Objective 7: Health Information Exchange (HIE)
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Medicaid Promoting Interoperability - Stage 3
Objective: | The eligible professional (EP) provides a summary of care record when transitioning or referring their patient to another setting of care, receives or retrieves a summary of care record upon the receipt of a transition or referral or upon the first patient encounter with a new patient, and incorporates summary of care information from other providers into their electronic health record (EHR) using the functions of certified EHR technology (CEHRT). The EP must complete the authentication process with UpDox to enable the sending and receiving of patient health information securely. See Set Up Direct Messaging. |
Measure 1 - Transmit: | For more than 50 percent of transitions of care and referrals, the EP that transitions or refers their patient to another setting of care or provider of care: (1) Creates a summary of care record using CEHRT; and (2) Electronically exchanges the summary of care record. |
Denominator: | The number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider.
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Numerator: | The number of transitions of care and referrals in the denominator where a summary of care record was created using certified EHR technology and exchanged electronically.
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Exclusion: | An EP may take an exclusion from the measure if any of the following apply:
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Measure 2 - Receive: | For more than 40 percent of transitions or referrals received and patient encounters in which the EP has never before encountered the patient, he/she incorporates into the patient’s EHR an electronic summary of care document. |
Denominator: | Number of patient encounters during the EHR reporting period for which an EP was the receiving party of a transition or referral or has never before encountered the patient and for which an electronic summary of care record is available.
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Numerator: | Number of patient encounters in the denominator where an electronic summary of care record received is incorporated by the provider into the certified EHR technology.
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Exclusion: | An EP may take an exclusion from the measure if any of the following apply:
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Measure 3 - Reconcile: | For more than 80 percent of transitions or referrals received and patient encounters in which the EP has never before encountered the patient, he/she performs a clinical information reconciliation. The EP must implement clinical information reconciliation for the following three clinical information sets: (1) Medication. Review of the patient’s medication, including the name, dosage, frequency, and route of each medication. (2) Medication allergy. Review of the patient’s known medication allergies. |
Denominator: | Number of transitions of care or referrals during the EHR reporting period for which the EP was the recipient of the transition or referral or has never before encountered the patient.
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Numerator: | The number of transitions of care or referrals in the denominator where the following three clinical information reconciliations were performed: medication list, medication allergy list, and current problem list. From within a note, access the Medications, Allergies and Problems sections and reconcile each:
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Exclusion: | An EP may take an exclusion from this measure if the total transitions or referrals received and patient encounters in which the he or she has never before encountered the patient, is fewer than 100 during the EHR reporting period. |
Attestation: | An EP must submit the numerators and denominators generated by the Medicaid Promoting Interoperability dashboard. |
Audit Documentation: | We recommend that a copy of your Medicaid PI report is placed in your audit folder and retained for a minimum of 6 years after your attestation. Your audit folder should provide necessary verification if you are selected for a CMS Incentive Program audit. |