Promoting Interoperability Objectives (formerly ACI)
Base Score Measures (50 Points)
- * Protect Health Information - Security Risk Analysis
- * Electronic Prescribing - E-Prescribing & Formulary Comparison
- * Provide Electronic Access - Provide Patient Access to Health Information within 4 days
- * Health Information Exchange - Send a Summary of Care
- * Health Information Exchange - Request/Accept Summary of Care
You must complete all 5 base score measures to receive 50 points. Completing some of the measures will NOT earn you partial credit. Failure to complete a security risk assessment will yield 0 points for the PI category. You only need to have 1 in the numerator for Electronic Prescribing, Provide Patient Access, and Health Information Exchange to receive credit as based score measures.
Performance Score Measures (Earn up to 90 Points):
- * Public Health and Clinical Data Registry Reporting = 0 or 10 points
- * Provide Patient Access to Health Information within 4 days = 10 points
- * Patient-Specific Education = 10 points
- * View, Download and Transmit (VDT) or API access = 10 points
- * Secure Messaging = 10 points
- * Patient-Generated Health Data = 10 points
- * Send a Summary of Care = 10 points
- * Request/Accept Summary of Care = 10 points
- * Clinical Information Reconciliation = 10 points
You must complete all base score measures in order to earn any additional credit, up to 90 points, for the performance scored measures. Select the measures that best suit your practice.
Bonus Points (Earn up to 25 points):
- * Report using the 2018 Objective and Measures (2015 Edition CEHRT ) exclusively = 10 points
- * Using certain activities (PI Bonus) in the Improvement Activities category = 10 points
- * Public Health and Clinical Data Registry Reporting not reported in Performance Score section = 0 to 5 points
You must complete all base score measures in order to earn any additional bonus points (up to 25 points).
Promoting Interoperability Hardship Exceptions
If you’re participating in MIPS during the 2018 performance year as an individual, group, or virtual group—or participating in a MIPS Alternative Payment Model (APM)—you can submit a Quality Payment Program Hardship Exception Application for the PI performance category, citing one of the following specified reasons for review and approval.
- * MIPS-eligible clinicians in small practices (new for 2018)
- * MIPS-eligible clinicians using decertified EHR technology (new for 2018)
- * Insufficient Internet connectivity
- * Extreme and uncontrollable circumstances
- * Lack of control over the availability of certified electronic health record technology (CEHRT)
An approved Quality Payment Program Hardship Exception will:
- * Reweight your PI performance category score to 0 percent of the final score.
- * Reallocate the 25 percent weighting of the PI performance category to the Quality performance category.
Please note that simply not using CEHRT does not qualify you for reweighting of your PI performance category.
You must submit a hardship exception application by December 31, 2018 for CMS to reweight the PI performance category to 0 percent. The PI Hardship Application can be completed at: https://cmsqualitysupport.service-now.com/exception_application.do
Some clinicians who participate in MIPS are granted Special Status and will be automatically reweighted if they choose not to report on PI measures. Special Status clinicians do NOT need to submit a Quality Payment Program hardship exception application.
Special Status clinicians are identified as: Hospital-based clinicians, Non-patient Facing clinicians, NP, PA, Clinical Nurse Specialist, Certified Registered Nurse Anesthetists and Ambulatory Surgical Center (ASC) based clinicians.
View the objectives/measures specification facts, including how to achieve within ChartMaker Medical Suite, below:
Objective: Protect Health Information
Measure: Security Risk Analysis
Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by CEHRT in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician’s risk management process.
Reporting Requirements
- To meet this measure, eligible clinicians must attest YES to conducting or reviewing a security risk analysis and implementing security updates as necessary and correcting identified security deficiencies.
Scoring Information
- Required for Base Score (50%): Yes
- Percentage of Performance Score (up to 90%): 0
- Eligible for Bonus Score: In CY 2018, a one-time bonus of 10% will be earned by MIPS eligible clinicians and groups who report using 2015 Edition CEHRT exclusively.
How do I achieve this measure?
In order to qualify for this measure, the provider must have a security management process in place to “implement policies and procedures to prevent, detect, contain and correct security violations.” The specifications require the practice to conduct an analysis of potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic health information.
