How to Use Zoom’s Epic FHIR integration

In order for health care organizations to integrate Zoom into Epic FHIR’s video visit workflow, they can now connect Zoom to Epic FHIR’s Epic FHIR integration. In video visit appointments, Zoom video links will be displayed. Physicians can access appointments in Hyperspace, start Zoom video calls directly from the Hyperspace software, and document their experience in Epic. The MyChart Patient portal allows patients to launch the Zoom video visit from a computer or mobile device using their personal computer.

The following features are provided by this integration:

  • Integrates with Epic’s OAuth authorization system.
  • Using Zoom, meetings can be created by the person hosting the encounter or, if a different person is hosting the encounter, by the first person who joins the video conference.
  • Using the integration, patients will be automatically given a temporary Zoom account.
  • Using the SMS integration, providers will be able to share Telehealth meeting links with patients.

Prerequisites for Zoom’s Epic FHIR integration

  • Administrators who are responsible for adding and configuring Zoom integrations such as Zoom account administrators will know who these people are
  • As Zoom app version 2.0 is enabled through Epic App Orchard
  • Account for “Pro” subscribers
  • The BAA for HIPAA-compliance has been signed

How to add from the Zoom App Marketplace

  1. You will need to log in as the account administrator to the Zoom App Marketplace.
  2. Search for Epic FHIR in the search box at the top right corner of the screen to find the app.
  3. Look for the Epic FHIR app in your search results and click it.
  4. Then click Add.
  5. After you verify that the app has the permissions it needs, click Allow.
    A new page will appear containing instructions on how to configure the app.

How to configure Epic FHIR

Make sure you complete all the required information on the integration configuration page.
Note: Please make sure you have the Zoom app configuration information on Epic on hand for this task.

  1. Here are the settings you need to configure:
    • Zoom API Key: This is the Zoom API Key associated with your Marketplace JWT app.
    • Zoom API Secret: This is the Zoom API Secret associated with your Marketplace JWT app.
    • Note: You should only share Zoom API Keys and Secrets with Zoom or the appropriate employees within your company. It is not advisable to share them with anyone else. There are two keys and a secret that are used in JWT authorization for Zoom Rooms API, which is necessary for Epic FHIR Zoom Room video visits that are using this key.
    • Zoom App Secret: In order to enable Zoom for App Orchard, you will need the client secret provided by Zoom.
    • Zoom App Private Key: When enabling the Zoom app in the App Orchard, Zoom provides the privatekey.pem file with the value contained in it.
    • Epic FHIR R4 Base URL:You can access the Epic FHIR R4 endpoints by using the FHIR R4 base URL for your Epic instance.
    • Epic Telehealth Base URL: There is a base URL in your instance that can be used to access the telehealth endpoints in Epic 2020.
    • Epic OAuth Base URL (Optional): Enter the base URL of the Epic FHIR authorization server in order to access custom telehealth endpoints. In order to make launch more efficient we can include this field which does not have to be present, but it can be included if we wish to avoid the need to call Epic remotely to get this value.
    • Epic Environment:
      1. If a testing environment, you should set it to Test.
      2. To use Epic in a live production environment, it is set to Production.
    • Patient Admittance Policy: The policy can be adjusted as needed.
    • Provider User Type: It is an efficient integration that automatically creates user accounts for providers who do not have an existing Zoom account when starting telehealth meetings. All you have to do is choose the type of user you want to assign to these accounts.
    • (Optional) Epic Device Test Endpoint URL: Make sure that you put in the full URL where users will be able to test the meetings feature before the video meeting.
    • (Optional) Healthcare Provider Device Test Help URL: Users will be able to get assistance from this URL for testing the meetings feature.
  2. To save your changes, click Save Changes.

How to configure account-level settings

The following Zoom account-level settings must be unlocked in order for Epic FHIR integration to be functional.

