Health Information Exchange and Meaningful Use

Jim TateBy Jim Tate, EMR Advocate
Meaningful Use Audit Expert
Twitter: @JimTate, eMail:

It used to be called the “Summary of Care” but now we know it as “Health Information Exchange”. It is perhaps the most misunderstood of the Meaningful Use (MU) measures for everyone from solo docs to large health systems. I get emails everyday asking questions. Are there are any exclusions? Can I fax the information? Can I push the information to a HIE? Let’s break it down, one step at a time.

Overview: Here is what CMS tell us: “The EP, eligible hospital or CAH who transitions their patient to another setting of care or provider of care, or refers their patient to another provider of care, provides a summary care record for each transition of care or referral”

The Measure: “The EP, eligible hospital or CAH that transitions or refers their patient to another setting of care or provider of care must— (1) Use certified EHR technology (CEHRT) to create a summary of care record; and (2) Electronically transmit such summary to a receiving provider for more than 10 percent of transitions of care and referrals.”

The Document: The format of the document is the technical standard required for CEHRT (Certified Electronic Health Record Technology) functionality to create summary of care documents. That standard is the C-CDA (Consolidated Clinical Document Architecture).

Transition of Care (TOC) and Referrals: OK so what is considered a TOC or a Referral? CMS lays this out clearly for us: “A transition of care is defined as the movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. At a minimum, this includes all discharges from the inpatient department and after admissions to the emergency department when follow-up care is ordered by an authorized provider of the hospital.” And what about those EP referrals? How does CMS define those? “Referrals are cases where one provider refers a patient to another, but the referring provider maintains their care of the patient as well”. CMS provides more details in the reference documents below but you get the gist of it.

Electronic Transmission: Hopefully it is now clear when a Summary of Care, or TOC document (C-CDA generated from CEHRT) needs to be sent. But what about this “electronic transmission” business? Luckily, a wide variety of transmission methods are acceptable including secure email, HIE, HISP, etc. Just make sure the transmission method is HIPAA compliant. Interesting details are that the document does not have to be sent by CEHRT and a third party may send the summary of care record.

Exclusion: EPs get a potential break: “Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period.” Not so for EHs and CAHs as the TOC potential eligible patient definition “includes all discharges from the inpatient department and after admissions to the emergency department when follow-up care is ordered by an authorized provider of the hospital”.

Questions? OK time to respond to the 2 unanswered questions from the top of this post:

1) Can I fax the information? CMS helps us out here by clarifying that: “Faxing in general is not acceptable since it is not in C-CDA format. It is only acceptable when a third party is used to transmit the summary of care record and they must convert the transmission to fax because that is the only way the receiving provider can accept the transmission. Additionally, the conversion to fax by the third party must not be a default approach.”

2) Can I push the information to a HIE? Well you can but that action by itself does not count for MU as there must be “reasonable certainty of receipt of the summary of care document. This means that a ‘‘push’’ to an HIE, which might be queried by the recipient, is insufficient. Instead, the referring provider must have confirmation that a query was made to count the action toward the measure. (This could be a call to the receiving provider or email confirmation from the HIE itself in instances where a third party is used.) The exchange must comply with the privacy and security protocols for ePHI under HIPAA.”

CMS Resources for 2016 Meaningful Use Health Information Exchange

EHR Incentive Programs in 2015 through 2017 Health Information Exchange Tipsheet

Eligible Hospital Tip Sheet for Meaningful Use Stage 2: Implementation Tips for Summary of Care Objective

Jim Tate is known as the most experienced authority on the CMS Meaningful Use (MU) audit and appeal process. His unique combination of skills has brought successful outcomes to hospitals at risk of having their CMS EHR incentives recouped. He led the first appeal challenge in the nation for a client hospital that had received a negative audit determination. That appeal was decided in favor of the hospital. He has also been successful in leading the effort to reverse a failed appeal, even after the hospital had received notification of the failure with the statement, “This decision is final and not subject to further appeal”. That “final” decision was reversed in less than a week. If you are a hospital with questions or concerns about the meaningful use audit process, contact him at: