Full Core Platform release notes history

February 2024

Customer-Facing / Visible Features

The following are customer-facing features. These are the features that customers can choose to enable or not that would change the way that the system behaves for them and their customers/patients.

3rd Party Kiosk Guest Flow Integration with Virtual Care (e.g., Higi)

Higi is a health services company that provides publicly accessible health service stations in pharmacies, banks, grocery stores, etc. DexCare has partnered with Higi to enable their terminals to schedule and conduct virtual visits using DexCare’s Virtual Care platform.

• With this release, our customers will be able to support on-demand virtual (ODV) visits for their rural patients via (Higi) kiosks at locations such as banks or pharmacies.
• To support this capability, a new service was added to the DexCare booking API. Client applications running on kiosks may call the “queued guest visit” end point to integrate with the booking flow UI. The waiting room and video session may now be hosted in an iframe.

True Patient Demographics Updates

Within the DexCare booking flow, when a user signs-in with MyChart, they will be allowed to update a limited set of fields related to demographics information. Updates are limited to the information that is most likely to change, including:

• Phone number
• Email address
• Address line 1
• Address line 2
• City
• State
• Zip Code

Any change to these fields will be used to update the patient record in Epic.

Discrete Insurance Field Population (Retail, Virtual)

When a patient adds insurance details in the booking flow, the integration with Epic may now be configured such that these will go to the discrete and appropriate field in Epic as opposed to the appointment notes field.

If the patient has an existing patient record in Epic and the insurance information added during booking does not match existing insurance information, the new insurance will be appended to their set of insurance policies. If the insurance information already exists, it will not be duplicated.

During the booking flow, the patient will have the option of scheduling the appointment with insurance for which they are the primary policyholder or with someone else’s insurance that they are covered under.

• If the patient is the policyholder the following fields are collected:
  • Insurance Provider
  • Policy Member ID
  • Policy Group ID (optional)
• If the patient is on someone else’s insurance the following fields are collected:
  • Policy holder’s first name
  • Policy holder’s last name
  • Policy holder’s DOB
  • Insurance Provider
  • Policy holder’s Member ID - known as Subscriber ID in this scenario.
  • Policy Group ID (optional)

Note: This feature is new for Retail and Virtual as of the February 2024 Release. It has existed as part of Provider Direct since mid-2023.

Urgent Flag, Additional Details for Emergency Department (ED) Follow-up, Triage

DexCare has added support to its on-demand virtual (ODV) platform for use cases such as follow-up visits and care triage with the addition of an “urgent” flag and an “additional details” field. These changes will allow health systems to minimize the cost of ED patient follow-ups and drive more volume to their virtual on-demand business line.

• When an emergency department (ED) would like the patient to have a follow-up visit through a care opportunity that doesn’t require another visit to the emergency department, the patient may be sent to the ODV platform served by the virtual urgent care provider team. The “additional details” field will contain “ED Follow-up” and the visit will be flagged “urgent” so the patient is seen more quickly.
• If a patient is determined to be a candidate for Nurse Triage, staff may flag their visit using the “additional detail” field so it may be handled by the appropriate practitioner.

To facilitate easily booking these visits, DexCare will provide a URL to the health system so it may be sent to the patient any way they see fit (e.g., SMS, email, QR code, etc.) whenever the patient needs it. The URL provided will ensure the follow-up virtual visit is given the proper level of urgency and provides the clinician with the appropriate additional details.

The “additional details” fields will be displayed on the Provider Portal patient profile page. Furthermore, these types of visits will be identified through data in the DexCare All Visit Report (AVR) and data used for analytics. The urgency flag information and additional details will be stored in our data warehouse.

Note: This capability is enabled via our platform’s custom visit attribute feature, which allows DexCare and health systems to implement custom virtual booking flows. Customers are requested to work with DexCare to identify additional use cases where this feature meets their business needs so that DexCare can configure the system appropriately.

Caregiver Portal Updates: Visit History Search Persistence / Multiple Credential Support / Visit Transfers / New Analytics

Visit History Search Persistence Added

Caregiver Portal now saves visit history searches on a new tab.

• The search visit history page saves the search criteria and search results for each unique search of the MRN, first name, or last name. If a user navigates to another page and comes back to the Visit History Page, the submitted values and results will be restored.
• A new tab icon will be visible on the left-hand side of the Visit History Page on each visit detail row. Clicking on the icon or anywhere on the visit search detail row will open a new tab within the browser to show the visit details.
• Search criteria and results will not persist when a user logs out of the Caregiver Portal or refreshes that page.

Multiple Credential Flexibility, New Visit Assignment Methods for Providers Added

Well-defined visit assignment methods, multiple credential flexibility, analytics on provider data have all been added to this release.

• Added new provider credentials to better fulfill unmet demand. Administrators can now assign up to 2 credentials (now a required field) to providers through the Self-Service Portal. Options include ARNP, NP, RN, MD, PA or DO.
• The visit assignment methods “auto assignment” or “manual assignment” may now be assigned explicitly to a provider through the Self-Service Portal.
  • With automatic assignment mode, visits are assigned by the system to the clinician.
  • With manual assignment mode, a clinician can manually pick up visits.

Note: To enable this change, please reach out to your ARE. Staff training is required.

Visit Resolution Changes

Once a visit is started and the provider has met with a patient, there are three ways in which a visit may be resolved.

• A visit may be marked as “Charge” and goes in “Done” status.
• A visit may be marked as “Waive”, meaning it could not be completed due to X reasons (e.g., the patient was out of the service area, the patient was a no show, etc.). After the reason is selected, the visit is marked “Done.”
• A visit may be marked as “Transfer” (see below), meaning it could be either transferred to another provider or back to the queue. The visit is not in “Done” status yet. The video visit patients will receive a message that another provider will see them in some time. They are put back in the waiting room and once another provider picks that visit, they are seen and marked as complete. That visit then goes to a “Done” status.