Some examples of this may include, but are not limited to:
- Perform Security Risk Analysis/ Assessment
- Implement Security Policies, such as providing passwords to computers and installing anti-virus software, screensaver for auto-log off, changing options in Preferences > User Security in ChartMaker Clinical
- Appoint a Security Official – Prepare and Implement Job Responsibilities
- Implement Audit Control Policies& Procedures
- Implement Automatic Log-off Processes
- Install Virus Protection Software
- Implement Firewall Technology
- Review and Implement Computer Backup Policies and Procedures
- Implement Facility Maintenance Log
- Develop Facility Security and Contingency Plans
- Create Computer Workstation Use Policies and Procedures
- Obtain Signed Workforce Confidentiality Agreements form all Physicians and Staff
- Create Workforce Termination Procedures
- Implement Sanction Policy
As part of the process in creating such a manual, STI Managed Services can perform a basic Security Risk Analysis on network and hardware vulnerability for your office by request. The practice is responsible for maintaining HIPAA compliance; however STI will work with you to assure the Information Technology portion of the Security Risk Analysis is complete. Upon completion of your analysis, you will be informed of STI findings whether positive or negative. The analysis will include some, but not all, of the examples listed above.
This service is provided free of charge for Platinum level maintenance clients and for a fee for all other clients. Contact STI Managed Services (800-487-9135; option 2) for more information.
Please keep in mind that the analysis completed by STI or another IT vendor is only a subset of this measure. There are other requirements that must be completed by the practice itself. If your practice would like a more thorough analysis, we can recommend a vendor to do so.
Tools to complete the assessment:
HIT Security Risk Assessment Tool (Downloadable Tool to Complete Assessment -** MUST BE COMPLETED DURING YOUR REPORTING PERIOD DATE RANGE**)
Objective: Electronic Prescribing
Measure: E-Prescribing & Formulary Comparison
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using CEHRT.
Reporting Requirements:
- NUMERATOR: The number of prescriptions in the denominator generated, queried for a drug formulary, and transmitted electronically using CEHRT.
- DENOMINATOR: Number of prescriptions written for drugs requiring a prescription in order to be dispensed other than controlled substances during the performance period; or number of prescriptions written for drugs requiring a prescription in order to be dispensed during the performance period.
- Exclusion: Any MIPS eligible clinician who writes fewer than 100 permissible prescriptions during the 2017 performance period.
Scoring Information:
- Required for Base Score (50%): Yes
- Percentage of Performance Score (up to 90%): 0%
- Eligible for Bonus Score: In CY 2018, a one-time bonus of 10% will be earned by MIPS eligible clinicians and groups who report using 2015 Edition CEHRT exclusively.
How do I achieve this measure?
The clinician needs to enter a new or renewed prescription in the patient’s EMR and send it electronically during their performance period. The denominator is achieved when the prescription is entered in a patient’s chart. The numerator is achieved when the prescription is sent electronically. ChartMaker’s Drug Formulary function is automatically turn on. You only need ONE in the numerator to receive credit for this base score measure.
NOTE: If a clinician does not write ANY prescriptions during their performance period they can report that they meet the exclusion. As long as the other 3 base score measures are completed, the clinician will receive 50 points with the eRx exclusion.
Enter a new prescription in the patient’s EMR and send it electronically:
- Open a chart note for the patient, then click the Medication button, and then click Add Medication to prescribe a new medication.
- Enter the medication in the search window, then click the Search button.
- Highlight the medication in the results window, and then click the Select button.
- In the Prescribe Medication dialog, enter or select information for all appropriate fields. If the clinician’s preference is set to E-Prescribe, then the Transmission method will default to E-Prescribe. If not, click the Transmission drop-down, and select E-Prescribe.
- When all the information has been configured, click the Next button.
- Select the patient’s Pharmacy, if they have more than one on file, and then click the Confirm button.
Enter a renewed prescription in the patient’s EMR and send it electronically:
- Open a chart note for the patient, then click the Medication button, then click Renew Medication, and then select the applicable Medication from the list.
- In the Prescribe Medication dialog, all the appropriate fields will populate as it was previously prescribed. If the clinician’s preference is set to E-Prescribe, then the Transmission method will default to E-Prescribe. If not, click the Transmission drop-down, and select E-Prescribe.
- When all the information has been configured, click the Next button.
- Select the patient’s Pharmacy, if they have more than one on file, and then click the Confirm button.
