Automated numerator recording

Required Attestation

Health IT developers with Health IT Modules certified to (g)(1) are required to attest that they have provided to other health IT developers and end-users documentation, including the following as applicable:

• Identify and acknowledge specific situations where the Health IT Module certified to (g)(1) does not have access to information that allows the module to determine if a numerator should be incremented or decremented for a measure. 
• Identify and acknowledge that the Health IT Module does not record TIN/NPIs and that the health IT developer or end-user is responsible for calculating performance at the TIN/NPI or group TIN for Promoting Interoperability measures. 

Required Attestation

Tester verifies that the attestation includes all required elements.

The health IT developer records and creates four reports, one for each ONC Test Data Scenario(s). Note that the health IT developer may create each report for a single required test or it may create one report for all of the required tests for which it is seeking certification. Any prescriptions written by the eligible clinician (EC), or discharge medication orders in an inpatient setting, will populate the numerator once per prescription transmitted electronically for a patient who was seen/admitted during the reporting/performance period.

EH/CAH Measure Description

Medicare Promoting Interoperability Program Measure:

• EH/CAH: At least one hospital discharge medication order for permissible prescriptions (for new and changed prescriptions) is transmitted electronically using certified electronic health record technology (CEHRT).

Medicare Promoting Interoperability Program Measure English Statements:

• Numerator: The number of prescriptions in the denominator generated and transmitted electronically.

Medicare Promoting Interoperability Program Measure Elements:

• Numerator: Prescription generated and transmitted electronically.

EC Measure Description

Merit-based Incentive Payment System (MIPS) Promoting Interoperability Performance Category Measure:

• EC: At least one permissible prescription written by the MIPS eligible clinician is transmitted electronically using certified electronic health record technology (CEHRT).

MIPS Promoting Interoperability Performance Category English Statements:

• Numerator: The number of prescriptions in the denominator generated and transmitted electronically using CEHRT.

Merit-based Incentive Payment System (MIPS) Promoting Interoperability Performance Category Measure Elements:

• Numerator: Prescription generated and transmitted electronically.

The tester verifies that each report, including the numerator, is created correctly and without omission and includes sufficient detail to match the patients or actions in the numerator report to the measure’s denominator limitations. The tester ensures that the correct patients are included in the numerator. The tester will use the information provided in required Test 1 and use ONC Test Data Scenario(s) 1, 2, 3, and 4.

The health IT developer records and creates four reports, one for each ONC Test Data Scenario(s). Note that the health IT developer may create each report for a single required test or it may create one report for all of the required tests for which it is seeking certification. The act of giving a patient timely online access to his or her health information will populate the numerator if:

Medicare Promoting Interoperability Program: Patient health information must be made available to the patient within 36 hours of its availability to the eligible hospital or CAH.

Promoting Interoperability performance category: Patient health information is made available to the patient within four business days of its availability to the EC.

Test Data

• Health IT Modules that are certified to § 170.315 (e)(1), (g)(9) or (g)(10) must use test data in tab RT 2a Provider Patient Exchange (EH/CAH and EC).
• Health IT Modules that are certified to § 170.315 (e)(1) only must use test data in tab RT 2b Provider Patient Exchange (EH/CAH and EC).
• Health IT Modules that are certified to § 170.315 (g)(9) or (g)(10) must use test data in tab RT 2c Provider Patient Exchange (EH/CAH and EC) and will only be tested for the Medicare Promoting Interoperability Programs and Promoting Interoperability performance Category measures.

EC/EH Measure Description

Medicare Promoting Interoperability Program Measure:

• Medicare EH/CAH: For at least one unique patient discharged from the EH or CAH inpatient or emergency department (POS 21 or 23): (1) The patient (or the patient-authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The eligible hospital or CAH ensures the patient’s health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the API in the eligible hospital or CAH's CEHRT.

Medicare Promoting Interoperability Program English Statements:

• Numerator: The number of patients in the denominator (or patient-authorized representatives) who are provided timely access to health information to view online, download, and transmit to a third party and to access using an application of their choice that is configured meet the technical specifications of the API in the hospital's or CAH's CEHRT.

Medicare Promoting Interoperability Program Measure Elements:

• Numerator:
  • Date and time information made available online to the patient;
  • Date and time of discharge;
  • Date and time information made available to an API.

EC Measure Description

MIPS Promoting Interoperability Performance Category Measure:

• For at least one unique patient seen by the MIPS eligible clinician: (1) The patient (or the patient-authorized representative) is provided timely access to view online, download, and transmit his or her health information; and (2) The MIPS eligible clinician ensures the patient's health information is available for the patient (or patient-authorized representative) to access using any application of their choice that is configured to meet the technical specifications of the Application Programming Interface (API) in the MIPS EC CEHRT.

MIPS Promoting Interoperability Performance Category English Statements:

• Numerator: The number of patients in the denominator (or patient authorized representatives) who are provided timely access to health information to view online, download, and transmit to a third party and to access using an application of their choice that is configured to meet the technical specifications of the API in the MIPS EC’s CEHRT.

MIPS Promoting Interoperability Performance Category Measure Elements:

• Numerator:
  • Date and time information available to the EC;
  • Date and time information made available online to the patient;
  • Date and time information made available to an API.

