MIPS 2019, 3 of 4

In our last post we did an overview of Promoting Interoperability (PI) and its objectives. However, there are some major changes in the Health Information Objective measures, particularly in how they are scored. Since this particular objective can generate up to 50 points of your PI score (if you claim an e-Prescribing exclusion) a little more detail and explanation is warranted.

The biggest change for 2019 is that the scoring is percentage based, meaning that you'll need to send as many CCDs via Direct Message as possible, as well as incorporating all that you receive electronically. Detailed instructions are below.

There are two measures in the objective:

• Support Electronic Referral Loops by Receiving and Incorporating Health Information
• Support Electronic Referral Loops by Sending Health Information

We will discuss what to do about each measure in turn.  But first, if you have any questions about the meaning of terms like CCD or Direct Message or you're wondering how to get a Direct Messaging address, or how to get the addresses of other providers, please ask the question in the comments section - if you are wondering, so are others.


Support Electronic Referral Loops by Receiving and Incorporating Health Information

Scoring: 20 points

Scoring Formula:

(Number of CCDs incorporated into AuroraEHR)

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(Number of CCDs you receive electronically)

You need to be sure that you receive at least one referral or transfer of care in a structured format (CCD) via Direct message.  This might involve reaching out to your referrers, but remember they are probably also working to reach their MIPS goals. They should be happy to cooperate with you, since this will help them on the Sending measure within this objective.

You can find out if you have any incoming Direct messages in two ways.  We suggest that you either use the first option or make a staff member responsible for doing a check using the second method every day.

•  AuroraEHR -> Task View:  The second option on the screen is External Alerts - my Direct (secure) Messages.  You could check this toggle box, save the default with the red heart button, and make the Task View run automatically every time you log in.  This way you'll never miss an incoming message.
• AuroraEHR -> Secure MD Toolbox Messages:  As soon as you enter this screen, the system will check for any new Direct Messages and display them to your screen.

When you do receive a message with an attached CCD (structured clinical data) follow these steps.

• One way or another, you'll be in the Secure MD Toolbox Messages screen.
  

• In the grid, select the the new message. Look under the Added to Chart column on the far right to see if it's been processed yet.

• Select the Add to Patient's Chart tab and press the Add to Chart - Pick Account button. You'll need to match the incoming message to a patient already in your system.  Part of the incoming message should be identifying information about the patient, and AuroraEHR can often make the match for you.

• The CCD itself will be saved in the patient's Outside Reports, but in order to make it truly useful, you'll need to reconcile problems, allergies, and medications between the incoming record and the information (if any) already in your system. 

Support Electronic Referral Loops by Sending Health Information

Scoring: 20 points.

Scoring Formula:

(Number of  referrals/transitions of care you send via Direct Message)

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(Number of referrals/transitions of care you perform)

Here are some notes and steps to follow:

• The Continuity of Care you send must include all the patient's clinical data, including your assessment and plan. This means that your progress note (or other free text notes) should be complete before sending.
• It must include information about medications, allergies, and problems.  It's OK to use the Allergies screen to indicate "no known allergies", but not to skip the allergy task altogether, etc.
• Therefore, a Direct Message should be sent right before or right after completing the encounter. We suggest that you add (or ask Client Services to add) a Send Direct Message task to your AuroraEHR task list and that Mark as done automatically after running this task is NOT checked.  This is the biggest change you'll need to make in your work flow.
• This new task will take you to the Direct Message screen, where you can send either a referral or a Continuity of Care message.  You can also add any other files you wish, such as an image file or a PDF with lab results:

• Important: Do not add private information to the Subject. This line is not encrypted and any sensitive information will display there for any hacker to see. You can add sensitive and private material to the Message box which is safely encrypted.  The patient's name and date of birth is entered for you as a default.
• When you press the Send button, AuroraEHR will display a pop-up message letting you know if the Direct Message was sent successfully or not.
• Note: The message is not sent until you press the Send button. If you forget to to do so, you will not get credit for this measure.

Make sure to complete the Providers Orders/Notes (or similarly named) task for every referred patient to get the full 20 point credit for this measure.

Blog posts in this series:

Part 1 (Overview of 2019 MIPS)
Part 2 (Promoting Interoperability)
Part 3 (Health Information Objective)
Part 4 (Quality Performance Category)