provide guidance on the process to submit functional or technical help tickets.

j. Working Groups. There are number of working groups or meetings that each Clinic must have attendance at, which include but are not limited to:

(1) End-User Work Group. Forum for clinic leaders to raise issues, work through systematic challenges, discuss standardized business processes and workflows, and gain insight on the status of initiatives.

(2) Super Users/ End User Forum. At each meeting, staff will have the chance to learn about the newest system updates, discuss workflows, see demos on advanced functionality, and work through the deeper questions with the Sustainment Trainers and peer experts. This meeting is typically held bi-monthly. The sustainment training reduces the information that is presented at the Defense Health Agency Health Informatics User Impact Series to only MHS GENESIS updates, info, and training relevant to the CG. Clinic attendees shall ensure applicable system updates are disseminated to the remainder of the clinic staff.

CHAPTER 3. MHS GENESIS SYSTEM ACCESS, TRAINING AND USE.

a. Phases of System Roll-Out.

(1) Pre-Sustainment. Prior to system go-live.

(2) Sustainment Phases. System sustainment begins at go-live.

b. User Role Assignments (URA) & Training.

(1) User Roles Selection.

(a) User Roles are based on assigned duties and responsibilities and should align with the recommendations within the User Role Trees posted on the CG MHS GENESIS functional community portal site.

(b) Assigned User Roles within MHS GENESIS do not directly correlate with scope of practice within the CG health services program. All staff must operate within their scope of practice, even if the system allows them more capability than authorized.

(2) Pre-Sustainment Phase.

(a) User Role Assignments (URA).

1) User Role Assignment (URA) is a process of collecting/validating user data and assigning MHS GENESIS role (s) to each end user in preparation for training assignment and account provisioning.

2) The USER Role Tree is an MHS GENESIS enterprise tool to ensure end-users are assigned the proper role (s). The User Role Assignment Coordinator (URAC), Training Coordinators (TC), and Leidos Partnership for Defense Health (LPDH)

Solution Architect teams will leverage the User Role Trees and account provision workflows within the MHS GENESIS Help Desk Service Level Agreement (SLA) to collect appropriate data. The User Role Trees and MHS GENESIS Help Desk SLA workflows can be accessed via the HSWL SC MHS GENESIS portal site.

3) Vector (SharePoint) is a web-based collaborative document and data management system that integrates with Microsoft Office applications. It is the tool that LPDH utilizes to coordinate deployment related documents and actions, to include pre-sustainment URA.

(b) Training Requirements. MHS GENESIS training will include, but is not limited to, Joint

Knowledge Online (JKO) Computer Based Training (CBT), Just in Time Training

(JITT), and one-on-one training provided by clinic Super Users and/or Training

Coordinators.

1) Joint Knowledge Online (JKO) Computer Based Training (CBT) end user assignments will occur during the URAC coordination process.

2) Just in Time Training (JITT).

a. One-on-one or two-on-one personalized training sessions with LPDH Trainers in a Training Domain environment.

b. JITT sessions range between 1-4 hours each.

c. While existing DOD agendas and practice activities are utilized, there will be opportunities for future customization of certain processes and training to support

CG workflows. Staff shall forward feedback to clinic TC who will then forward to sustainment trainers via D05-SMB-HSWLSC-GenesisTraining@uscg.mil.

d. CBTs must be completed prior to attending JITT.

e. Completion of JITT requires 80% or higher score on 500 level JKO competency.

This is required in order to receive access to MHS GENESIS. If the End User receives lower than an 80%, ONLY the questions they miss are reviewed. If they still are below 80% then the End User will again ONLY take the questions they got wrong. If they are still below 80%, the Training Coordinator will work with eHRa PMO Training and Deployment Lead to identify what type of remediation is required.

f. Upon completion user will be certified for their MHS GENESIS role(s) and obtain Go-Live provisioning.

g. JITT includes completion of sign-on and favorites checklists.

h. End users with incomplete JITT training will not have access to MHS GENESIS.

(3) Sustainment.

