Support Electronic Referral Loops by Sending Health Information

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Measure Overview

This measure reports the number of referrals (or other transitions of care), in which the provider who transitions the patient to another caregiver or setting of care electronically sent a summary of care document to the provider the patient’s care is being transitioned to.

In this section, we will use the word referral to mean referral or transition of care.

Measure Overview
Denominator

The number of unique transitions of care and referrals in which the provider transitioned patient care to another provider.

Multiple referrals during a single visit are counted separately. Additionally, referrals may occur outside the context of a visit. For example, a referral may be made based on test results.

Numerator The number of transitions or referrals in which the provider generated a summary of care document and provided it electronically to the receiving provider.
Medicare Goal

At least 1 transition in numerator

See the following sections for more information about the Support Electronic Referral Loops by Sending Health Information measure:

Denominator Criteria

In Prime Suite, you can use either Updox or Referral Management to send a transition of care to a provider. Depending on whether Updox or Referral Management is used to send the referral, the criteria to qualify for the denominator differ.

  • If using Updox, all the following must be met to qualify a referral for the denominator:
  • The patient must have a qualifying visit checked-in during the performance period. The best practice is to also check-out the visit during the performance period.
  • A transition of care was sent using the Updox – Direct Messaging: CCD system link to the provider the patient’s care is being referred to.
  • The Care Transition check box is selected in the Plan section of the visit note.
  • If using Referral Management, creating a referral in Referral Management qualifies the referral for the denominator.

You can launch the process of creating the referral from the Plan section of a Note or directly in the Referral Management tool.

Pre-authorization referrals can qualify for this measure's denominator and affect its overall score. The best practice to prevent these from counting is to create a Care Provider that can be used when sending pre-authorization referrals. This provider should not be included in the Prime Suite RegulatoryReportingGroup. You will need to edit any existing pre-authorization referrals to list the new Pre-Authorization Care Provider as the From Provider. You can the Comments section of the referral to note the original ordering provider. By using this workflow, you will prevent pre-authorization referrals from affecting your score for this measure. See Adding a Care Provider for more information about adding a new care provider in Prime Suite.

Numerator Criteria

Referrals that qualified for the denominator count in the numerator if they show that a transition of care document was provided electronically to the provider that the patient’s care is being transitioned to. The transition of care or summary of care document must be sent and received by the other provider during the performance period (the date range you set in the Program Settings in Prime Suite Reporting 2020).

Transition of care documents can qualify using two methods, both of which send the document via a Direct Message:

1. Selecting Send Transition of Care Document in Referral Management after creating the referral.
2. Selecting Updox – Direct Messaging: CCD from System Links in Prime Suite. When using this method, the following check boxes must be selected in the Plan section of a Note.
  • Care Transition
  • TOC Sent: This check box must be selected at the same time or after the start of the visit.
  • Receipt Confirmed: This check box should NOT be selected until the message is confirmed as received.

The Updox – Direct Messaging: CCD option is only available for providers registered with Updox. Clinical Staff and non-providers can send referrals through Referral Management. If you send the document through Referral Management, DO NOT select the check boxes listed above in the Plan section of the Note. Otherwise, the measure counts will be inaccurate.

For either method, the message must also be received to qualify.

  • Your practice must verify the Direct Message with the attached document is received. You can use the DM Status Report to monitor these receipts, so you will have the chance to resend the message within the performance period.
  • If the message is not received within the performance period, the referral will not qualify for the numerator.

See Verifying Receipt of the Direct Message for additional information.

Setup Requirements

For this measure, you must have the following setup in your Prime Suite system:

  • Your site must be registered with Updox to send a Direct Message or have one sent on your behalf in Prime Suite. See the Updox Registration topic in the Prime Suite help system for additional information.

You must have Updox Direct Messaging; Updox Fax and Updox Reminders do not count toward this measure.