Set Clinician’s preference to “E-Prescribe” (Optional)
- The clinician will have to log into Clinical.
- Click Edit > Preferences.
- In the Preferences dialog, click the Prescription tab.
- In the Default Destination field, select E-Prescribe.
- Click the Set button, and then click the OK button.
Objective: Patient Electronic Access
Measure: Provide Patient Access to Health Information within 4 days
To meet the Base Score requirement, at least one patient seen by the MIPS eligible clinician during the performance period: (1) the patient (or patient-authorized representative) is provided timely access to view online, download, and transmit their health information subject to the MIPS eligible clinician’s discretion to withhold certain information; and (2) the MIPS eligible clinician ensures the patient's health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programing Interface (API) in the MIPS eligible clinician's certified electronic health record technology (CEHRT).
Reporting Requirements
• NUMERATOR: The number of patients in the denominator (or patient authorized representative) who are provided timely access to health information to view online, download, and transmit to a third party and to access using an application of their choice that is configured meet the technical specifications of the API in the MIPS eligible clinician's CEHRT.Do note, that for a patient to be counted in the numerator, they must be provided timely access (within 4 days) to their health information each time they are seen (where a note is created or a lab/result is imported) within the performance period. If there is one instance where a patient did not receive online access to their health information, then they can never get numerator credit for that reporting period.
• DENOMINATOR: The number of unique patients seen by the MIPS eligible clinician during the performance period.
Scoring Information
• Required for Base Score: Yes
• Percentage of Performance: Up to 10%
• Eligible for Bonus Score: One-time bonus of 10% for MIPS eligible clinicians and groups who report using 2015 Edition CEHRT exclusively for the 2018 performance period and submit only Advancing Care Information measures.
How do I achieve this measure?
You must be enrolled with ChartMaker® PatientPortal service and provide API Access.
The EC must have completed and signed an office note with a valid CPT code. Authorization must be sent, within 4 business days of the visit, to either the patient or patient’s authorized representative, for them to register for the PatientPortal, and API Access must be granted.
Likewise, the patient must be provided timely access (within 4 days) to their health information every time they are seen (where a note is created or a lab/result is imported) within the performance period. If there is one instance where a patient did not receive online access, then they can never get numerator credit for that reporting period.
Finally, each patient must be enabled for API access. API (Application Programming Interface) is a set of protocols that can allow different software systems to communicate with each other. APIs may be enabled by a health care provider to provide the patient with access to their health information through a third-party application.
To enroll to receive ChartMaker® PatientPortal service:
Go to: https://sticomputer.com/register-patientportal/ and complete the Register PatientPortal enrollment form to register your practice for the ChartMaker PatientPortal service.
To enroll/authorize the patient for the PatientPortal (with or without an email) and provide API access:
1. In Practice Manager, click the Patient tab, and then access the patient’s account.
2. In the Patient tab, click the Patient Access button.
3. In the Patient Portal account settings section of the Patient Access dialog, click the first Authorize button option if the patient provides you with their email address; or, click the second Authorize option if the patient does not have an email address.
NOTE: If the patient does not have an email address - Give printed instructions to the patient and encourage them to complete registration later.
4. After you click the Authorize button, an Authorize Patient dialog will appear outlining the option selected. Click the Yes button to confirm you want to authorize the patient to use the Patient Portal.
5. In the API Access section, check the Enable this patient for API access. A new Authentication code will be generated.
6. Check the Print this patient's authentication code option if you want to print the authentication code for the patient after saving; or check the Send an email to this patient with their authentication code option if you want the system to send an email to the email address on the Patient screen after saving. Do note, that when the Send an email option is selected, the email sent will not be encrypted, therefore, we suggest that you only use this option for API access if the patient authorizes you to send it that way.
NOTE: If an email address is not entered for a patient, you will only have the option to print the authentication code. If an email is entered, you can choose whichever manner the patient wishes to receive the code.
7. When finished, click the OK button in the Patient Access dialog.
8. The Patient Access button will now show as yellow, indicating a pending registration. The button will turn green once the patient completes the registration process. In the Patient screen, click the Save button to close the patient’s account.
Steps taken by the patient to complete registration and login to the Patient Portal
NOTE: This does not need to be complete by the patient for the EC to receive credit for this measure.
