Objective: The 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 EHR using the functions of CEHRT.

Measures: EPs must attest to all three measures and must meet the threshold for at least two measures to meet the objective.

Measure 1: 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.

Measure 2: For more than 40 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP incorporates into the patient’s EHR an electronic summary of care document.

Measure 3: For more than 80 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP performs a clinical information reconciliation. The provider 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. 3) Current Problem list. Review of the patient’s current and active diagnoses.

Exclusions:

Measure 1: A provider may exclude from the measure if any of the following apply: (a) Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period; or, (b) Any EP that 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 may exclude the measures.

Measure 2: A provider may exclude from the measure if any of the following apply: (a) Any EP for whom the total of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, is fewer than 100 during the EHR reporting period is excluded from this measure; or, (b) Any EP that 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 may exclude the measures.

Measure 3: Any EP for whom the total of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, is fewer than 100 during the EHR reporting period is excluded from this measure.

Definition of Terms

Transition of Care – The movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory, specialty care practice, long-term care, home health, rehabilitation facility) to another. At a minimum this includes all transitions of care and referrals that are ordered by the EP.

Summary of Care Record – All summary of care documents used to meet this objective must include the following information if the provider knows it: Patient name; Demographic information (preferred language, sex, race, ethnicity, date of birth); Smoking status; Current problem list (providers may also include historical problems at their discretion)*; Current medication list*; Current medication allergy list*; Laboratory test(s); Laboratory value(s)/result(s); Vital signs (height, weight, blood pressure, BMI); Procedures; Care team member(s) (including the primary care provider of record and any additional known care team members beyond the referring or transitioning provider and the receiving provider)*; Immunizations; Unique device identifier(s) for a patient’s implantable device(s); Care plan, including goals, health concerns, and assessment and plan of treatment; Referring or transitioning provider's name and office contact information; Encounter diagnosis; Functional status, including activities of daily living, cognitive and disability status; and Reason for referral.

*Note: An EP must verify that the fields for current problem list, current medication list, and current medication allergy list are not blank and include the most recent information known by the EP as of the time of generating the summary of care document or include a notation of no current problem, medication and/or medication allergies.

Current problem lists – At a minimum a list of current and active diagnoses.

Active/current medication list – A list of medications that a given patient is currently taking.

Active/current medication allergy list – A list of medications to which a given patient has known allergies.

Allergy – An exaggerated immune response or reaction to substances that are generally not harmful.

Care Plan – The structure used to define the management actions for the various conditions, problems, or issues. A care plan must include at a minimum the following components: goals, health concerns, assessment, and plan of treatment.

Attestation Requirements: DENOMINATOR/NUMERATOR/THRESHOLD/EXCLUSION 

MEASURE 1: 

DENOMINATOR: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring or referring provider.

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.

THRESHOLD: The percentage must be more than 50 percent in order for an EP to meet this measure.

EXCLUSION: A provider may exclude from the measure if any of the following apply: (a) Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period; or, (b) Any EP that 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 may exclude the measures.

MEASURE 2: 

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.

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.

THRESHOLD: The percentage must be more than 40 percent in order for an EP to meet this measure.

EXCLUSIONS: A provider may exclude from the measure if any of the following apply: (a) Any EP for whom the total of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, is fewer than 100 during the EHR reporting period is excluded from this measure; or, (b) Any EP that 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 may exclude the measures.

MEASURE 3: 

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.

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.

THRESHOLD: The resulting percentage must be more than 80 percent in order for an EP to meet this measure.

EXCLUSIONS: Any EP for whom the total of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, is fewer than 100 during the EHR reporting period is excluded from this measure.

How do I achieve Measure 1?

The clinician must electronically send a Transition of Care (CDA) document to the provider they have referred their patient to. The denominator count is captured when a TOC is generated or the clinician documents who they are referring their patient to through the use of the “Referral” button. You receive credit towards the numerator once the TOC is sent electronically to that provider. The two requirements, create a TOC and send it electronically, can both be achieved through Direct Messaging.