  1. As an admin, I am allowed to edit account settings as long as I am logged in to the Zoom web portal as an admin.
  2. You can access account settings by clicking on Account Management in the navigation menu.
  3. Click the Meetings tab to access the account settings.
  4. Make sure that none of the following settings are locked:
    • You will need to ensure that the Allow participants to join before host setting is unlocked under the Schedule meeting section.
    • Under Security, you will need to make sure that the Waiting Room setting is unlocked.

How to remove from the Zoom App Marketplace

  1. As the account administrator, you need to login to the Zoom App Marketplace.
  2. To do so, click Manage at the top right of the page.
  3. Then click Added Apps from the navigation menu.
  4. Select Epic FHIR from the list of apps, then click Remove.

Security

  • Zoom complies with HIPAA regulations.
  • AES-256 bit encryption is used by Zoom, Epic, and Zoom video sessions to encrypt communications between them.
  • In addition, Zoom video sessions launched from Epic are protected with dynamic passwords.
  • In order to ensure that your video sessions are protected, all account-level settings will apply. In other words, you could disable recording, annotation, and other features as needed for the sake of security.
  • Based on the data from Epic FDI records, Zoom user accounts are automatically created using information from Epic FDI records for patients and providers. Provider accounts can be manually deleted by an administrator by:
    1. Log in to the Zoom web portal as an administrator who has the permission to edit your account settings.
    2. Click the User Management menu item in the navigation menu.
    3. Navigate to the provider user accounts that you would like to delete and click Delete.
      Note: Users with account names ending in @zoomtelevisit.com can be identified by their email addresses.

How your data is used

The following information is accessed and used from your Zoom account by this integration:

  • User account’s first and last name: While the video visit meeting takes place in a video room, the integration displays the provider’s first and last name.
  • Meeting settings: If you want to set up a meeting for video call, you will need to use the account wide settings.

It is possible to access and use the following information from your Epic account through this integration:

  • Session ID: Identifies the epic video visit session within the Epic interface when it comes to reporting the connectivity status (connected/disconnected) and device test results of patient and provider meetings.
  • Epic user ID: When a patient’s connection status (connected/disconnected) is reported to Epic, this is the unique identifier that is used to identify the patient. A Zoom account is also automatically created when a video visit meeting takes place.
  • Epic provider ID: Provider meeting connection statuses (connected/disconnected) are reported to Epic based on the unique identification of the provider. When the encounter provider is different from the one used for the video visit, the automatic creation of a Zoom account is also used.
  • Epic encounter provider ID: Is used to identify the encounter provider with regard to the schedule video visit in order to provide you with the appropriate information. For example, it is used when setting up a Zoom meeting in order to find out who the host is. A Zoom account is also created automatically for the video visit meeting when this parameter is used.
  • User first and last name: Identifies an individual whose Zoom account is automatically created when a video visit meeting is set up. Additionally, this information is seen during the video visit meeting as well.
  • Provider email: It is possible to use a provider’s existing Zoom account if provider launch is enabled to find the provider’s account through the email. The Zoom account used for the video visit meeting is borrowed from the user’s existing Zoom account.
  • Zoom Room name: This is the identifier for the Zoom Room that is connecting to the meeting during Zoom Room video calls (Epic Monitor calls).

Configuring Epic FDI records

In order to configure the FHIR integration, FDI records are configured for each type of launch of video visit supported by the integration. Each of these records contains an URL string that is an expression matching particular APIs within the integration application. It also contains parameters that identify participants and the Epic event that is associated with the meeting.

Below you will find a list of the URLs that are required for each type of visit. In the installation mnemonic values field, these are entered in the “URL” field.

  • Provider (Hyperspace)
    https://applications.zoom.us/epicfhir/providerlaunch?org_id=<Zoom API key>
  • Nurse (hyperspace)
    https://applications.zoom.us/epicfhir/nurselaunch?org_id=<Zoom API key>
  • Patient (MyChart)
    https://applications.zoom.us/epicfhir/patientlaunch?org_id=<Zoom API key>
  • Zoom Room (In-Patient)
    https://applications.zoom.us/epicfhir/zoomroomlaunch?org_id=<Zoom API key>
  • Device Test
    https://applications.zoom.us/epicfhir/devicetest?org_id=<Zoom API key>

Below are the parameters that can be used to identify the launch context. “Installation Mnemonic Values” will prompt you to enter these into the “CONTEXT” field.

