2019 Reporting and HIE

For the performance year 2019, 2015 Edition CEHRT is required for participation in this performance category and the PI measures fall under four objectives. Clinicians are required to report measures from each of the four objectives to complete their PI requirements.

  1. e-Prescribing – Worth 10 percent of PI score
  2. Health Information Exchange – Worth 20 percent each for sending and receiving information via EHR
  3. Provider to Patient Exchange – Worth 40 percent of PI score
  4. Public Health and Clinical Data Exchange – Worth 10 percent for participating in two registries

Participants must submit collected data for certain measures from each of the 4 objectives measures for 90 continuous days or more during 2019.

What is HIE?

The number one question Qsource receives about Promoting Interoperability is “What is health information exchange and how do I do it?” With all the quality improvement programs promoting Electronic Health Records (EHR) the demand for Electronic Health Information is increasing. Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other healthcare providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety and cost of patient care. [i] So patient information can be securely exchanged with more providers and facilities across our nation when participating in HIE.

We need to share timely, appropriate patient information to assist providers and facilities to:

  • Avoid readmissions – lowering cost
  • Avoid medication errors – improve patient safety
  • Improve diagnoses – access more test and information about previous patient care
  • Decrease duplicate testing – improve patient satisfaction and reduce cost

Direct Message/Exchange

In our area, direct messaging is a vital resource for sharing patient information. Direct messaging is a way providers can easily and securely send patient information—such as laboratory orders and results, patient referrals, or discharge summaries, a summary of care —directly to another healthcare professional. This information is sent over the internet in an encrypted, secure, and reliable way amongst healthcare professionals who already know and trust each other, and is commonly compared to sending a secured email. This form of information exchange enables coordinated care, benefitting both providers and patients. For example:

A primary care provider can directly send electronic care summaries that include medications, problems, and lab results to a specialist when referring their patients. This information helps to inform the visit and prevents the duplication of tests, redundant collection of information from the patient, wasted visits, and medication errors.

Directed exchange is also being used for sending immunization data to public health organizations or to report quality measures to The Centers for Medicare & Medicaid Services (CMS).

Promoting Interoperability

For 2019 HIE means:

Support Electronic Referral Loops by Sending Health Information

For at least one transition of care or referral, the MIPS eligible clinician that transitions or refers their patient to another setting of care or health care provider — (1) creates a summary of care record using certified electronic health record technology (CEHRT); and (2) electronically exchanges the summary of care record. A transition of care is defined as 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 MIPS eligible clinician. The denominator is the number of transitions of care (the number of patients you have meeting the criteria) and referrals during the performance period for which the MIPS eligible clinician was the transferring or referring clinician. The numerator is the number of transitions of care and referrals in the denominator where a summary of care record was created using CEHRT and exchanged electronically.

There is an exclusion – any MIPS eligible clinician who transfers a patient to another setting or refers to a patient fewer than 100 times during the performance period. When your denominator is less than 100 the exclusion applies.

Support Electronic Referral Loops by Receiving and Incorporating Health Information

For at least one electronic summary of care record received for patient encounters during the performance period for which a MIPS eligible clinician was the receiving party of a transition of care or referral, or for patient encounters during the performance period in which the MIPS eligible clinician has never before encountered the patient, the MIPS eligible clinician conducts clinical information reconciliation for medication, medication allergy, and current problem list. The denominator is calculated by the number of electronic summary of care records received using CEHRT for patient encounters during the performance period for which a MIPS eligible clinician was the receiving party of a transition of care or referral, and for patient encounters during the performance period in which the MIPS eligible clinician has never before encountered the patient. Your numerator is the number of electronic summary of care records in the denominator for which clinical information reconciliation is completed using CEHRT 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.

There are two exclusions for this measure:

  1. Any MIPS eligible clinician who is unable to implement the measure for a MIPS performance period in 2019 would be excluded from having to report this measure. Or
  2. Any MIPS eligible clinician who receives fewer than 100 transitions of care or referrals or has fewer than 100 encounters with patients never before encountered during the performance period.

The complete specifications are found on the QPP Resource page with the link below – specifically what to include in your Clinical Summary Report so you are sure to meet the specification for sharing:

Summary of Care Record – All summary of care documents used to meet this objective must include the following information if the MIPS eligible clinician knows it:

  • Patient name
  • Demographic information (preferred language, sex, race, ethnicity, date of birth)
  • Smoking status
  • Current problem list (eligible clinicians 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 clinician and the receiving clinician)*
  • 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 clinician’s name and office contact information
  • Encounter diagnosis
  • Functional status, including activities of daily living, cognitive and disability status
  • Reason for referral

Work with your EHR vendor to ensure your HIE process is completely set up based on CEHRT requirements and that your Summary of Care includes all required information. As always, we are here to assist with this process. Completing this measure is part of the free service we offer providers. If you have additional questions or need assistance in completing this process, please contact us at 844-205-5540 Monday – Friday 8:30 am – 5 pm (Central Time) or through techassist@qsource.org.