To generate and send a Transition of Care Summary through Direct Messaging

1. Open the patient’s clinical chart.
2. Click To-Do > Direct Messaging > Send New Message.

3. Click the To button.

4. Enter the last name of the provider you are sending the document to. Enter city, state and addition fields to narrow the search results.
5. Click the Search button.
6. Click the provider in the search result window to highlight, and then click the To button.
7. Click the OK button.

8. Click the From drop-down arrow, and select the Provider who is sending the document.

9. You must enter a Subject in the corresponding field.

10. Click the Generate and Attach CDA button.

11. In the Provider Selection field, select the Provider, and then click the Save button.

12. In the Patient Information Document Exclusions dialog, check items you want to exclude, and then click the OK button.

13. When the export is complete, click the OK button.

14. Click the Send button.

15. The direct message must be successfully delivered for credit to be given. To check the status of direct messages, click the To-Do > Direct Messaging > View Sent Messages.
16. In the User field in the Direct Messages Sent dialog, change the User to the person who sent the message. A status of Delivered in the Status column is required to get credit for this measure.

To document the transition of care through the “Referral Button” (Optional):

NOTE: You may use the Referral button in an office visit note to document who you are referring your patient but this will only get you in the denominator. You must generate and send the Transition of Care Summary through Direct Messaging to receive credit in the numerator.

1. In an office visit note, click the Referral button.
2. In the Referrals dialog, click the New button.

3. Click the Choose Provider button, then search and highlight the applicable provider name, and then click the OK button.
4. Select at least one Diagnosis in the corresponding fields.
5. Enter any Comments, if applicable.
6. Click the OK button.
7. In the Referrals dialog, click the OK button.

How do I achieve Measure 2?

As the recipient of a transition or referral or for a new patient, the clinician must incorporate an electronic summary of care document into the CEHRT. Clinical supports three different methods of receiving this document electronically, as outlined below.

Denominator credit is obtained by using the Patient Assignment widget in a chart note that falls within the reporting period. This widget can be added using the  Template Editor, and is used to satisfy the denominator criteria for both this measure and the Clinical Information Reconciliation measure.

To do this, click the Patient Assignment button in a patient's chart note, and select the appropriate responses to the questions asked. Answering Yes to any of the first three options will generate denominator credit for this patient.

Selecting Yes to the last question will create a denominator exclusion for the patient. This patient will be omitted from the calculation and will count neither for, nor against, the EC. Providers can exclude patients from the denominator where a reasonable due diligence has been conducted, such as querying a Health Information Exchange, or requesting but not receiving a transition of care summary from the referring provider. Choosing this option is a way of documenting this due diligence in the chart note.

Numerator credit can be earned in one of three ways: Incorporating a Transition of Care Summary from the Health Information Exchange (HIE), Accepting a Summary of Care through a Direct Message, or Importing a Transition of Care Summary Saved on your PC.

Method 1 – Incorporating a Transition of Care summary from the Health Information Exchange (HIE)

If your office is connected to a HIE through our interface, you may be able to download a Transition of Care Summary directly from the exchange, provided the patient has given consent. This fulfills one of the primary functions of a HIE, which is to reduce gaps in patient care by making relevant health information available when a patient transitions. Consent is required by law whenever viewing or downloading patient health information from a HIE. It is therefore the first step in this process.

The Consent button can be found in the ID tab in Clinical, and in the Patient Screen in Practice Manager. The ID tab is the first tab on the top right-hand side while in a patient’s chart in Clinical. In Practice Manager, you will find the consent button in the Other section of the Patient Screen. Both buttons access a shared Consent dialog. After clicking on the Consent button, a Consent dialog will appear.

The patient can give consent to either the entire Practice, or on a Provider basis. Double-click either the Practice Name or the Provider Name in the HIE Consent section. Import consent must be changed from Not Asked to Yes before the download can be attempted.