(a) Staff will follow the workflow guidance in MHS GENESIS Help Desk SLA which can be found on HSWL SC MHS GENESIS portal site. These workflows include all user access management functions, such as account provisioning, account changes, and account suspension/de-activation. Access to MHS GENESIS is Common Access Card

(CAC) enabled, thus any general CAC system access issues will prevent an end user from accessing MHS GENESIS.

1) Account provisioning and changes.

a. End user shall work with the site Super User or TC and use of the User Role

Trees to identify and request necessary user roles.

b. End user completes the account provisioning form and gets local supervisory approval. The completed form is then submitted to the HSWL SC URAC via email: D05-SMB-HSWLSC-GenesisTraining@uscg.mil. The URAC will coordinate provision with the MHS GENESIS Global Services Center (GSC) and will communicate directly back to the end user upon provisioning. The sustainment training team will assign necessary CBTs within JKO for completion based on the requested user roles. Once CBT are completed, Sustainment Trainers will complete JITT training within the end user which will then enable access to the system.

mailto:D05-SMB-HSWLSC-GenesisTraining@uscg.mil

2) Account deactivation/suspensions. To correct MHS GENESIS deactivations or suspensions email the HSWL SC URAC: D05-SMB-HSWLSC-

GenesisTraining@uscg.mil who will coordinate resolution with the MHS

GENESIS GSC.

(b) Training. Training requirements for accessing the system in sustainment are the same as that for pre-sustainment, CBT and JITT. Sustainment training team will have appropriate access in JKO to assign required CBTs. Sustainment training team will be engage to schedule JITT training when an end-user’s CBT trainings are completed. Requests for training in sustainment will be submitted to: D05-SMB-HSWLSC-

GenesisTraining@uscg.mil. The sustainment training team also provides ad-hoc, recurring, and episodic training on system-related subject matter. Additional information regarding MHS GENESIS sustainment training can be found at:

https://cg.portal.uscg.mil/units/hswlsc/cg.portal.uscg.milunitshwslscmhsgenesis/mhsgene sistraining/SitePages/Home.aspx . This sustainment training plan, found at the portal site, goes into great detail about sustainment training availability. In addition, if a end-users is unsure where to go with an issue they should follow the below process:

1) Contact a super user who shall assist in identifying the problem and resolving if able.

2) If the end-user is the super user or the super user needs assistance, contact the sustainment training team. There are many ways to contact the sustainment trainer.

MHS GENESIS functional community portal site has information on how to contact the sustainment training team or an email can be sent to D05-SMB-HSWLSC-

GenesisTraining@uscg.mil.

3) Lastly, go to CG FIX IT and create a training help ticket.

(4) Individual Access Audit. During the fourth quarter of each calendar year, the URAC will utilize available account metrics to verify users’ need for system access.

c. Help Desk.

(1) To submit information technology (IT) or system functionality help tickets, users will contact the CG Centralized Services Desk either via telephone or the CGFIXIT desktop icon. The

CSD will follow guidance in the Service Level Agreement (SLA) MHS-G Help Desk

Services to resolve functional, hardware, network, and change management issues.

(2) Each clinic shall designate a help desk ticket coordinator to assist applicable Defense

Medical Information System (DMIS) Identifier assigned end-users in ticket resolution. This coordinator should submit tickets on behalf of site staff in order to assist in resolving tickets and to ensure help desk staff have an available point of contact to work towards resolution when the end-user is not available. The ticket coordinator should ensure that the end-user’s name is clearly annotated in the comments section of the ticket as an alternate point of contact. The coordinator should establish a ticket tracker in order that contains includes the applicable end user, date submitted, CG Fix It Ticket Number, DHA Ticket Number, issue, and comments.

d. MHS GENESIS Down-Time.

mailto:D05-SMB-HSWLSC-GenesisTraining@uscg.mil mailto:D05-SMB-HSWLSC-GenesisTraining@uscg.mil mailto:D05-SMB-HSWLSC-GenesisTraining@uscg.mil mailto:D05-SMB-HSWLSC-GenesisTraining@uscg.mil https://cg.portal.uscg.mil/units/hswlsc/cg.portal.uscg.milunitshwslscmhsgenesis/mhsgenesistraining/SitePages/Home.aspx https://cg.portal.uscg.mil/units/hswlsc/cg.portal.uscg.milunitshwslscmhsgenesis/mhsgenesistraining/SitePages/Home.aspx

