Medicaid PI Quick Start: HIE Create and Exchange Summary of Care

Measure Overview Medicaid Goal
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 referred to.

Must Exceed 50%
Setup Requirements

The following must be setup in your Prime Suite system for this measure:

  • The site must be registered with Updox to send direct messages.
  • 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.
  • The Access the Report Status Page user right must be assigned to any users who need access to monitor the Direct Messaging Status Report.
Denominator

If using Updox, transitions of care count when:

  • The patient had a qualifying visit checked-in during the measurement period.
  • A transition of care document was sent using the Updox – Direct Messaging: CCD link.
  • The Care Transition check box was selected in the Plan section of the Note associated with the visit.

If using Referral Management, transitions of care count when the referral is created using Referral Management.
Numerator

If using Updox, transitions of care count when:

  • The Care Transition, TOC Sent, and Receipt Confirmed check boxes are selected in the Plan section of a note.
  • The direct message to the provider receiving the referral is confirmed as received.

If using Referral Management, transitions of care count when:

  • Send Transition of Care Document is selected in Referral Management after creating the referral.
  • The direct message to the provider receiving the referral is confirmed as received.