Transfer Visit Feature Added

Now a queue manager or a provider can transfer a visit to another provider, back to the queue, or to a cross market/backup market from the visit details page.

• If a visit is in the queue and not assigned yet, it may be transferred to another provider.
• If a visit is already assigned to a provider but not started, then it may be transferred to another provider or back to the queue.
• Transfer is disabled if visit is in progress for video/in visit status.
• The visit details page will show all the provider events with timestamps such as provider assignments, transfers, etc.

Updates to Caregiver Portal Analytics

Multi-Provider Field Added to the All Visits Report (AVR)

The field Multi-Provider (TRUE/FALSE) has been added to the AVR for Virtual Visits. This field will always be populated.

Customers should consult with ARE for All Providers Report (APR — see below) to get a more granular view of what happened during the visit.

Note: In-session (as opposed to assigned — see Provider History Changes below) was selected to allow customers to know where multi-credentialing is allowing providers to operate at the top of their licenses. A provider being assigned then unassigned, but never interacting with the patient, does not support that goal.

All Providers Report (APR) Added

DexCare now provides a search API of provider history records, which are built from reporting events sent to the reporting system. These events include changes to a provider’s settings (e.g., changes to their credentials/transferring/getting in the queue-start and end of their shift/breaks on the caregiver portal) and their interactions with patients during a visit.

Provider Settings Changes

• create_provider - Create a new provider.
• assignment_method - Update a provider’s assignment methods (automatic/manual/off).
• credentials - Update a provider’s credentials.

Provider History Changes (aka interactions with visits/patients)

• assigned - Assign a provider to a visit.
• insession - Provider goes in session for a visit, meaning the video visit started.
• unassigned - Provider is unassigned from a visit they were assigned to, but where they were not in session. Visit goes back to the queue.
• end_and_unassign - Provider is unassigned from a visit where they were in session. Visit goes back to the queue.
• transfer - Assigned visit is transferred to another provider.
• end_and_transfer - In session visit is ended for the current provider and transferred to another provider.
• endvisit - Visit is ended for all providers.

Provider History Records

The full list of actions available in the API responses

HL7 Message Ingestion and Processing

Support has been added for HL7v2, a standard plain text message format used to capture and exchange events within a health system that describe changes to electronic health records.

Call center and back-office scheduling events may now update the appointment time slot information DexCare maintains (the slot cache) via HL7v2 SIU (Scheduling Information Unsolicited) messages, a message type corresponding to schedule changes such as new appointment bookings, cancellations, and rescheduling.

• Provides improved “slot cache” accuracy by reducing cases of the DexCare appointment time slot information becoming stale, meaning patient time slot selections are less likely to later become unavailable in the DexCare booking flow.
• Reduces the number of calls made to EMR APIs.

Note: This feature requires additional infrastructure and CloudAMQP configuration.

Bug Fixes

We have addressed the following high-priority, customer reported bug fixes in this release:

Ability Added to Automatically Display All Queued Visits

• Existing issue: Currently the patient queue displays a maximum of 10 visits, if the Queue Manager wants to see additional visits they need to click the “Load More” button. 
• New behavior: With this fix, the “Load More” button will be removed and all visits in the queue will be automatically displayed by default.  
• Location of the fix: Patient queue. 
• Feature flags needed: Yes. 

Providers Disappearing in Caregiver Portal Until a New Visit is Automatically Assigned

• Existing issue: After a provider ends a visit, the Queue Manager is no longer able to see them in Caregiver Portal until a new visit is auto assigned to that provider or the Queue Manager attempts a transfer. 
• New behavior: With this fix, the provider does not disappear from Caregiver Portal for as long as they are on-call.  
• Location of the fix: Caregiver Portal. 
• Feature flags needed: No. 

Providers Appear on Duty in Their View Getting Turned Off, Unable to See Their Waiting Room

• Existing issue: Some providers are reporting that they appear on duty and can see their waiting room but in the Provider Management portal they are being turned off so they are unable to get assigned visits. Additionally, some providers are having intermittent issues seeing their waiting room unless they refresh the screen.
• New behavior: With this fix, providers will not be turned off in the Provider Management portal, should be able to get assigned visits while they appear on duty and should have no issues seeing their waiting room.   
• Location of the fix: Provider Management portal, patient queue. 
• Feature flags needed: No. 

Miscellaneous

This release includes other miscellaneous bug fixes and performance enhancements across the entire application platform.

Core / Back-End Features

The following features and changes improve system performance or modify the system architecture but otherwise will not result in any noticeable functional changes a customer’s implementation.

EMR Slot-Call Reduction

Effective, January 1, 2024 Epic has changed their pricing model for calls made to Epic APIs. Accordingly, DexCare has made changes in the way we make those calls.

Slot cache hydration currently hydrates using API calls on slots per provider/department/visit type combination per day, which generates many API calls for a 30-day window. Furthermore, the cache operates with a Time to Live (TTL) policy, where the cache expires and then needs to be re-populated after a given time window. This requires additional API calls on a consistent basis in order to keep slots in the cache. We have optimized this operation to make this more efficient.

EMR Gateway and EMR Adapters

DexCare is introducing new software architecture that allows for connectivity to an expanding number of EMR systems. Modern health systems, while often using a single EMR vendor, often have affiliate partnerships with independent practices that use alternate EMR systems.

The DexCare EMR Gateway hides this complex network of EMR systems and booking vendors. Doing so allows our system’s business logic to treat all EMRs consistently and uniformly through EMR Adapters. This allows complexity to be hidden from the patients and healthcare providers while allowing DexCare to create a strong network of partners for each health system.