(1) Notifications. Scheduled system performance issues or downtime will be populated on the

DHMSM Communications and Web Development maintained MHS GENESIS Information

Portal, select “View the Release Calendar” in top section of home page or, go to https://www.milsuite.mil/book/docs/DOC-783272. Each clinic has its own notifications shared mailbox; end users shall be identified to monitor said shared mailbox and forward applicable notifications.

(2) Patient care shall be documented on standardized paper forms. Most authorized forms are found in reference (a) and (b). Specific forms applicable to contract partners, such as the contracted reference laboratory, will be posted on the MHS GENESIS portal site, Laboratory Director’s portal site, and/or other applicable site.

(3) All documents shall be scanned and uploaded into the appropriate individual encounter(s) and within the scheduled encounter, if applicable, in MHS GENESIS within 72 business hours of system availability. Providers shall complete and sign legacy paper forms, finalize

MHS GENESIS documentation with orders and coding (i.e. Dx, CPT, E&M) and sign the

MHS GENESIS encounter. Specific guidance is below:

(a) If downtime is less than one hour, clinic staff will backload data into MHS GENESIS by typing in documentation analogous to procedures as if there was no system down-time.

If downtime is greater than one hour, all paper documents shall be scanned into MHS

GENESIS.

1) Each department shall ensure paper documentation is on-hand at all times to include, at a minimum, paper encounter notes (e.g. SF600/SF603), forms and labels for specimen collection/specimen labels, and forms and paper labels for Pharmacy prescriptions.

2) Each site shall identify responsible staff for back loading data and scanning documentation into MHS GENESIS and ensuring signature/co-signature by the responsible clinician.

3) Encounters. All scheduled appointment will be checked in once the downtime is resolved. Utilize encounters associated with scheduled appointment for entering documentation and orders into MHS GENESIS. All encounters not previously scheduled can be entered as walk-in encounters. Note: Encounters generate a

PreReg Financial Identification Number (FIN) 10 days prior to patient’s scheduled appointment. If downtime occurs, these scheduled appointments should be checked-in to ensure all documentation stays within the previously associated FIN tied to the scheduled appointment.

4) Orders. All orders must be entered into applicable MHS GENESIS encounters once the system is operational.

a. Laboratory. Clinicians shall forward a copy of the encounter note with laboratory orders, or a LabCorp Downtime Order/Results Requisition (once developed), to the Laboratory Technicians. For specific labeling, ordering, and processing requirements, staff shall seek the latest guidance at the HSWL SC (om) https://www.milsuite.mil/book/docs/DOC-783272

Laboratory Directors portal site:

https://cg.portal.uscg.mil/units/hswlsc/OpMed/Laboratory/Forms/AllItems.aspx.

1. In-house labs. Once downtime is resolved, all laboratory orders and results shall be entered into MHS GENESIS.

2. Reference laboratory labs. For non-urgent testing, it is recommended to wait until the next business day to begin manually processing specimens to allow a buffer of time to maximize opportunity to process electronically within the system. For urgent testing or testing when the system has been down more than one business day, technicians shall process and package specimens utilizing either reference laboratory web-based portal site labels and EDI packing list or, if the internet is down, manual labels, order request form, and packing list with site-specific account number (unique to each site). Reference laboratory will manually access the specimens using the EDI packing list and manually push the results through the EDI accounts once downtime is resolved. Note: Reference laboratory offers a web- based orders/results product, which USCG clients with a contract will have access to accounts for order/result capability as well as training.

b. Radiology. Clinicians shall submit paper orders to clinic-based x-ray technicians.