1. The patient will receive an email regarding their Patient Portal registration.
2. Click the link to access the Patient Portal to complete registration.
3. Fill out the required information (Username, Date of Birth, Password, Confirm Password, Security Question and Answer).
NOTE: The Date of Birth must match what is documented in Practice Manager/Clinical.
4. Accept the Terms of Use along with typing the security characters that are displayed in the picture.
5. When finished, click Register.
Additional Information
The timely access to health information requirement of four days only applies to sending notes generated in Clinical and electronic lab results. These notes must include some form of structured data to be counted, such as allergies, procedures, medications, or diagnoses. Scans and notes that do not include this structured data (such as telephone messages) are not included and do not need to be sent to the Patient Portal within four days.
For patients that are in a Pending status (yellow) for the Patient Portal, numerator credit will be given if all signed notes were done within 4 days. As with patients that have Active status (Green), if a note is not signed within 4 days, that patient can never receive numerator credit during the reporting period.
Enabling API access for a patient generates a unique case-sensitive code for that individual. This code can be used with participating third-party applications to view an up-to-date summary of that patient’s health information.
Objective: Patient Electronic Access
Measure: Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide electronic access to those materials to at least one unique patient seen by the MIPS eligible clinician.
Reporting Requirements
- NUMERATOR: The number of patients in the denominator who were provided access to patient-specific educational resources using clinically relevant information identified from CEHRT during the performance period.
- DENOMINATOR: The number of unique patients seen by the MIPS eligible clinician during the performance period.
Scoring Information
- Required for the Base Score: No
- Percentage of Performance Score: Up to 10%
- Eligible for bonus score: In CY 2018, a one-time bonus of 10% will be earned by MIPS eligible clinicians and groups who report using 2015 Edition CEHRT exclusively.
How do I achieve this measure?
The EC must provide the patient with access to clinically relevant educational materials electronically. Patient access means that the patient possesses all necessary information needed to view these materials. Therefore, either a yellow pending status or a green active status on the Patient Portal is sufficient to get numerator credit for this measure.
For this to occur, the patient must first be registered on the Patient Portal with an active (green) status.
There are two ways to receive numerator credit for this measure.
Method 1 - Educational materials can be saved in the note itself using the educational materials button and searching Medline Plus.
Click the Educational Materials button in a note. In the dialogue that follows, click the MedlinePlus button. A window will open to MedlinePlus. The tools at the top allow you search for information using the medications and diagnoses in the chart.
Chose a clinically relevant educational resource from MedlinePlus and click the Save button.
When the save button is clicked, a URL link to that resource is created. The link will be included in the Clinical Summary that is sent to the PatientPortal when the note is signed. When the patient clicks the item listed next to Educational Materials on the Patient Portal, it will take the patient to that resource.
Method 2 – Use the Scan Manager to attain numerator credit.
In the Scan Manager, select the document you wish to use for educational materials, and then click the Scan as Educational Materials box. This will flag the scan as Educational Materials in the system.
Open the chart note, right-click anywhere in the note, and then click Send note for Patient Access. This completes the process to attain numerator credit using this method.
Denominator credit is achieved by having a valid CPT encounter code in a chart note that falls within the reporting period.
Paper-based actions will not be counted in the calculations. The MIPS eligible clinician may still provide paper-based educational materials for their patients, but these are not included in measure calculations.
Objective: Coordination of Care Through Patient Engagement
Measure: View, Download or Transmit (VDT) or access API
During the performance period, at least one unique patient (or their authorized representatives) seen by the MIPS eligible clinician actively engages with the EHR by either - (1) viewing, downloading or transmitting to a third party their health information; or (2) accessing their health information using an Application Programming Interface (API) that can be used by applications chosen by the patient and configured to the API in the MIPS eligible clinician’s CEHRT.
Reporting Requirements
- NUMERATOR: The number of unique patients (or their authorized representatives) in the denominator who have viewed online, downloaded, or transmitted to a third party the patient’s health information during the performance period and the number of unique patients (or their authorized representatives) in the denominator who have accessed their health information using an API during the performance period.
- DENOMINATOR: Number of unique patients seen by the MIPS eligible clinician during the performance period.
Scoring Information
- Required for the Base Score: No
- Percentage of Performance Score: Up to 10%
- Eligible for bonus score: No
How do I achieve this measure?
EC will need to be enrolled to receive ChartMaker® PatientPortal service.
