Transition of Care Referral Summaries Stage 2 Core Measure 15 of 17

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1 Transition of Care Referral Summaries Stage 2 Core Measure 15 of 17 Objective: The EP who transitions their patient to another setting of care or provider of care, or refers their patient to another provider of care should provide a summary care record for each transition of care or referral. Measure(s): This core measure has 3 separate components. EPs must meet both of the following measures and satisfy the 3 rd criteria in order to meet the objective: Note: To count in the numerator of any of the measures, the EP must verify that the current problem list, current medication list, and current medication allergy list are not blank, and include the most recent information known by the EP at time of generating the summary of care document. Measure 1: summary of care record for more than 50 percent of transitions of care and referrals. Numerator: The number of transitions of care and referrals in the denominator where a summary of care record was provided. Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring /referring provider >50% Denominator: Total number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring /referring provider. Calculated by the number of LMR referral transactions (Patient Chart / Referrals) created by the referring provider during the reporting period where the referred to provider is a non LMR user. Only non LMR users will be added to the denominator Referrals that are not finalized or that are retracted are not included in the denominator o Referrals that are not finalized are referrals whose next step is Draft Staff to Complete, Draft MD to Complete, Staff to Complete or Pending Authorization o Referrals that are retracted are any closed referrals where the closed reason is Error, Denied or No longer needed Numerator: The number of transitions of care and referrals in the denominator where a summary of care record was provided. LMR Number of CCDA referral summaries that were provided: Created in LMR referral manager (LMR/Patient Chart/Referral) o and Printed or o transmitted (MaHIway, ) Page 1

2 Threshold: The percentage must be more than 50 percent in order for an EP to meet this measure. Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider fewer than 100 times during the EHR reporting period is excluded from all three measures. Measure 2: summary of care record for more than 10 percent of such transitions and referrals either (a) electronically transmitted using CEHRT to a recipient or (b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN. summary of care record for more than 10 percent of such transitions and referrals via electronic transmission using the transport standard certified by the LMR. The LMR was certified to electronically transmit a summary of care and referrals according to the primary Direct Project Specification via the Mass HIway the Mass HIway is collaboration between the Massachusetts Executive Office of Health and Human Services (EOHHS) and MeHI to deploy a secure statewide health information exchange. Numerator: The number of transitions of care and referrals in the Denominator where a summary of care record was electronically transmitted via Mass HIway >10% Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring /referring provider. Denominator: Number of transitions of care and referrals during the EHR reporting period for which the EP was the transferring /referring provider Calculated by the number of LMR referral transactions (Patient Chart / Referrals) created by the referring provider during the reporting period where the referred to provider is a non LMR user. Only non LMR users will be added to the denominator Referrals that are not finalized or that are retracted are not included in the denominator o Referrals that are not finalized are referrals whose next step is Draft Staff to Complete, Draft MD to Complete, Staff to Complete or Pending Authorization o Referrals that are retracted are any closed referrals where the closed reason is Error, Denied or No longer needed Numerator: The number of transitions of care and referrals in the denominator where a summary of care record was electronically transmitted via the Mass HIway. LMR Number of CCDA referral summaries that were provided: Created in LMR Referral Manager (LMR/Patient Chart/Referral) o and transmitted (MaHIway, ) Page 2

3 Threshold: The percentage must be more than 10 percent in order for an EP to meet this measure. Exclusion(s): Any EP who transfers a patient to another setting or refers a patient to another provider fewer than 100 times during the EHR reporting period is excluded from all three measures. Measure 3: An EP must satisfy one of the following criteria: 1. Conducts one or more successful electronic exchanges of a summary of care document, as part of that which is counted in "Measure 2" (for EPs the measure at 495.6(j)(14)(ii)(B) with a recipient who has EHR technology that was developed and designed by a different EHR technology developer than the sender's EHR technology certified to 45 CFR (b)(2)). a. If you have a numerator for measure 2, you have fulfilled measure 3. Measure 2 counts successful exchanges to non LMR users and therefore the recipient will have EHR technology that was developed and designed by a different EHR technology developer. 2. Conducts one or more successful tests with the CMS designated test EHR during the EHR reporting period. Exclusion(s): Any EP who transfers a patient to another setting or refers a patient to another provider fewer than 100 times during the EHR reporting period is excluded from all three measures. Additional Information The EP that transfers or refers the patient to another setting of care or provider should provide the summary of care document. The provider who has the most recent information on the patient will be providing the report which may be crucial to the provider to whom the patient is transferred or referred. The EP can send an electronic or paper copy of the summary care record directly to the next provider or can provide it to the patient to deliver to the next provider, if the patient can reasonably be expected to do so, and meet Measure 1. If the provider to whom the referral is made or to whom the patient is transitioned has access to the medical record maintained by the referring provider, then the summary of care record would not need to be provided, and that patient must not be included in the denominator for transitions of care (referral will check for LMR user status of receiving provider). To count in the numerator of Measure 2, the summary of care record must be received by the provider to whom the sending provider is referring or transferring the patient. The acknowledgement from the Mass HIway will serve as the receipt acknowledgement. Page 3

4 How to use the LMR to fulfill the Transition of Care Referral Summary core requirement: 1. From the LMR, select the Patient Chart and then select Referrals, or select Desktop and then Referral Manager. 2. Select the New button and the referral transaction screen will be displayed. 3. Select a Specialist (referred to provider) by selecting from Favorites list or from the Corporate Provider Master. 4. Select a Prelim Diag/Reason for referral. Select a referring provider (may be preselected to logged on user).note: Referral summaries are only required when the specialist is a non LMR user. The Clinical Summary checkbox will be automatically checked if the specialist is a non LMR user. 5. Ensure that the Send immediately after signing checkbox is selected. 6. Select Ok Final or OK/Final Print Page 4

5 7. Sign for the transaction Eligible Professional Meaningful Use Stage 2 A referral summary document request will be submitted. Once it is created it will be transmitted to the specialist selected. The COMM column will display the status of the request submitted then ed if successful. The text e mailed will be linked to the referral summary document sent. Clicking on this link will display the referral document which was transmitted. Printing and Mailing the Referral Document If you would like to print the referral and mail it to the specialist, either because the specialist is not found in the provider dictionary or does not have an option: 1. Click on the Show details link within the specialist area this will display the send by options. 2. Select the Print option. 3. Submit the request to create the referral summary. 4. The COMM column will display the status submitted. When the document is ready the status will change to Ready to Print. 5. Clicking on the Ready to print link will display the referral summary document. 6. Click on the Print button located on the document. 7. The referral summary will be printed and the status will change to Printed. Note: If the referral summary has a status of Printed or E mailed in the Comm column, this referral will be counted in the numerator for Measure 1. Page 5