Technicians shall continue to submit x-rays to tele-radiology contractor via the direct internet connection into tele-radiology web-based interface. Technicians shall log into tele-radiology interface to retrieve the radiology reads. Once downtime is resolved, Radiology orders and reports received during downtime are entered into MHS GENESIS.

c. Pharmacy. Clinicians shall forward a copy of the encounter note with medication orders to the Pharmacy. Pharmacy will then generate an ad-hoc label consistent with current federal law and, once the downtime is resolved, medications dispensed to patients shall be entered into MHS GENESIS’s Med Manager Retail application. Note: Regional Pharmacy Executive may recommend transition to paper prescriptions for fill at TRICARE network pharmacies, if indicated.

d. Referrals. Most referrals processing can be delayed until the system is back up and the encounter documentation has been entered into MHS GENESIS as per procedures above. Referral Management Coordinators shall only manually enter referrals into the Managed Care Support Contractor’s (MCSC) government services portal or via fax/phone for urgent/emergent referrals that cannot be delayed. For these referrals, the orders and associated documentation shall be subsequently entered into MHS GENESIS to ensure proper referral tracking within the Referral Management worklist.

(4) Staff shall develop procedures to ensure visibility of appointment schedules in the event the system goes down, i.e. screen shot or print to file the next days and weeks schedules at the end of each day, and on Friday for the following week, and save in common drive or print hard copy for posting.

e. Training Materials – CG has developed a document titled MHS GENESIS Playbook, which https://cg.portal.uscg.mil/units/hswlsc/OpMed/Laboratory/Forms/AllItems.aspx includes CG-specific supplemental training content, various request forms, quick reference cards, diagrams, workflows, job aides, tip sheets, user guides, etc. This document, as well as other guiding materials, is posted at the MHS GENESIS functional community portal site identified in 2.e (6). This guidance is intended to supplement the materials promulgated by

Defense Health Agency, posted at reference (k). CG-specific guidance shall be approved by the EHR FSC prior to promulgation/posting.

CHAPTER 4. PATIENT ADMINISTRATION.

a. Registration. Generally staff shall follow the MHS GENESIS Patient Administration Division

(PAD) 1.0 Patient Registration Guide/ Standard Operating Procedure which is located at reference

(j) and/or (k).

(1) Initial system registration. Patients only need to be registered once in the enterprise

MHS GENESIS system. Staff shall verify enrollment and any identified patient registration duplicates must be resolved by contacting the helpdesk who will work with MHS GENESIS Global Service Center (GSC) to correct. Initial registration is completed prior to scheduling an encounter, at the time of admission, or at intake.

Prior to MHS GENESIS go-live, the eHRa PMO will work with partners to batch auto-register (BAR) both direct enrollees and the indirect active duty and select reserve clinic empanelment as per the current Clinic Unit Responsibility List which establishes the mapping between the unit’s Department ID to a clinic. Local clinic registration and/or sickbay staff will have to manually register any patients not already in the system. During this manual registration, the staff shall also create a

Lifetime Pharmacy Encounter (LPE), which is required prior to Providers placing new prescription orders. MHS GENESIS interfaces in real-time with the Defense

Eligibility Enrollment Reporting System (DEERS). Staff shall follow the MHS

GENESIS Patient Registration Guide found at reference (j). If clinic staff register a patient in the system that cannot be found in DEERS (and should be in DEERS), the clinic (with the exception of accession points) must provide the patient a DEERS

Add Alert letter for submission to the local personnel or RAPIDS office when the patient goes to get their identification card. A template for this letter is also available within guide found at reference (j). At accession points, there is no need to provide a letter for submission to a RAPIDS office. Once these members are reflected in

DEERS, their MHS GENESIS record will update via the interface to reflect current

DEERS demographic information.

(2) Patient verification. In the event of an emergency, clinic personnel must first render care necessary to preserve life, limb, and/or eyesight, and determine patients’ eligibility after treatment. During all other circumstances, clinic personnel will perform the following checks at every encounter to confirm the patient’s identity and verify entitlement prior to treatment:

(a) Complete a physical check of the Common Access Card (CAC) or Uniformed Services

Identification card and validate it belongs to the patient and is not expired.

(b) Verify status in Defense Enrollment Eligibility Reporting System (DEERS), valid orders and/or Notice of Eligibility (NOE) validating entitlement for care.