The EC will need to enter a valid CPT code in their office visit note and submit health information for their patient through the ChartMaker® PatientPortal. The EC will need to Provide Patient Access first through Practice Manager, and the patient must verify the registration before an exchange of information can occur.
Once the registration is verified, ChartMaker Clinical will automatically send updates at a preconfigured amount of time. The patient must also log into their PatientPortal account and either view Clinical Summaries or Lab Reports, download or transmit their information to a third party.
API access should be given at the time of registration. This is a required step to achieve numerator credit for the Patient Online Access to Health Information measure. In the case of this measure, it will provide an additional method for patients to engage with their Health Information electronically.
To enroll to receive ChartMaker® PatientPortal service:
Go to: https://sticomputer.com/register-patientportal/ and complete the Register PatientPortal enrollment form to register your practice for the ChartMaker PatientPortal service.
To enroll/authorize the patient for the PatientPortal (with or without an email) and provide API access:
1. In Practice Manager, click the Patient tab, and then access the patient’s account.
2. In the Patient tab, click the Patient Access button.
3. In the Patient Portal account settings section of the Patient Access dialog, click the first Authorize button option if the patient provides you with their email address; or, click the second Authorize option if the patient does not have an email address.
NOTE: If the patient does not have an email address - Give printed instructions to the patient and encourage them to complete registration later.
4. After you click the Authorize button, an Authorize Patient dialog will appear outlining the option selected. Click the Yes button to confirm you want to authorize the patient to use the Patient Portal.
5. In the API Access section, check the Enable this patient for API access. A new Authentication code will be generated.
6. Check the Print this patient's authentication code option if you want to print the authentication code for the patient after saving; or check the Send an email to this patient with their authentication code option if you want the system to send an email to the email address on the Patient screen after saving. Do note, that when the Send an email option is selected, the email sent will not be encrypted, therefore, we suggest that you only use this option for API access if the patient authorizes you to send it that way.
NOTE: If an email address is not entered for a patient, you will only have the option to print the authentication code. If an email is entered, you can choose whichever manner the patient wishes to receive the code.
7. When finished, click the OK button in the Patient Access dialog.
8. The Patient Access button will now show as yellow, indicating a pending registration. The button will turn green once the patient completes the registration process. In the Patient screen, click the Save button to close the patient’s account.
Steps taken by the patient to complete registration and login to the Patient Portal
1. The patient will receive an email regarding their Patient Portal registration.
2. Click the link to access the Patient Portal to complete registration.
3. Fill out the required information (Username, Date of Birth, Password, Confirm Password, Security Question and Answer).
NOTE: The Date of Birth must match what is documented in Practice Manager/Clinical.
4. Accept the Terms of Use along with typing the security characters that are displayed in the picture.
5. When finished, click Register.
- Login using the credentials designated in Step 3
- Complete one or all of the following actions: a) view Clinical Summaries by clicking Clinical Summaries, b) view Lab results by clicking Lab Results, c) download information by either going to Clinical Summaries or Lab Reports, and then clicking Download, or d) transmitting a Clinical Summary or Lab Report by going to Messages, and then clicking Send a Direct message.
Objective: Coordination of Care Through Patient Engagement
Measure: Secure Electronic Messaging
For at least one patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient authorized representative), or in response to a secure message sent by the patient (or the patient authorized representative), during the performance period.
Reporting Requirements
- DENOMINATOR: Number of unique patients seen by the MIPS eligible clinician during the performance period.
- NUMERATOR: The number of patients in the denominator for whom a secure electronic message is sent to the patient (or patient-authorized representative), or in response to a secure message sent by the patient (or patient-authorized representative), during the performance period.
Scoring Information
- Required for Base Score (50%): No
- Percentage of Performance Score (up to 90%): Up to 10%
- Bonus Score: In CY 2018, a one-time bonus of 10% will be earned by MIPS eligible clinicians and groups who report using 2015 Edition CEHRT exclusively.
How do I achieve this measure?
The EC sends a new or replied secure message to a patient through ChartMaker® PatientPortal. The secure message and an office visit must occur within the clinician’s reporting period. All message types will count toward the calculation of this measure.
To send the patient a new secure message:
- Open the patient’s chart.
- Click To-Do > New Patient Portal Message.