To Download the Transition of Care Summary from the HIE, close the patient’s chart (if it is open). The click Chart > Import > From HIE. Enter the desired patient’s name in the search field. At the bottom, check the This patient has been transferred or referred to provider or has not yet seen the provider option.

After selecting the appropriate patient, click the Next button, and then click the Next button in the following dialog. If there are any documents to download, they will import directly into the patient’s chart. Typically, this process takes 2 to 4 minutes. A To-Do List reminder will be created once the Transition of Care document is available. This completes the process for method 1.

Method 2 – Accepting a Summary of Care through a Direct Message

Other providers may send Transition of Care (TOC) summaries directly to the receiving provider through direct messages. In your To-Do List, double-click a Direct Message that was sent to you. You will be able to see if the direct message contains an attachment. A TOC summary will have a .xml extension.

To import the TOC summary, click the Import into chart button at the bottom left.

In the Direct Message Import dialog, you have the option of selecting an existing patient, or creating a new one for this import. If the direct message contained a TOC document, you will be able to modify the values in the Import CDA section in the lower right-hand corner. Otherwise, the section will be grayed out.

Check the This patient has been transferred or referred to provider or has not yet seen the provider option at the bottom-right of the dialog. This will give numerator credit for this patient.

Click the OK button complete this process for Method 2.

Method 3 – Importing a Transition of Care Summary Saved on your PC

According to CMS, the intent of this measure is to allow flexibility in how Summary of Care information is transferred between providers. Therefore, a third method of achieving numerator credit for the Request/Accept Summary of Care measure is available in Clinical. This is the ability to import the document by browsing files on your computer. It would be used in cases where the referring provider has transmitted the TOC summary to you using some other method besides direct messaging.

To accomplish this in Clinical, click Chart > Import >Patient Data.

In the Import Document dialog, you can choose to Import the document to an existing patient chart or Create new patient from imported data. Next, click the ellipsis button to the right of the File field to open an Open dialog that allows you browse your PC to select the applicable file. Do note that a TOC Summary will be a CCDA file, which is the default file format.

After the file has been selected, at the bottom of the Import Document dialog, check the This patient has been transferred or referred to provider or has not yet seen the provider option. This will give numerator credit for this patient.

Click the Next button, and then the Finish button in the following dialog to complete this process for Method 3.

How do I achieve Measure 3?

During the process of incorporating a transition of care (TOC) summary for a new patient or a patient transferred or referred to the EC, reconcile the medications, medication allergies, and diagnoses.

Denominator credit is obtained by using the Patient Assignment widget in a chart note that falls within the reporting period. This widget can be added using the  Template Editor, and is used to satisfy the denominator criteria for both this measure and the Request/Accept Summary of Care measure.

To do this, click the Patient Assignment button in a patient's chart note, and select the appropriate responses to the questions asked. Answering Yes to any of the first three options will generate denominator credit for this patient.

Selecting Yes to the last question will create a denominator exclusion for the patient. This patient will be omitted from the calculation and will count neither for, nor against, the EC. Providers can exclude patients from the denominator where a reasonable due diligence has been conducted, such as querying a Health Information Exchange, or requesting but not receiving a transition of care summary from the referring provider. Choosing this option is a way of documenting this due diligence in the chart note.

Numerator credit is earned by clicking the Reconcile button in the TOC Summary once it has been imported into the correct patient’s chart, and then clicking the Confirm button for medications, medication allergies, and diagnoses. All three categories must be reconciled to receive numerator credit.

As outlined in the Request/Accept Summary of Care measure, CCDA files containing summary of care information from other settings/providers, can be imported electronically in one of three ways. If your office is connected to our Health Information Exchange (HIE) interface, the files can be downloaded directly from the patient’s medical record, provided that the patient has given consent. Otherwise, CCDAs are typically sent as attachments to direct messages from other providers. Alternative methods for transferring the file also exist, which is why these documents can also be imported from a saved location on your computer. See the Health Information Exchange – Request/Accept Summary of Care section, for further details on how to import a TOC Summary using one of these three methods.