  • Provider (Hyperspace)
    epicSessionId=%CSN%&firstName=%USERFNAME%&lastName=%USERLNAME%&epicUserId=%EPICUSERID;;; ; ;;NONE;%&useProviderZoomAccount=<true|false>&noRedirect=<true|false>
  • Patient (MyChart)
    epicSessionId=%CSN%&epicUserId=%WPRID;;; ;;;NONE;%&firstName=%WPRFNAME%&lastName=%WPRLNAME%&encounterProviderId=%EXTENSION;<Provider LPP ID>%&useProviderZoomAccount=false&noRedirect=<true|false>
  • Zoom Room (In-Patient)
    epicSessionId=%CSN%&epicProviderId=%USERPROVID;;;;;<ID TypeValue>%&useProviderZoomAccount=<true/false>&roomName=<Zoom Room Name>&roomDisplay=<Zoom Room Display Name>&noRedirect=<true|false>
  • Nurse (hyperspace)
    epicSessionId=%CSN%&firstName=%USERFNAME%&lastName=%USERLNAME%&epicProviderId=%USERPROVID;;;;;<ID type value>%&useProviderZoomAccount=<true|false>&noRedirect=<true|false>
  • Device Test
    epicSessionId=%CSN%&epicUserId=%WPRID;;; ;;;NONE;%&firstName=%WPRFNAME%&lastName=%WPRLNAME%

Usage

Healthcare administrators configure the FDI records for each type of meeting within the Hyperspace portal. Then providers can launch the video chat session from inside the Hyperspace portal once they have located their telehealth appointment. They will be automatically added to the meeting when the meeting starts with the provider set as the host, and will automatically participate when the meeting begins.

In fact, patients are able to access their appointments through the MyChart portal, and from there initiate their visit. Patients will observe a loading screen that says “Please wait for the host to start this meeting, if the provider has not yet joined the meeting.”, if the provider has not yet joined the meeting. According to the patient admittance policy that was configured by the administrator, as soon as the provider joined the meeting, the patient will either join the meeting automatically, or they must wait for the provider to manually admit them.

Troubleshooting for Zoom’s Epic FHIR integration

Meeting Indicator

Whenever a patient joins telehealth meetings, Epic’s Hyperspace client displays a green light to indicate that they are present. It is possible to use notification records as a tool to help diagnose a problem with the indicator when it is not working correctly.

In order to access the notification records screen, please follow these steps:

  1. As the administrator of the Zoom user account, log into the Zoom App Marketplace.
  2. At the top of the page, you will find a Manage button.
  3. Click Configure for the Epic FHIR app, then select Notification Records.
  4. If the indicator was not functioning properly, you will need to enter the Zoom meeting ID for the meeting, or the Epic CSN in case it was a Zoom meeting.
  5. Click on the Search button.
    Click on “Notification Records” to view the notification records. There are many rows within each Table and each row corresponds to a notification sent from Zoom to Epic and every row contains the date and time when the patients and the providers entered and left the meeting.

Depending on the value in the RespCode column, Epic may have successfully handled the notification. In this case, the notification will display 200. In this case, if the indicator does not have a value of “200”, then there probably is a problem in communicating the notifications to Epic, resulting in the indicator not working correctly.

If there are any problems, here are a few things to check:

  • Verify that the Epic Telehealth Base URL is configured correctly.
  • Make sure all the Zoom IP addresses that are capable of emanating notifications are on your network allow list, if you are using an IP allow list. Zoom has listed the IP addresses of the network firewall (network firewall TCP addresses) in the network firewall settings page (network firewall settings page).
  • Ensure that the FDI records on Epic are correctly configured.