(c) Validate and update, with patient confirmation, address, phone numbers and Primary

Care Manager (PCM) enrollment.

(d) Ensure the patient has a LPE.

(e) Verify under which eligibility entitlement the patient is seeking care and ensure encounter documentation reflects the correct patient category (PATCAT). Patient category guidance can be found at Military Health System Uniform Business Office website: https://health.mil/Military-Health-Topics/Business-Support/Uniform-Business-

Office/Patient-Categories.

(f) Verify or select patient communication preference for appointment reminders in either

Cerner Millennium for medical or Dentrix for dental. The patient’s selected preference in one system is independent of the selection in the other, so it should be completed in both applications.

(3) Notice of Privacy Practices (NoPP) Acknowledgment. Clinic staff can upload existing, from the paper health record, NoPP Acknowledgment Privacy Act Statement. If one does not exist, patients shall sign a CG-5211B NoPP Acknowledgment Privacy Act Statement and it shall be scanned and uploaded into MHS GENESIS documents at the person (rather than encounter) level. This document only needs to be scanned into the medical application within MHS GENESIS, though it will apply to dental (i.e. Dentrix) components of the record as well.

b. Patient Care Locations (PCL), also known as Location Hierarchy, Location, Clinic Location, and

Nurses Unit. The Location Hierarchy is the backbone of local MHS GENESIS configuration. All additional local design (e.g., local formulary, radiological procedures, lab orders/results) is a derivative this hierarchy. PCL also serve as the backbone for all administrative processes, to include appointment scheduling and data reporting within the system. Below is a list of some of the

PCL and their intended purpose. This is not an all-inclusive list.

(1) Most primary and military readiness care provided to military members will be provided within the Military Medicine clinic. The only exception will be for sites that care for both military members and dependents. For those sites primary care will be documented within the Family

Medicine PCL. This also applies to occupational health care provided to non-federal civilian employee beneficiaries.

(2) All federal civilian occupational health care will be provided within the Occupational Medicine

PCL.

(3) Generally, each specialty department (Physical Therapy, Behavioral Health, Optometry, etc.)

will have a unique PCL and care should be scheduled and documented there-in.

(4) Non-privileged provider physical exam visits shall be scheduled within the Physical Exams

PCL.

(5) Immunization PCL shall be used to schedule and document discrete immunizations that are not associated with a primary care encounter.

(6) Mass Vaccination PCL shall be used when conducting mass vaccination evolutions (numerous https://health.mil/Military-Health-Topics/Business-Support/Uniform-Business-Office/Patient-Categories https://health.mil/Military-Health-Topics/Business-Support/Uniform-Business-Office/Patient-Categories https://health.mil/Military-Health-Topics/Business-Support/Uniform-Business-Office/Patient-Categories personnel at once).

c. Appointing. Sites shall use MHS GENESIS as the sole appointing system. All appointment templates must be available for booking a minimum of 42 days into the future. Appointing may be centralized or decentralized based on the staffing and physical space constraints that exist at each site. Ideally, medical and dental appointing will be conducted by separate staff to gain efficiency and expertise in administrative management of care; however, this may not be achievable at all sites.

(1) Medical. Appointing shall follow applicable sections of reference (o) as closely as possible until HSWL SC promulgates CG specific guidance. Sites will utilize standardized menu of templates posted by HSWL SC on the portal site. Primary care appointment templates shall follow the 20/30/40/60 minute appointment lengths. During initial roll out of MHS

GENESIS, and when new personnel are indoctrinating, HSA are authorized to block appointment encounters in order to allow time for staff to learn the system. Primary Care appointment rules of thumb are as follows:

(a) 20 mins: Urgent visits (Same Day) and routine primary visit.

(b) 30/40 mins: Complex routine, primary care (multiple issues/Medical

Boards/Temporary Limited Duty/High Risk patients)/Periodic Health Assessment

(PHA) follow ups.

(c) 60 mins: Physical exams/Occupational Medicine/Procedures.

(2) Dental. Dental scheduling practices within the Dentrix enterprise system are fairly flexible and allow staff to optimize the use of available time to meet dental population health demand.