  • Both the provider referring the patient and the provider the patient is being referred to must be added as Care Providers in Prime Suite with an associated Direct E-mail Address. See the Creating a Direct Email Address topic in the Prime Suite help system for additional information.
  • To view the Direct Messaging Status Report (used to verify that the provider the patient is being referred to receives the Direct Message with the summary of care document), a user must have the Access the Report Status Page user right assigned within the Reporting Rights module in the Status category.

For providers registered with Updox, this report is also available in the My Links > System Links.

Send a Summary of Care Workflows

You can create a referral and send a Direct Message with the transition of care document using:

  • Referral Management: Creating a referral in Referral Management qualifies the referral for the denominator. Taking the additional Referral Management steps to electronically send the transition of care document and ensure its receipt qualifies the referral for the numerator.

You can launch the process of creating the referral from the Plan section of a Note or directly in the Referral Management tool.

  • Updox - Direct Messaging: CCD (Direct Admit): This method sends the transition of care document without creating a referral. This method is generally used when referring the patient for immediate care during a visit (often referred to as a Direct Admit) and, to qualify for this measure, requires that you also record your actions in the Plan section of the Note associated with the visit. You must record your actions within the performance period.

You must also monitor the status of the Direct Message to:

  • Ensure that the other provider received the message with the document attached within the performance period.
  • Resend the message if it was not received.
  • Mark your confirmation of the receipt (if sent with Updox ).

Creating a Referral and Sending a Transition of Care Document

See the sections below for information on creating a referral and sending a transition of care document:

Creating a Referral and Sending a Transition of Care using Referral Management

1. Ensure that both the sending and receiving provider have a Direct E-mail Address specified in your system.
2. Do one of the following to open the Outbound Referral window:
a. Launch Referral Management (Registration > Referral Management).
b. Search for and select the patient, if necessary. If you have the patient's chart open before launching Referral Management, the patient is automatically selected.
c. Select the Add Referral icon in the upper-right corner of the Referral/Authorization tab.
d. Select Outbound.
e. Select Internal if the referral is to another provider within your practice.

The Internal Referral Reporting parameter (System > System Configuration) must be set to True for internal referrals to qualify.

f. Select the Save icon.

OR

a. Open the Plan section of a Note associated with a visit.

Use this method only if creating the referral during a visit.

b. Scroll down to the Outbound/Inbound Referral area.
c. Select Add New Outbound Referral.

3. Select the Select link in the Referral To: field. Follow the prompts to search for and select the provider the patient is being referred to from all Care Providers defined in your system.

If Send Transition of Care Document does not appear below the Create Date on the screen, the selected provider does not have a Direct Email Address in your system.

4. Enter the purpose for the referral in the Reason field.
5. Complete the remaining fields for the referral, as applicable.
6. (Optional) Before you are ready to send the referral, perform the following actions to generate the Referral ID to use in the Subject of the Direct Message. The Referral ID makes it easier to determine whether the direct message is received by the other provider.
a. Select Save to save the information you have entered.
b. Select No when prompted to send the referral electronically. Prime Suite saves the referral and assigns a Referral ID.

Completion of this step qualifies the referral for the denominator of this measure.

c. When you are ready to send the referral and transition of care, select the referral in the Referral Management window. Then select the Edit Referral icon to open the Outbound Referral window again. The Referral ID displays at the top of the window.
7. Select Send Transition of Care Document to open the Transition of Care window, which allows you to send a Direct Message to the provider selected in the Referral To field on the referral.

8. Enter the desired Subject and Message. The paperclip icon indicates the CCDA/transition of care document is attached.

Include the Referral ID in the Subject line to make it easier to verify that the other provider receives the message for this referral.

9. Select Send.
10. Verify the direct message is received within the time frame required for the PI program. See Verifying Receipt of a Direct Message below for step-by-step instructions.

Sending a Transition of Care using the Updox - Direct Messaging: CCD System Link (Direct Admit)

1. Select My Links , select the System Links tab, and then select Updox – Direct Messaging: CCD to open the Transition of Care window.

This option is only available for providers registered with Updox; clinical staff and non-providers can send referrals through Referral Management.

The paperclip icon shows that the CCDA/transition of care document is attached.

2. In the To field, either enter the Direct E-mail Address or select Find in Directory to search for the provider you are referring the patient to.
3. Enter the desired Subject and Message.

Include text, such as Direct Admit, in the Subject line to help you identify the message in the DM Status Report, making it easier to verify that the other provider receives the message for this referral.

4. Select Send.
5. Open the Plan section of the Note associated with the visit and select the following the check boxes:
  • Care Transition: Selecting this check box indicates you referred the patient to another provider. This qualifies the referral for the denominator.
  • TOC Sent:. Selecting this check box indicates you sent a transition of care document to the provider the patient is being referred to.

You must select the TOC check box at the same time or after the start of the visit.

Both the TOC Sent and Receipt Confirmed check boxes must be selected for the referral to qualify for the numerator. However, do not select the Receipt Confirmed check box until you confirm the provider received the message.

Verifying Receipt of a Direct Message

The DM Status Report log displays the status of all direct messages sent from Prime Suite whether using Referral Management or the My Links option.

To open the DM Status Report, select Reporting > Report Selection > Report Status > DM Status Report tab.

Because the other provider must receive the message within the performance period, the best practice is to view this report often for two reasons. First, you allow yourself time to resend any messages that were not received. Secondly, you must select the Receipt Confirmed check box for any successful messages sent using Updox before the performance period ends.

The Receipt Confirmed check box should only be selected for qualifying messages sent using Updox. This is because Updox is a third-party partner that supplies the ability to send and receive Direct Messages to Prime Suite. The DM Status Report log can display information supplied by Updox, but Prime Suite cannot use information from this log for measure results. Because of this, the Receipt Confirmed checkbox is used to indicate the direct message was received successfully.

Interpreting the DM Status Report

The DM Status Report includes the following columns:

  • Status: Indicates whether the message was received (Received) or not (Sent).
  • Status Date/Time: Contains the date and time that the message reception or failure occurred.
  • Sent Date/Time: Indicates the date and time that the message was sent (when you selected Send in the Transition of Care window).
  • Subject: Can help you identify whether you used Referral Management or not if you added the Referral ID or Direct Admit in the subject when sending the message.

Based on the status for a message in the DM Status Report, you can determine the next best steps by referencing the two tables below.

If the Status is Received…
And the performance period has… And the method is… Then…
Not ended Referral Management The referral will qualify. No further action is needed.
Direct Admit

The referral will qualify if you also record the receipt within the performance period:

  1. Open the Plan section of the Note associated with the referral.
  2. Select the Receipt Confirmed check box.
Ended Referral Management

The referral will qualify or not, based on the Status Date/Time. No further action is needed.

Direct Admit

If you have not reviewed this report and selected the Receipt Confirmed check box within the performance period, the referral will NOT qualify, regardless of whether the Status Date/Time is before the end of the performance period.

Do NOT select the Receipt Confirmed check box in the Note.

 

If the Status is Sent…
And the performance period has… And the method is… Then…
Not ended Referral Management

Resend the message:

  1. Open the referral in Referral Management (use the Patient ID and Referral ID).
  2. Select Send Transition of Care Document, update the Subject to include the attempt number after the Referral ID, and send the message again.
  3. Verify the receipt of this message.
Direct Admit

Resend the message:

  1. Recreate and send the Direct Admit message. (include the attempt number in the Subject).
  2. Verify the receipt of this message.
Ended Referral Management The referral will NOT qualify, but you should resend the message so that the other provider receives the transition of care document.
Direct Admit

The referral will NOT qualify, but you should resend the message so that the other provider receives the transition of care document.

Do NOT select the Receipt Confirmed check box in the Note.