When the CCDA file has been imported successfully, the chart will open automatically to that document. Click the Reconcile button, located directly beneath the Summary of Care Record.

After clicking the Reconcile button, a Clinical Information Reconciliation (CIR) dialog will appear containing three panes of information. The left pane contains diagnoses, medications, or allergies that are already in the chart. The middle pane displays the information available in the document you are reconciling. And the right pane shows the final merged list. Items are added to the final list by selecting them in the center pane, and then clicking the Add button, or by clicking the Add All button. The Medications, Diagnoses, and Allergies tabs at the top of the dialogue allow you to alternate between the three different categories.

To receive numerator credit for Clinical Information Reconciliation, you must click the Confirm button in all three tabs. If the Confirm button is not clicked for Medications, Diagnoses, and Allergies, numerator credit will not be given. The requirement is that all three must be reconciled with the patient’s current medical record.

Note that if a category is empty for a patient, such as in cases where the patient has no known allergies or no current medications, that section is automatically considered reconciled.

Objective: The EP is in active engagement with a public health agency or clinical data registry to submit electronic public health data in a meaningful way using certified EHR technology, except where prohibited, and in accordance with applicable law and practice.

Measure Options: 

Measure 1 -Immunization Registry Reporting: The EP is in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS).

Measure 2 – Public Health Registry Reporting: The EP is in active engagement with a public health agency to submit data to public health registries.

Measure 3 – Clinical Data Registry Reporting: The EP is in active engagement to submit data to a clinical data registry.

Exclusions:

Measure 1: Any EP meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the EP—

• Does not administer any immunizations to any of the populations for which data is collected by their jurisdiction’s immunization registry or immunization information system during the EHR reporting period;
• Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
• Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data as of 6 months prior to the start of the EHR reporting period.

Measure 2: Any EP meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the EP—

• Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction’s syndromic surveillance system;
• Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from EPs in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
• Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs as of 6 months prior to the start of the EHR reporting period.

Measure 3:  Any EP meeting at least one of the following criteria may be excluded from the public health registry reporting measure if the EP—

• Does not diagnose or directly treat any disease or condition associated with a public health registry in their jurisdiction during the EHR reporting period;
• Operates in a jurisdiction for which no public health agency is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
• Operates in a jurisdiction where no public health registry for which the eligible hospital or CAH is eligible has declared readiness to receive electronic registry transactions as of 6 months prior to the start of the EHR reporting period.

Measure 4:  Any EP meeting at least one of the following criteria may be excluded from the clinical data registry reporting measure if the EP—

• Does not diagnose or directly treat any disease or condition associated with a clinical data registry in their jurisdiction during the EHR reporting period;
• Operates in a jurisdiction for which no clinical data registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period;or
• Operates in a jurisdiction where no clinical data registry for which the eligible hospital or CAH is eligible has declared readiness to receive electronic registry transactions as of 6 months prior to the start of the EHR reporting period.

Definition of Terms

Active engagement means that the provider is in the process of moving towards sending "production data" to a public health agency or clinical data registry, or is sending production data to a public health agency or clinical data registry.

Active Engagement Option 1–Completed Registration to Submit Data: The EP registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the EHR reporting period; and the EP is awaiting an invitation from the PHA or CDR to begin testing and validation. This option allows providers to meet the measure when the PHA or the CDR has limited resources to initiate the testing and validation process. Providers that have registered in previous years do not need to submit an additional registration to meet this requirement for each EHR reporting period.

Active Engagement Option 2 - Testing and Validation: The EP is in the process of testing and validation of the electronic submission of data. Providers must respond to requests from the PHA or, where applicable, the CDR within 30 days; failure to respond twice within an EHR reporting period would result in that provider not meeting the measure.

