> ## Documentation Index
> Fetch the complete documentation index at: https://help.elationhealth.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Sharing data outside Elation- CCDA, HIE, Direct messaging & Patient Passport

> This article explains how patient data flows out of and into Elation across CCDA exports/imports, Carequality (Outside Care), Direct messaging & Elation Connect, and Patient Passport.

## Overview

This article explains how patient data flows **out of** and **into** Elation across four main channels:

* C-CDA (**CCDA**) exports/imports
* **Carequality** (Outside Care)
* **Direct messaging** & **Elation Connect** (secure provider portal)
* **Elation Patient Passport** (patient portal)

It focuses on two questions clinicians and admins ask most:

* What exactly leaves my chart, and who can see it?
* When I "view" outside records vs **import** them, where do those records live in Elation?

## Quick comparison: external data channels

| **Channel**                            | **Primary audience**                               | **Direction**                            | **What they can see**                                                                                                                                                                                                                                          | **View vs import in Elation**                                                                                                                                                                                                                                         | \*\*Who initiates?                                                                                                                                                                                                                                                    |
| -------------------------------------- | -------------------------------------------------- | ---------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **CCDA export/import**                 | Other EHRs, registries, HIEs, patients             | Outbound & inbound                       | Standard clinical summary (problems, meds, allergies, encounters, labs, care plan, etc.), optionally scoped to a specific use case (referral, complete record, care plan only).                                                                                | Inbound CCD/CCDA files always create a **Patient Summary** report. Only demographics, allergies, problems, immunizations, and medications can be imported as structured data; all other sections remain view-only in the Patient Summary unless manually transcribed. | You initiate exports from the chart or Patient List report; outside organizations initiate inbound CCD/CCDA sends.                                                                                                                                                    |
| \*\*Carequality (Outside Care)         | Carequality-enabled clinicians, HIEs, and EHRs     | Bi-directional                           | Outbound: a CCDA summary for matched, consented patients. Inbound: CCDs plus other document types (e.g., PDFs, images) depending on the trading partner.                                                                                                       | Inbound CCDs appear in the \*\* Outside Care\*\* viewer and can be filed and (optionally) imported into structured sections. Other document types are view-only in the viewer; to retain them you must download and upload them as Reports.                           | You initiate \*\* queries\*\* via the \*\* Outside Care\*\* button; external organizations initiate \*\* pulls\*\* of your CCDA data when they query Carequality and a match is found.                                                                                |
| **Direct messaging & Elation Connect** | External clinicians, facilities, and organizations | Mainly outbound; inbound for Direct      | Direct messages: the Letter/Referral body, attachments you choose, plus an automatically attached CCDA file for the patient when supported. Elation Connect: a secure, read-only snapshot of the exact documents you attached—never a live copy of your chart. | Inbound Direct CCD/CCDA attachments become Patient Summary reports. For new auto-created charts, compatible sections can auto-populate; for existing charts, you choose what to import, exactly like other CCD/CCDA imports.                                          | You initiate outbound messages via **Provider Letters** and **Referrals**; external systems initiate inbound Direct messages to your Direct address. Connect invitations are triggered when you address a Letter/Referral to a non-Elation contact with fax or email. |
| **Patient Passport**                   | Patients and patient-authorized delegates          | Mainly outbound from Elation to patients | By default: Clinical Profile (except records marked confidential), visit summaries for signed visit notes, Patient Letters, and any attachments you choose to send (e.g., labs, imaging, handouts).                                                            | Patient-visible data is read-only from the patient's perspective and does **not** change your internal structured chart. You control additional sharing (e.g., lab reports, orders) by attaching records to Patient Letters.                                          | You invite patients and send messages/records from within the chart or via Bulk Letters; patients and delegates can reply if you allow messaging.                                                                                                                     |

## CCDA exports & imports

### What leaves Elation in CCDA exports

When you export a CCDA for a single patient or a cohort, Elation generates a structured clinical summary that can include (depending on the export type):

* Reason for referral
* Allergies, adverse reactions, alerts
* Medication history
* Problem list
* Encounters
* Immunizations
* Vital signs
* Social history
* History of procedures and implantable devices
* Relevant diagnostic tests and/or laboratory data (all structured values from signed lab results)
* Functional and mental status
* Assessments, plan of care, goals, and health concerns

You can control the scope by choosing:

* **Complete Record** (all available data, excluding confidential records)
* **Customized Record** (manually pick sections such as labs only, or meds + problems)
* **Referral Record** (referral-oriented subset)
* **Progress Notes** or **Care Plan** exports for more focused use cases

### What you can import from inbound CCD/CCDA files

When another EHR, registry, or HIE sends you a CCD/CCDA file (whether via Direct, Carequality, or manual upload):

* Elation converts the file into a **Patient Summary** report in the patient's chart.
* From that Patient Summary, you can import **only** the following sections as structured data into the Clinical Profile:
* Demographics
* Allergies
* Problems
* Immunizations
* Medications

Other sections—such as lab results, imaging reports, visit notes, and discharge summaries—remain part of the read-only Patient Summary. You can reference them any time but they are **not** merged into Elation's structured fields automatically.