(a) The appointment system allows for booking appointments into the future without limitations, thus active template management is required to ensure minimal facility cancellations due to inaccurate patient booking. Future days may be blocked to prevent users from scheduling dental appointments too far in advance. Each dental clinic will determine what is most appropriate, however there must be a minimum of 42 continuous days open on the schedule.

(b) The Dental appointment types and default lengths are below. The encounter lengths can be modified with direction from the treating clinician in 10 minute increments:

Appointment Reasons Length

ADDP 30 min

Biopsy 60 min

CAD/CAM 60 min

Dental Sleep 60 min

Endo 90 min

Eval 30 min

Exam 30 min

Ex/ProTech 60 min

Exam / RDH 60 min

High Caries 30 min

Hyg/Pro Tech 60 min

Hygiene/RDH 60 min

Nitrous 60 min

Oral Surgery 90 min

Orofacl Pain 60 min

Ortho 60 min

Pedo 60 min

Perio 90 min

Post Op 30 min

Pros 90 min

RAD (X-ray) 30 min

Restorative 60 min

Sedation 90 min

Sick Call 30 min

PerioMaint 60 min

(3) Patient bookable appointments. Reference (o) recommends appointments (typically 90%) be available for booking by the patient from the MHS GENESIS patient portal; however, the EHR

FSC has decided that CG Clinics will not utilize the patient portal direct booking feature at this time. As configured at the time of promulgation of this directive, the patient portal allowed beneficiaries to book appointments at any MHS GENESIS live site, in any appointment, with any provider that had a bookable appointing available via the portal. This resulted in appointment errors disrupting patient flow and requiring valuable staff time for ongoing correction. Any request to enable this feature must be presented to the EHR FSC for concurrence prior to implementation. Patients should be encouraged to utilize the request an appointment feature which sends a secure message within MHS GENESIS to request an appointment from the scheduling team.

(4) Scheduling Local Analyst, Template Management, and Revenue Cycle Maintenance.

Clinics shall assign a primary and alternate Schedule Template Manager. The HSA shall authorize any non-routine schedule blocks or facility appointment cancellations. The

Regional Practice Director or Senior Health Services Officer also has the authority to authorize schedule blocks. Each Regional Practice shall assign one Scheduling Local

Analyst to enable advanced revenue cycle resourcing maintenance activities as per the

Revenue Cycle Appointing SOP found at reference (j).

(5) Combining Encounters. Schedule Managers and Schedulers will have to pay attention and research duplicate encounters and combine them, as appropriate. Duplicate encounters can be identified by Registration Clerks, Scheduling Clerks, or Clinicians reviewing a patient's record and shall be combined in MHS GENESIS by a Health Information Management

(HIM) Manager.

(6) Patient Arrival. Upon patient arrival, registration/appointing staff must change patient status within the system to “Arrived,” while conducting patient registration and verification checks.

d. Release of Information (ROI).

(1) All health record ROI requests shall be tracked in MHS GENESIS Health Information

Management (HIM) applications. HIM is simply managing health information and documentation, to include developing, analyzing, gathering, and protecting it. ROI requests from third parties shall be processed within 7 days. ROI requests from patients shall be processed within 30 days. The urgency of the request may necessitate a faster turn-around; HIM staff shall use their best judgment in response to these requests.

(2) eFax. HIM staff will process and disseminate ROI requests through the electronic fax

(eFax) option in HIMAccess (Cerner Millennium) when appropriate. This will allow staff to electronically send a fax from within the system, negating the need to print and then fax via a traditional phone based fax machine. HIM staff will have to first enter the release requesting agency or person into the system and then follow the ROI Request

Management – eFax guide at reference (j). The eFax option is not available through

Dentrix,

(3) Types of information release and their descriptions are below. Assigned HIM staff shall select the best type of ROI for the requested purpose:

(a) Amend Record. This request type is used when a patient requests to modify information contained in their record. Modifications include adding information, deleting information, or correcting erroneous information.

(b) Confidential Communications. This request type is used when a request is made by a patient to provide the health record documentation by an alternative means or to an alternate, unverified location.

