- The Centers for Medicare & Medicaid Services (CMS) has issued three new frequently asked questions (FAQs) to clarify meaningful use requirements around health information exchange and patient engagement following the recent changes to the EHR Incentive Programs (i.e., meaningful use modifications).
The first FAQ focuses on the meaningful use HIE objective requirements eligible professionals, hospitals, and critical access hospitals to provide a summary care record for each transition of care or referral when transitioning a patient to another care setting or provider's care.
Specifically, the FAQ (FAQ 12817) provides details about calculating a numerator for this meaningful use requirement when third-party organizations are involving in determining where the patient is transferred or referred:
For the Health Information Exchange objective for meaningful use in 2015 through 2017, may an eligible professional (EP), eligible hospital or critical access hospital (CAH) count a transition of care or referral in its numerator for the measure if they electronically create and send a summary of care document using their CEHRT to a third party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document?
Yes. An EP, eligible hospital or CAH may count transmissions in this measure’s numerator when a third party organization is involved so long as:
- The summary of care document is created using certified EHR technology (CEHRT);
- The summary of care document is transmitted electronically by the EP, eligible hospital or CAH to the third party organization
In instances where a “third party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document” is involved, the service the third party provides does not have to be certified for the transmission to be counted in the numerator for measure 2. Nor are there any specific requirements around the technical standards or methods by which the third party delivers the summary of care document to the receiving provider (e.g., SOAP, secure email, fax).
The second and third FAQs focus on patient engagement requirements in meaningful use. Of all the modifications to meaningful use requirements impacted by recent rulemaking, patient engagement thresholds saw the most significant reduction as in the case of view, download, or transmit where now only a single patient rather than five percent is required to satisfy the measure.
The first (FAQ 12821) centers on patient specific education and patient electronic access:
If multiple eligible professionals or eligible hospitals contribute information to a shared portal or to a patient's online personal health record (PHR), how is it counted for meaningful use when the patient accesses the information on the portal or PHR?
This answer is relevant to the following meaningful use objectives: Patient Specific Education and Patient Electronic Access measure 2.
If an eligible professional sees a patient during the EHR reporting period, the eligible professional may count the patient in the numerator for this measure if the patient (or an authorized representative) views online, downloads, or transmits to a third party any of the health information from the shared portal or online PHR. The same would apply for an eligible hospital or CAH if a patient is discharged during the EHR reporting period. If patient-specific education resources are provided electronically, it may be counted in the numerator for any provider within the group sharing the CEHRT who has contributed information to the patient's record if that provider has the patient in their denominator for the EHR reporting period. The respective eligible professional, eligible hospital, or CAH must have contributed at least some of the information identified in the Medicare and Medicaid Programs; Electronic Health Record Incentive Program - Stage 3 and Modifications to Meaningful Use in 2015 Through 2017 final rule (80 FR 62807 through 62809) to the shared portal or online PHR for the patient. However, the respective provider need not have contributed the particular information that was viewed, downloaded, or transmitted by the patient.
Although availability varies by state and geographic location, some Health Information Exchanges (HIEs) provide shared portal or PHR services. If a provider uses an HIE for these services to make information available to patients, in order to meet meaningful use requirements the provider must use an HIE that is certified as an EHR Module for that purpose. The HIE must be able to verify whether a particular provider actually contributed some of the information identified in the Medicare and Medicaid Programs; Electronic Health Record Incentive Program - Stage 3 and Modifications to Meaningful Use in 2015 Through 2017 final rule to the shared portal or PHR for a particular patient. If a provider elects to use the HIE for these shared portal or PHR services, the provider must include the HIE’s certification number as part of their attestation.
Lastly, the third FAQ (FAQ 12825) goes over the process of calculating a patient's electronic activity (e.g., messaging, access):
In calculating the meaningful use objectives requiring patient action, if a patient sends a message or accesses his/her health information made available by their eligible professional (EP), can the other EPs in the practice get credit for the patient’s action in meeting the objectives?
Yes. This transitive effect applies to the Secure Electronic Messaging objective, the 2nd measure of the Patient Electronic Access (View, Download and Transmit) objective, and the Patient Specific Education objective.
If a patient sends a secure message about a clinical or health related subject to the group practice of their EP, that patient can be counted in the numerator of the Secure Electronic Messaging measure for any of the EPs at the group practice who use the same certified electronic health records technology (CEHRT) that saw and patient during their EHR reporting period.
Similarly, if a patient views, downloads or transmits to a third party the health information that was made available online by their EP, that patient can be counted in the numerator of the 2nd Patient Electronic Access measure for any of the EPs in that group practice who use the same CEHRT and saw that patient during their EHR reporting period.
If patient-specific education resources are provided electronically, it may be counted in the numerator for any provider within the group sharing the CEHRT who has contributed information to the patient's record if that provider has the patient in their denominator for the EHR reporting period.
More FAQs about the EHR Incentive Programs are available on the CMS website.