### "View only" vs import for CCDA

* **View only. If you simply open and sign off a Patient Summary without importing any sections, the CCD/CCDA stays as an attachment in the chart. It does \*\* not** alter the Clinical Profile or other structured areas of the chart.

* **View + import. If you choose \*\* Import All** or \*\* Import & Reconcile\*\* for specific sections, Elation pulls demographics, allergies, problems, immunizations, and medications into the appropriate structured sections. All other sections remain view-only inside the Patient Summary.

This is true whether the CCD/CCDA arrived as a bulk migration file, a Direct message attachment, or through Carequality.

## Carequality (Outside Care)

### What Carequality is doing with your data

When your practice enables **Patient Data Sharing with Outside Care** and records patient consent, Elation participates in the national **Carequality** framework:

* Other Carequality-enabled organizations can **query** for your mutual patients.
* When there is a qualified match and consent, Carequality pulls a **CCDA file** of your patient's data from Elation and shares it with the querying organization.
* Elation does **not** share images or other non-CCDA document types through Carequality; we share CCDA-formatted data only.

The CCDA content we expose via Carequality matches the CCDA sections listed in the CCDA export guide (problems, medications, allergies, encounters, labs, care plan, goals, etc.).

### What you see when you query Outside Care

When you click **Outside Care** in the Clinical Profile and the patient has granted consent:

* Elation queries the Carequality network using the patient's demographics.
* Any matched outside records appear in the **Outside Care document viewer**.
* You may see multiple document types:
* **CCDs/CCDAs** – structured clinical summaries.
* \*\*PDFs, images (PNG, TIFF, etc.) – scanned notes, results, or other unstructured content.

<Note>
  Labs and notes may be available as documents depending on trading partner capabilities. Elation can only return what other Carequality-enabled organizations choose to share and what their patients have consented to share.
</Note>

### Viewing vs importing Carequality documents into the chart

Carequality documents \*\* do not\*\* automatically merge into your chart:

* For **CCDs/CCDAs** in the Outside Care viewer:
* **Sign Off** – files the document into the patient's chart as a report, without importing discrete data.
* **Sign Off & Import** – files the document and allows you to select and import discrete data (demographics, allergies, problems, immunizations, medications) into the Clinical Profile, just like other CCD/CCDA imports.
* For **PDFs and images** in the Outside Care viewer:
* These are **view-only** in the viewer.
* To retain them in the chart, you must **download** the file and **drag-and-drop** it into the chart to file it as a Report.

Elation has no control over gaps or omissions in what other organizations share.

## Direct messaging & Elation Connect

### What's in an outbound Direct message

When you send a Provider Letter or Referral and the yellow banner indicates **Direct messaging**, Elation transmits a secure Direct message that typically includes:

* The **Letter/Referral body** text.
* Any attached chart records that are supported for Direct (e.g., visit notes, reports, labs, summaries).
* An automatically attached **CCDA file** for the patient's data, when supported by the recipient.

The receiving EHR decides:

* Whether to show the message body as a note, inbox item, or both.
* Whether to store attachments as scanned documents.
* Whether and how to parse the CCDA into their structured chart.

### What you see for inbound Direct messages

When you receive a Direct message in Elation:

* Incoming messages appear in:
* **Provider Letters inbox** on Practice Home; and/or
* **Requiring Action** in the patient's chart.
* Any attached CCD/CCDA file appears as a **Patient Summary** above the Direct message.
* Behavior differs by chart status:
* **No existing chart** – Elation creates a new chart and can automatically populate the Clinical Profile from the CCD/CCDA.
* **Existing chart** – Elation keeps the CCD/CCDA as a Patient Summary; you choose whether to import structured sections.

You can always:

* Open the Direct message to see **exactly** what text and attachments were received.
* Open the associated Patient Summary to see what was shared in the CCD/CCDA, and optionally import sections.

### What Elation Connect recipients can see

When you address a Provider Letter or Referral to a **non-Elation contact** with fax and/or email, Elation can invite that contact to **Elation Connect**, our secure provider portal:

* Connect is a **read-only** portal: it stores patient charts that contain only the records you sent from Elation, not your full internal chart.
* A Connect user can:
* View the **Letter/Referral** and its attachments.
* Download those records to transfer into their own system.
* Reply back to you; replies come into your Provider Letters inbox and the patient's chart.

