Messaging

With our messaging module, you can allow:

• Patients to message their care team and vice versa
• Organization members to chat with groups of patients
• Organization members to chat internally with other organization members

Each message thread has two types of members:

• Participants: Who have read and write access to the message thread and get notified when new messages come in
• Observers: Who only have read access to the message thread and do not get notified when new messages come in

There are three types of messages that can be sent from the EMR:

• External Messages: External message are messages that can be viewed from both the EMR and patient portal (everyone on the message thread can see the message).

• Internal Notes: Internal notes can only be viewed on the EMR (patients can not see internal notes). Internal notes are useful when you want to discuss information about patients without the patient seeing it.

• Pages: Pages are a way to notify organization members that they should check out a message thread ASAP.

  • Any organization member that is not a a member of the message thread already will automatically added into the message thread as a participant.
  • Any observer in the thread that's paged will be upgraded to participant status.
  • All paged members will get an email, in-app, and text notification that they have been paged.
  • Next to each message thread on the sidebar will be a red circle containing the number of unresolved pages the member has in the thread. If the member has no unresolved pages in the thread, the red circle will be hidden.
  • A page can be resolved by clicking the "Resolve page" button on the page message.
  • A page can be unresolved by clicking the "Resolved by {{name name}} a {{time since the page was resolved}}" button on the page message.

Each message can be one of four formats:

• Regular text
• Image
• File
• Video

All of the steps listed below can also be done using Avon's APIs.

Prerequisites

Part 1: Set up the triage team (EMR)

First, set up your triage team.

The triage team is the set of organization members that are automatically added as participants into message threads with patients. The triage team is meant to be the first-line defense for answering questions from patients and can page other members into the thread as needed.

Follow the instructions here to set up your triage team.

Part 2: Modify automations (EMR)

In the default automation, all the participants in message thread will:

• Receive an SMS that've gotten a new message
• Receive an email that've gotten a new message
• Receive an in-app notfication that they've gotten a new message

Follow the instructions here to mmdify the automations[automations].

Part 3: Set up your email integrations (EMR)

In order for an email notification to be sent about receiving a message, the email integration needs to be set up.

Follow the instructions here to set up your email integration[email-integration].

Part 4: Set up your SMS integration (EMR)

In order for a SMS notification to be sent about receiving a message, the SMS integration needs to be set up.

Follow the instructions here to set up your SMS integration[sms-integration].

Steps

Step 1: Create a care team message thread (EMR)

A care team message thread is a thread between a patient and their care team. Each patient will always have one and only one care team thread.

Care team threads are automatically created when patients are registered.

The automated flow is:

• When a patient is registered, a new care team thread is created for the patient. In this thread, the triage team members are added as participants and the care team members are added as observers.
• These care team thread can be found by click on the hamburger menu on the top left corner and then either:
  • Clicking on Chat
  • Click Patients > Click on "View chart" for the appropriate patient > Click on Chat on the top bar
• The thread's name will show up as "{{Patient}}'s Care Team" (e.g. Sally's Care Team) in the EMR and "My Care Team" in the patient portal.

The recommended flow for using the care team message thread is:

• Create a triage team with whoever you want the patient's first point of contact to be.
• Whenever a patient messages the thread, the triage team will be notified.
• The triage team pages in the appropriate organization members to resolve the patient's questions. Those members are now added into the message thread and can converse with the patient.
• If a care team member (who are currently observers in the message thread) want to message a patient first, they should change their status to a participant in the thread.
• When the incident is resolved, the triage team can move the organization members' status to observers. That way the organization members' can retain view-only access to the message thread (for reference when charting, etc.) but won't get constantly notified about new messages.
• If an organization member needs to be re-added into the message thread as a participant in the future, they can be re-paged in or their status can be changed back to participant.

Other important notes:

• If a new member is added into the patient's care team, they are automatically added as an observer to the patient's care team thread.
• If a member is removed from the patient's care team, they are not automatically removed from the patient's care team thread. They must be manually removed from the thread.

Step 2: Create a group message thread with patients (EMR)

To create a group message thread with patients:

• Go to the EMR (e.g. emr.avonhealth.com)
• Click on the hamburger menu on the top left corner > Chat
• Click on the "New" Button next to the "Direct Messages" label
• Set a name for the new message thread
• Select which organization members and patients you want to add as participants in the new message thread.
• Select which organization members and patients you want to add as observers in the new message thread.
• NOTE: You must select 2+ patients to add into the group message thread so that patients don't get confused between this thread and their care team thread.
• Select "Create thread"

Step 3: Create a group, internal-only message thread (EMR)

To create a group, internal-only message thread:

• Go to the EMR (e.g. emr.avonhealth.com)
• Click on the hamburger menu on the top left corner > Chat
• Click on the "New" Button next to the "Direct Messages" label
• Set a name for the new message thread
• Select which organization members you want to add as participants in the new message thread.
• Select which organization members you want to add as observers in the new message thread.
• Select "Create thread"

Step 4: View message threads (EMR)

To view message threads:

• Go to the EMR (e.g. emr.avonhealth.com)
• Click on the hamburger menu on the top left corner and then either:
  • Click on Chat. All threads that the member is a participant or observer in will show up here.
  • Click Patients > Click on "View chart" for the appropriate patient > Click on Chat on the top bar. All threads involving the selected patient and that the member is a participant or observer in will show up here.
• Select the appropriate message thread from the sidebar

Step 5: View message threads (Patient portal)

For patients to view their message threads, they can:

• Go to the patient portal (e.g. portal.avonhealth.com)
• Click on the hamburger menu on the top left corner > Chat
• If the patient is only part of one message thread, that message thread will automatically be displayed
• If the patient is part of multiple message threads, the patient can select a thread from the sidebar

Step 6: Send a message (EMR)

There are three types of messages that can be sent from the EMR:

• External Messages: External message are messages that can be viewed from both the EMR and patient portal (everyone on the message thread can see the message).