(c) Access Record. This request type is used when patients request documentation from their own record.

(d) Accounting of Disclosure. This request type is used when a request is made by a person for a list of all information that has been released concerning a patient. An Accounting of

Disclosures letter and report can be printed in Request Management (opened from

AccessHIM.exe), and a Disclosure Audit Report can be printed in Report Request

Maintenance (ReportRequestMaint.exe). This disclosure audit incudes all releases, even those that are not required for inclusion in a HIPAA accounting of disclosures registry.

(e) Restrict Consent. Request made by a person to restrict the access or consent privileges of another person (such as a physician or family member) or an organization (such as an insurance agency).

(f) ROI Non-Bill. 3rd party entity is requesting patient records or the patient is requesting the records be provided to a third party entity. Some requesters are not charged for records; therefore the clinic does not need to collect payment from the requester.

(g) ROI Bill. 3rd party entity is requesting patient records. Some requesters are charged for services such as number of pages copied, postage, mileage, and so on. An invoice can be generated for these types of requests.

(h) ROI Pre-Bill. 3rd party entity is requesting patient records. Some requesters that are charged for services may be pre-billed, requiring payment before to sending the requested records. A prepayment letter can be generated for these types of requests.

(4) Preloaded requestors. USCG Coast Guard Investigative Service (CG-CGIS), USCG Judge

Advocate General, Chief Counsel (CG-094), and USCG Unit Commanding Officer (CG-

00) were added during deployment as ROI requestors. Sites are encouraged to use these for authorized CGIS, CG legal, or Commanding Officer requests (rather than entering in each

CGIS or legal office or command individually). Reminder, all ROI requests that are not authorized by the patient shall be vetted through the overseeing clinic’s HIPAA Privacy

Officer to ensure compliance with policy and law.

(5) Health Insurance Portability and Accountability Act (HIPAA) documentation. All HIPAA documentation shall be electronically filed in the Protected Health Information Management

Tool (PHIMT). This includes authorization for disclosure forms, restrictions on disclosures, and HIPAA accounting of disclosures entries. Not all disclosures require a HIPAA accounting of disclosure; refer to reference (a) and applicable HSWLSC Technical

Direction for guidance.

e. Patient Portal/Message Center. All direct communication between the clinical staff and patient shall be within Message Center to ensure appropriate documentation and privacy is maintained.

Individual email account communication shall be avoided. At a minimum, all clinics shall have a message center for scheduling and for all major clinical departments. Typically message centers align to PCLs.

(1) Patient Portal Champion. All Clinics shall assign a Patient Portal Champion to coordinate, market, and administer Patient Portal and Message Center activities. Each clinic’s HSA shall serve as the alternate Patient Portal Champion.

(2) Naming conventions. All message center names will use a standard naming convention of

USCG [Clinic location name] [Department, e.g. Primary Care, Behavioral Health, Dental, etc.] [Scheduling/Messaging], for example: USCG Base Alameda Primary Care Messaging.

(3) Record documentation. In MHS GENESIS, clinicians will use Message Center to document communication with patients between visits including phone interactions and refill requests replacing current Telephone-Consults. Patients will have the ability to communicate directly with providers in Message Center via the Patient Portal. If an order is needed, the clinician will need to create an in-between visit encounter type. An in-between encounter is most appropriate when there is a modification of orders or treatment following an original encounter documenting a diagnosis and associated treatment plan.

(4) All message center requests shall be preliminarily addressed within three business days. Each clinic shall develop internal procedures and designated responsibilities for each message center

“inbox.”

(5) Each user will have access in Powerchart that will allow them to view their own personal inbox, proxy, and pools; however users must opt into the appropriate pools for their department and facility.

(6) Each clinic must assign at least two personnel to monitor the Cerner Millennium Refusals

Inbox for both messages and orders. More than likely it should be assigned to the Outpatient

Supervisor, Clinic Supervisor, and/or Nurse Manager; however, the HSA shall select those ambulatory staff that will best serve this function. If a clinical end user determines that a message or order within their inbox is not appropriate for them to sign, they can “refuse” the message or order and it will get sent to…