- Enter the Subject and your Message.
*It is recommended that you save as a chart note.
- Click the Send button.
Reply to a message sent from the patient:
NOTE: The clinician MUST REPLY to the patient’s message to get credit for this measure.
- Double-click the patient portal message in your To-Do List.
- Click the Reply button.
- Type in your reply message in top window.
*It is recommended that you save as a chart note.
- Click the Send button.
*NOTE: When saving as a chart note, you can change the heading of the note if desired. Click the OK button.
Objective: Coordination of Care Through Patient Engagement
Measure: Patient-Generated Health Data
Patient-generated health data or data from a non-clinical setting is incorporated into the CEHRT for at least one unique patient seen by the MIPS eligible clinician during the performance period.
Reporting Requirements
- NUMERATOR: The number of patients in the denominator for whom data from non-clinical settings which may include patient-generated health data, is captured through the CEHRT into the patient record during the performance period.
- DENOMINATOR: The number of unique patients seen by the MIPS eligible clinician during the performance period.
Scoring Information
- Required for Base Score (50%): No
- Percentage of Performance Score (up to 90%): Up to 10%
- Bonus Score: In CY 2018, a one-time bonus of 10% will be earned by MIPS eligible clinicians and groups who report using 2015 Edition CEHRT exclusively.
How do I achieve this measure?
The intent of this measure is to encourage providers to incorporate patient health information from various other sources directly into the patient record in the CEHRT. It includes both health data from non-clinical settings, as well as health data generated by the patient. The type of information is not mandated but would include things like:
- Advance Directive/Living Will
- Headache/food diary
- Glucose readings
- Health Information from Devices or applications (home health or personal health monitoring devices or applications, fitness and nutrition apps)
There are four different ways to incorporate patient-generated health data in Clinical, designed to provide maximum flexibility in satisfying this measure. Each of the following methods can be used to achieve numerator credit.
Denominator credit is earned for all four methods by having a note with a valid CPT encounter code in the patient’s chart, which falls within the reporting period.
Method 1 – Marking a note as Patient-Generated Health Data from the Organizer.
In the Organizer, highlight the chart Items you want to mark as Patient-Generated Health Data, then right-click. From this menu, select Mark as Patient-Generated Health Data.
The applicable item, or items, will then have a Yes in the Patient-Generated column.
Method 2 – Using the Scan Manager to associate Patient-Generated Health Data to a chart.
Patient generated health data can sometimes take the form of a physical document the patient has with them. In these cases, the document can be scanned into Clinical and associated with the correct chart. Once the document has been scanned, check the box next to Scan as Patient-Generated Health Data. Then search for the patient and save the scan to his or her chart. This will provide numerator credit provided that the patient was seen during the reporting period.
Method 3 – Adding Patient-Generated Health Data directly in the chart by browsing files on your computer.
Patient health data can be added from the note tab in the patient’s chart. Open a patient’s chart, then click the Note tab on the right-hand side, and then click Add Patient-Generated Health Data.
An Open dialog will appear, allowing you to browse your PC for the patient’s health document. Once the file is selected, it will appear in the patient’s Organizer, marked with a Yes in the Patient-Generated column. Clicking the item will open it in a new window.
Method 4 – Creating a link to an external source to access the patient’s health data.
Finally, it is possible to add a link to a website to satisfy the numerator for this measure. Click the Chart drop-down menu, and then select Patient-Generated Health Data. Click the Add button at the bottom to add a health data website. Enter the Title and Website for this source. You can also include Additional Details, if needed. Click the OK button to commit the changes to the patient’s record.
If the patient has a note with a valid encounter code within the reporting period, completing these steps will achieve numerator credit for the patient. Note that at the bottom of this dialogue is a menu listing all the items that have been flagged as patient-generated health data. You can navigate to each of these items, by selecting it in the drop-down menu and clicking the Open Note button.
Objective: Health Information Exchange
Measure: Send a Summary of Care
To meet the Base Score requirement, the MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for at least one transition of care or referral.
Reporting Requirements
- NUMERATOR: The number of transitions of care and referrals in the denominator where a summary of care record was created using CEHRT and exchanged electronically.
- DENOMINATOR: Number of transitions of care and referrals during the performance period for which the EP was the transferring or referring health care clinician.