\*\*Connect users never receive live access to your Elation chart. They only see the specific snapshot (Letter + attachments) that you chose to send for that patient.

## Elation Patient Passport (patient portal)

### Default patient-visible data

Once a patient registers for **Elation Patient Passport**, they see:

* Practice contact information.
* Last and next appointment dates.
* Key demographics and contact preferences.
* The Clinical Profile (problems, allergies, medications, immunizations, history, etc.), **excluding** items marked as confidential.
* A **visit summary** for every signed visit note, which includes vitals, procedures, tests/treatments (including referrals, medications, and diagnostic test orders), care plan/instructions, and follow-up details.
* Any **Patient Letters** and attachments you send them (e.g., lab reports, imaging reports, handouts).

Visit summaries and Clinical Profile content are shared automatically once Passport is enabled for the patient; you do **not** need to attach them manually each time.

### What is not automatically shared

Patients are **not** automatically granted access to every record in the chart. For example:

* Individual lab reports, imaging reports, and other Reports are **not** visible by default.
* Specific visit note sections or chart items tagged as **Confidential** are never exported in CCDA files and are not surfaced via Patient Passport sharing.

To share those items, your practice must intentionally:

* Attach reports or notes to a **Patient Letter**, or
* Include them in a CCDA export you share directly with the patient.

### Messaging and attachments from patients

If you allow two-way messaging:

* Patients can send new messages from Passport and attach files (e.g., outside records or photos).
* Replies and attachments arrive as Patient Letters in your Practice Home; you can file attachments directly into the chart as Reports.

You can also configure Passport as **one-way** (you push information out but do not allow patients to initiate messages) via the Patient Passport Messages settings.

## Where to verify "what was sent"

Here's where clinicians and staff can double-check outbound and inbound data:

* **CCDA exports** –
* Single-patient exports: downloaded .zip file on your workstation, plus a record in the patient's Chronological Record indicating the type of export (Complete Record, Customized, Referral, etc.).
* Bulk exports: Patient List report -> **Download CCDA**, with password-protected .zip file and audit trail in the report UI.
* \*\*Carequality (Outside Care) –
* Use the **Outside Care** button in the Clinical Profile to re-open the viewer and see exactly which documents are available and what you previously filed or imported.
* **Direct messages & Elation Connect** –
* The signed **Provider Letter/Referral** in the patient's Chronological Record shows the final message body, attachments, and delivery method (Direct, fax, Elation, Connect).
* Sent faxes and Connect invitations show status such as **Fax Sent** or **Letter and its attachments will be faxed,** with error details for failures.
* **Patient Passport** –
* The **Patient Letters** and visit summaries in the patient's chart mirror what the patient can see; if a record is not attached to a Patient Letter or included in a visit summary, it is not automatically visible in Passport.

Use these locations to answer patient or partner questions about "what you sent" vs what their system or portal is currently showing.

## Related Articles

* [Patient Chart Guide- Sharing clinical care summaries with collaborating providers using C-CDA (CCDA) format](/articles/Supported-Elation-CCDA-types)
* [Patient Chart Guide - Importing patient information from another EHR (CCD/CCDA Format)](/articles/import-patient-information-from-another-ehr-c-cda-format)
* [Elation-Carequality Integration Introduction](/articles/Carequality-Integration-Introduction)
* [Letter & Referral Guide - Sending and receiving Direct messages](/articles/how-to-use-direct-messaging)
* [Letter & Referral Guide - Sending a fax](/articles/how-to-send-a-fax)
* [Elation Patient Passport Guide](/articles/elation-patient-passport-an-introduction)
* [Letter & Referral Guide - Accessing patient information sent by an Elation EHR user](/articles/access-patient-information-securely-shared-by-an-Elation-EHR-user)
* [Questions of the Month - Oct, Nov, Dec 2024](/articles/Questions-of-the-Month-Oct-Nov-Dec-2024)
* [Promoting Interoperability (MIPS) - Provider to Patient Exchange](/articles/Promoting-Interoperability-MIPS-Provider-to-Patient-Exchange)
* [Patient Chart Guide- Managing confidential records](/articles/confidential-items-in-your-patient-chart)
* [Questions of the Month - March 2025](/articles/Questions-of-the-Month-March-2025)
* [Patient List Report Guide- Searching your patient panel](/articles/find-patients-with-elations-patient-list)
* [Letter & Referral Introduction](/articles/letter-and-referral-introduction)