Active Engagement Option 3 – Production: The EP has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.

Production data refers to data generated through clinical processes involving patient care, and it is used to distinguish between data and “test data” which may be submitted for the purposes of enrolling in and testing electronic data transfers.

Attestation Requirements YES/NO/EXCLUSIONS 

• EPs are required to successfully attest to any combination of two measures of the Public Health and Clinical Data Registry Reporting Objective measures 1 through 4.
• An exclusion for a measure does not count toward the total of two measures. Instead, in order to meet this objective, an EP would need to meet two of the total number of measures available to them. If the EP qualifies for multiple exclusions and the remaining number of measures available to the EP is less than two, the EP can meet the objective by meeting the one remaining measure available to them and claiming the applicable exclusions. If no measures remain available, the EP can meet the objective by claiming applicable exclusions for all four measures.

MEASURE 1:

YES/NO: The EP must attest YES to being in active engagement with a public health agency to submit immunization data and receive immunization forecasts and histories from the public health immunization registry/immunization information system (IIS).

EXCLUSIONS: Any EP meeting one or more of the following criteria may be excluded from the immunization registry reporting measure if the EP—

• Does not administer any immunizations to any of the populations for which data is collected by their jurisdiction’s immunization registry or immunization information system during the EHR reporting period;
• Operates in a jurisdiction for which no immunization registry or immunization information system is capable of accepting the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
• Operates in a jurisdiction where no immunization registry or immunization information system has declared readiness to receive immunization data as of 6 months prior to the start of the EHR reporting period.

MEASURE 2:

YES/NO: The EP must attest YES to being in active engagement with a public health agency to submit syndromic surveillance data from an urgent care setting.

EXCLUSIONS: Any EP meeting one or more of the following criteria may be excluded from the syndromic surveillance reporting measure if the EP—

• Is not in a category of providers from which ambulatory syndromic surveillance data is collected by their jurisdiction’s syndromic surveillance system;
• Operates in a jurisdiction for which no public health agency is capable of receiving electronic syndromic surveillance data from EPs in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period; or
• Operates in a jurisdiction where no public health agency has declared readiness to receive syndromic surveillance data from EPs as of 6 months prior to the start of the EHR reporting period.

MEASURE 3:

YES/NO: The EP must attest YES to being in active engagement to submit data to a clinical data registry.

EXCLUSIONS: Any EP meeting at least one of the following criteria may be excluded from the clinical data registry reporting measure if the EP—

• Does not diagnose or directly treat any disease or condition associated with a clinical data registry in their jurisdiction during the EHR reporting period;
• Operates in a jurisdiction for which no clinical data registry is capable of accepting electronic registry transactions in the specific standards required to meet the CEHRT definition at the start of the EHR reporting period;or
• Operates in a jurisdiction where no clinical data registry for which the eligible hospital or CAH is eligible has declared readiness to receive electronic registry transactions as of 6 months prior to the start of the EHR reporting period.