Scoring Information
- Required for Base Score (50%): Yes
- Percentage of Performance Score (up to 90%): Up to 10%
- Bonus Score: Bonus Score: In CY 2018, a one-time bonus of 10% will be earned by MIPS eligible clinicians and groups who report using 2015 Edition CEHRT exclusively.
How do I achieve this measure?
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
- Open the patient’s clinical chart.
- Click To-Do > Direct Messaging > Send New Message.
- Click the To button.
- Enter the last name of the provider you are sending the document to. Enter city, state and addition fields to narrow the search results.
- Click the Search button.
- Click the provider in the search result window to highlight, and then click the To button.
- 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.
- In the Provider Selection field, select the Provider, and then click the Save button.
- In the Patient Information Document Exclusions dialog, check items you want to exclude, and then click the OK button.
- When the export is complete, click the OK button.
- Click the Send button.
- 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.
- 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.
- In an office visit note, click the Referral button.
- In the Referrals dialog, click the New button.
- Click the Choose Provider button, then search and highlight the applicable provider name, and then click the OK button.
- Select at least one Diagnosis in the corresponding fields.
- Enter any Comments, if applicable.
- Click the OK button.
- In the Referrals dialog, click the OK button.
Objective: Health Information Exchange
Measure: Request/Accept Summary of Care
To meet the Base Score requirement, for at least one transition of care or referral, the MIPS eligible clinician retrieves and incorporates an electronic summary of care document into the patient’s record.
Reporting Requirements
- NUMERATOR: The number of patient encounters in the denominator where an electronic summary of care record received is incorporated by the clinician into the CEHRT.
- DENOMINATOR: The number of patient encounters during the performance period for which a MIPS eligible clinician was the receiving party of a transition or referral or has never encountered the patient and for which an electronic summary of care record is available.
Scoring Information
- Required for Base Score (50%): Yes
- Percentage of Performance Score (up to 90%): Up to 10%
- Bonus Score: In CY 2018, a one-time bonus of 10% will be earned by MIPS eligible clinicians and groups who report using 2015 Edition CEHRT exclusively.
How do I achieve this measure?
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.
Objective: Health Information Exchange
Measure: Clinical Information Reconciliation
For at least one transition of care or referral received, or patient encounter in which the MIPS eligible clinician has never encountered the patient, the MIPS eligible clinician performs clinical information reconciliation. The MIPS eligible clinician 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, and (3) Current Problem list. Review of the patient’s current and active diagnoses.
Reporting Requirements
- 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.
- DENOMINATOR: Number of transitions of care or referrals during the performance period for which the MIPS eligible clinician was the recipient of the transition or referral or has never encountered the patient.
Scoring Information
- Required for Base Score (50%): No
- Percentage of Performance Score (up to 90%): Up to 20%
- Bonus Score: In CY 2018, a one-time bonus of 10% will be earned by MIPS eligible clinicians and groups who report using 2015 Edition CEHRT exclusively.
How do I achieve this measure?
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: Public Health and Clinical Data Registry Reporting
Measure: Registry Reporting
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:
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).
Syndromic Surveillance Reporting: The EP is in active engagement with a public health agency to submit syndromic surveillance data from an urgent care setting.
Public Health Registry Reporting: The EP is in active engagement with a public health agency to submit data to public health registries.
Clinical Data Registry Reporting: The EP is in active engagement to submit data to a clinical data registry.
Reporting Requirements
To meet this measure for the Performance Score, the MIPS eligible clinician must attest YES to submitting to one of the following public health or clinical data registries: (a) 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); (b) being in active engagement with a public health agency to submit syndromic surveillance data from an urgent care setting; (c) being in active engagement with a public health agency to submit data to public health registries; or (d) being in active engagement to submit data to a clinical data registry.
To meeting this measure for the Bonus Points, the MIPS eligible clinician must attest YES to submitting to one of the following public health or clinical data registries that is not reported under the performance score: (a) 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); (b) being in active engagement with a public health agency to submit syndromic surveillance data from an urgent care setting; (c) being in active engagement with a public health agency to submit data to public health registries; or (d) being in active engagement to submit data to a clinical data registry.
Scoring Information
- Required for Base Score: No
- Percentage of Performance Score: 10% for reporting to a single registry
- Eligible for Bonus Score: Yes, 5% if reporting to a single registry not reported under the performance score
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. and enrollment information.