• Internal Notes: Internal notes can only be viewed on the EMR (patients can not see internal notes). Internal notes are useful when you want to discuss information about patients without the patient seeing it.

• Pages: Pages are a way to notify organization members that they should check out a message thread ASAP.

  • Any organization member that is not a a member of the message thread already will automatically added into the message thread as a participant.
  • Any observer in the thread that's paged will be upgraded to participant status.
  • All paged members will get an email, in-app, and text notification that they have been paged.
  • Next to each message thread on the sidebar will be a red circle containing the number of unresolved pages the member has in the thread. If the member has no unresolved pages in the thread, the red circle will be hidden.
  • A page can be resolved by clicking the "Resolve page" button on the page message.
  • A page can be unresolved by clicking the "Resolved by {{name name}} a {{time since the page was resolved}}" button on the page message.

Each message can be one of four formats:

• Regular text
• Image
• File
• Video

To send a message:

• Go to the EMR (e.g. emr.avonhealth.com)
• Click on the hamburger menu on the top left corner and then either:
  • Click on Chat
  • Click Patients > Click on "View chart" for the appropriate patient > Click on Chat on the top bar
• Select the appropriate message thread from the sidebar
• By default, the message type is set to "External Message." Select "Internal Note" or "Page" if desired.
• For external messages and internal notes, type in the desired message (hit "Return" to add a new line) or click on image, file, or video icons to upload images, files, and videos respectively from your computer.
• For pages, select the organization members you want to page and a memo to describe what you are paging them about.

Step 7: Send a message (Patient portal)

Sending messages works similarly for patients except patients can only send external messages (not internal notes or pages).

To send a message:

• Go to the patient portal (e.g. portal.avonhealth.com)
• Click on the hamburger menu on the top left corner > Chat
• Type in the desired message (hit "Return" to add a new line) or click on image, file, or video icons to upload images, files, and videos respectively from your computer.

Step 8: Receive a message (EMR and patient portal)

In the default automation, all the participants in message thread will:

• Receive an SMS that've gotten a new message
• Receive an email that've gotten a new message
• Receive an in-app notfication that they've gotten a new message

Turning off or changing the verbiage of these notifications can be done through the automations modules[automations].

Step 8: Delete a message (EMR)

To mark a message thread unread:

• Go to the EMR (e.g. emr.avonhealth.com)
• Click on the hamburger menu on the top left corner and then either:
  • Click on Chat
  • Click Patients > Click on "View chart" for the appropriate patient > Click on Chat on the top bar
• Select the appropriate message thread from the sidebar
• Hover over a message that you sent that you want to delete and see the kebab menu
• Select the kebab menu and select "Delete"
• Confirm that you want to delete the message
• NOTE: Organization members can only delete their own messages. Patients can't delete messages at all.

Step 9: Mark a message thread as unread (EMR)

To mark a message thread unread:

• Go to the EMR (e.g. emr.avonhealth.com)
• Click on the hamburger menu on the top left corner and then either:
  • Click on Chat
  • Click Patients > Click on "View chart" for the appropriate patient > Click on Chat on the top bar
• Select the appropriate message thread from the sidebar
• Hover over a message you sent
• Select "Mark unread"

Step 10: Change status of message thread members (EMR)

• Go to the EMR (e.g. emr.avonhealth.com)
• Click on the hamburger menu on the top left corner and then either:
  • Click on Chat
  • Click Patients > Click on "View chart" for the appropriate patient > Click on Chat on the top bar
• Select the message thread that you want customize
• Click on the meatball menu across from the title of the chat
• To change a member's status to "Participant":
  • Find the member's name and the click on the meatball from the name.
  • Select "Change status to participant"
  • NOTE: If a member has not already been added to the thread, they can be added in as a participant by paging them in.
• To change a member's status to "Observer":
  • Find the member's name and the click on the meatball from the name.
  • Select "Change status to observer"
• To remove a member from the message thread:
  • Find the member's name and the click on the meatball from the name.
  • Select "Remove member"
  • Confirm that you want to remove the member in the "Remove from Chat" modal

Step 11: Customize the message thread (EMR)

To customize the chat:

• Go to the EMR (e.g. emr.avonhealth.com)
• Click on the hamburger menu on the top left corner and then either:
  • Click on Chat
  • Click Patients > Click on "View chart" for the appropriate patient > Click on Chat on the top bar
• Select the message thread that you want customize
• Click on the meatball menu across from the title of the chat
• To change the chat priority level:
  • Click "Change chat priority."
  • Select the appropriate priority level (options are Low, Medium, and High)
  • Hit "Save"
• To change the chat tags:
  • Click "Change tags"
  • Select one of the tags from the dropdown or create a new tag
  • Hit "Save"