Additional Information

• To meet all the measures within the public health objective, EPs must use CEHRT and the standards included in the 2015 Edition proposed rule. CMS anticipates that as new public health registries and clinical data registries are created, ONC and CMS will work with the public health community and clinical specialty societies to develop ONC-certified electronic reporting standards for those registries so providers have the option to count participation in those registries under the measures for this objective.
• EPs must attest to at least two measures from the Public Health Reporting Objective, Measures 1 through 4.
• If public health agencies have not declared 6 months before the start of the EHR reporting period whether the registry they are offering will be ready on January 1 of the upcoming year for use by providers seeking to meet EHR reporting periods in that upcoming year, a provider can claim an exclusion.
• An exclusion for a measure does not count toward the total of two measures. Instead, in order to meet this objective, an EP would need to meet two of the total number of measures available to them. If the EP qualifies for multiple exclusions and the remaining number of measures available to the EP is less than two, the EP can meet the objective by meeting all of the remaining measures available to them and claiming the applicable exclusions. Available measures include ones for which the EP does not qualify for an exclusion.
• For Measure 1, provider’s health IT system may layer additional information on the immunization history, forecast, and still successfully meet this measure.
• Bi-directionality provides that certified health IT must be able to receive and display a consolidated immunization history and forecast in addition to sending the immunization record.
• For Measure 1, an exclusion does not apply if an entity designated by the immunization registry or immunization information system can receive electronic immunization data submissions. For example, if the immunization registry cannot accept the data directly or in the standards required by CEHRT, but if it has designated a Health Information Exchange to do so on their behalf and the Health Information Exchange is capable of accepting the information in the standards required by CEHRT, the provider could not claim the second exclusion.
• For Measure 2, because syndromic surveillance reporting is more appropriate for urgent care settings and eligible hospitals, we removed this measure for eligible professionals for Stage 3 with the exception of providers who are practicing in urgent care settings. Note: some states have chosen to waive the urgent care setting requirement. Please contact your state Medicaid agency for more information.
• For Measure 2, an exclusion does not apply if an entity designated by public health agency can receive electronic syndromic surveillance data submissions. For example, if the public health agency cannot accept the data directly or in the standards required by CEHRT, but if it has designated a Health Information Exchange to do so on their behalf and the Health Information Exchange is capable of accepting the information in the standards required by CEHRT, the provider could not claim the second exclusion.
• For Measure 3, EPs may choose to report to more than one public health registry to meet the number of measures required to meet the objective.
• For Measure 3, a provider may count a specialized registry (such as prescription drug monitoring) if the provider achieved the phase of active engagement defined under Active Engagement Option 3: Production, including production data submission with the specialized registry, in a prior year under the applicable requirements of the EHR Incentive Programs for that year.
• For Measure 4, EPs may choose to report to more than one clinical data registry to meet the number of measures required to meet the objective.
• For Measure 4, the definition of jurisdiction is general, and the scope may be local, state, regional or at the national level. The definition will be dependent on the type of registry to which the provider is reporting. A registry that is ‘‘borderless’’ would be considered a registry at the national level and would be included for purposes of this measure.
• Providers who have previously registered, tested, or begun ongoing submission of data to registry do not need to “restart” the process beginning at active engagement option 1. The provider may simply attest to the active engagement option which most closely reflects their current status.
• In determining whether an EP meets the first exclusion, the registries in question are those sponsored by the public health agencies with jurisdiction over the area where the EP practices and national medical societies covering the EP’s scope of practice. Therefore, an EP must complete two actions in order to determine available registries or claim an exclusion:
  • Determine if the jurisdiction (state, territory, etc.) endorses or sponsors a registry; and,
  • Determine if a National Specialty Society or other specialty society with which the provider is affiliated endorses or sponsors a registry.
• If a provider is part of a group which submits data to a registry, but the provider does not contribute to that data (for example they do not administer immunizations), the provider should not attest to meeting the measure but instead should select the exclusion. The provider may then select a different more relevant measure to meet.
• If a provider does the action that results in a data element for a registry in the normal course of their practice and is in active engagement to submit to a registry, but simply has no cases for the reporting period, the provider is not required to take the exclusion and may attest to meeting the measure.
• CMS has published a centralized repository for public health agency (PHA) and clinical data registry (CDR) reporting. That centralized registry is available at https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/CentralizedRepository-.html.

 Enrollments and Additional Information

• * Immunization Registry Reporting: see https://sticomputer.com/immunizations/ for enrollment and further details.
• * Syndromic Surveillance Reporting: availability varies by state; you will need to check with your state to see if any public health agencies exist.
• * Public Health Registry Reporting: see https://sticomputer.com/enrollments/premier-registry-enrollment/ for further details regarding Premier Inc. (formerly CECity) and enrollment information.