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Objective 7: Health Information Exchange (HIE)

Updated: 10/21/2019
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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.
  • Create a note detailing the patient’s office visit.
  • Click to select "Transferring" at the bottom of a note to indicate the patient will be referred to another setting of care.
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.
  • From the bottom of the note, Click Care Coordination and select Send Referral.
    • Select Direct Message (eFax does not count for this measure)
    • Click to select or deselect any items. The "Summary of Care" box cannot be deselected.
    • Click Send Message.
    • Click Find in Directory and search for the receiving provider or medical entity the patient is being referred to. Click the name of the receiving provider once found.
    • If necessary, edit the default message.
    • Click Send.
  • Complete and sign the note.
Exclusion: An EP may take an exclusion from the measure if any of the following apply:
  • He or she transfers a patient to another setting or refers a patient to another provider fewer than 100 times during the EHR reporting period
  • He or she conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period
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.
  • Create a Note detailing the patient’s office visit
  • Check Receiving at the bottom of a Note to indicate this is a new patient or recipient of a transition or referral
  • Click Yes or No when asked: Have you requested a summary of care from the patient’s previous provider?
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.
  • From the Provider’s Direct Inbox (Updox) find a Summary of Care (SOC) or Continuity of Care Document (CCD) that was received via Direct Messaging.  Click the Import to EHR button to save the XML file into the Documents section of the patient’s chart (must search patient by name)
    • If a SOC or CCDA was provided in a different electronic method such as a CD or other memory device, go to the Documents section of the patient’s chart and click +Upload . Select the Summary of Care that should be uploaded. The file should be an XML file format.
    • Click Save. Then follow the steps below:
      • In Documents, find the newly imported XML file labeled Summary of Care Received or Continuity of Care Received and/or Referral Received.
      • Click Merge from the Actions area. 
      • Select patient data (Medications, Problems and Allergies) that is relevant to the receiving provider or merge all.  A message will display to indicate the selected data was successfully imported.
      • Click Merge to merge the selected patient data.
      • Click Edit on the newly merged document and select the name of the receiving provider.
      • Click Save.
  • Complete and sign the note.
Exclusion: An EP may take an exclusion from the measure if any of the following apply:
  • The total transitions or referrals received and patient encounters in which he or she has never before encountered the patient, is fewer than 100 during the EHR reporting period
  • He or she conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the EHR reporting period
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.
  • Create a note detailing the patient’s office visit.
  • Click to select "Receiving" at the bottom of a note to indicate this is a new patient or recipient of a transition or referral
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:
  • Click to select "Medication reconciliation performed".
  • Click to select "Allergies reconciliation performed".
  • Click to select "Problem reconciliation performed".
  • Complete and sign the note.
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.