The tester verifies that each report, including the numerator, is created correctly and without omission and includes sufficient detail to match the patients or actions in the numerator report to the measure’s denominator limitations. The tester ensures that the correct patients are included in the numerator. The tester will use the information provided in required Test 2a, 2b, or 2c and use ONC Test Data Scenario(s) 1, 2, 3, and 4. The tester verifies that all of the required information below is made available to patients.

1. USCDI (which should be in their English representation)
2. Provider’s name and office contact information (ambulatory setting only)
3. Admission and discharge dates and locations; discharge instructions; and reason(s) for hospitalization (inpatient setting only)
4. Laboratory test report(s)
5. Diagnostic image report(s)

The health IT developer records and creates four reports, one for each ONC Test Data Scenario(s). Note that the health IT developer may create each report for a single required test or it may create one report for all of the required tests for which it is seeking certification. The Health IT Module will populate the numerator when a provider creates and transmits/exchanges a summary of care record and confirms receipt of the transmitted/exchanged summary of care record. Actions taken before or after the reporting/performance period will not increment in the numerator.

Beginning with the 2024 Medicare Promoting Interoperability Program and MIPS Promoting Interoperability reporting period, the Health IT Module will populate the numerator when a provider creates and transmits/exchanges a summary of care record, and confirms receipt of the transmitted/exchanged summary of care record, no earlier than the first day of the calendar year of the reporting/performance period (for a 180-day reporting/performance period), during the reporting/performance period (for a 180-day and full calendar year reporting/performance period), or no later than the end of the calendar year (for a 180-day reporting/performance period).

EH/CAH Measure Description

Medicare Promoting Interoperability Program Measure:

• Medicare EH/CAH: For at least one transition of care or referral the EH or CAH that transitions or refers its patient to another setting of care or provider of care (1) creates a summary of care record using CEHRT; and (2) electronically exchanges the summary of care record.

Medicare Promoting Interoperability Program Measure English Statements:

• Numerator: The number of transitions of care and referrals in the denominator where a summary of care record was created using CEHRT and exchanged electronically.

Medicare Promoting Interoperability Program Measure Elements:

• Numerator:
  • Summary of care record created and exchanged;
  • Summary of care record receipt confirmed.

EC Measure Description

MIPS Promoting Interoperability Performance Category Measure:

• For at least one transition of care or referral, the MIPS EC that transitions or refers his or her patient to another setting of care or health care provider (1) creates a summary of care record using CEHRT; and (2) electronically exchanges the summary of care record.

MIPS Promoting Interoperability Performance Category English Statements:

• Numerator: The number of transitions of care and referrals in the denominator where a summary of care record was created using CEHRT and exchanged electronically.

MIPS Promoting Interoperability Performance Category Measure Elements:

• Numerator:
  • Summary of care record created and exchanged;
  • Summary of care record receipt confirmed.

The tester verifies that each report, including the numerator, are created correctly and without omission and include sufficient detail to match the patients or actions in the numerator report to the measure’s denominator limitations. The tester ensures that the correct patients are included in the numerator. The tester will use the information provided in required Test 7 and use ONC Test Data Scenario(s) 1, 2, 3, and 4.

The tester shall verify that at a minimum, the following fields (listed below) in the summary of care record contain all of the information (or an indication of none) prior to numerator population. If a summary of care record does not contain all of the information (or an indication of none), the numerator should not be populated for both ambulatory and inpatient settings:

1. Current problem list;
2. Current medication list;
3. Current medication allergy list.

The health IT developer records and creates four reports, one for each ONC Test Data Scenario(s). Note that the health IT developer may create each report for a single required test or it may create one report for all of the required tests for which it is seeking certification.

EH/CAH Measure Description

Medicare Promoting Interoperability Program Measure (starting in 2019):

• EH/CAH: For at least one electronic summary of care record received for patient encounters during the EHR reporting period for which an EH or CAH was the receiving party of a transition of care or referral, or for patient encounters during the EHR reporting period in which the EH or CAH has never before encountered the patient, the EH or CAH conducts clinical information reconciliation for medication, mediation allergy, and current problem list.

Medicare Promoting Interoperability Program Measure English Statements (starting in 2019):

• Numerator: The number of electronic summary of care records in the denominator for which clinical information reconciliation is completed using CEHRT for the following three clinical information sets: (1) Medication – Review of the patient's medication, including the name, dosage, frequency, and route of each medication; (2) Medication allergy – Review of the patient's known medication allergies; and (3) Current Problem List – Review of the patient’s current and active diagnoses.

Medicare Promoting Interoperability Program Measure Elements (starting in 2019):

• Numerator: The number of electronic summary of care records with an indication that clinical reconciliation of medications, medications allergy, and current problem list occurred.

EC Measure Description

MIPS Promoting Interoperability Performance Category Measures (starting in 2019):

• For at least one electronic summary of care record received for patient encounters during the performance period for which a MIPS EC was the receiving party of a transition of care or referral, or for patient encounters during the performance period in which the MIPS EC has never before encountered the patient, the MIPS EC conducts clinical information reconciliation for medication, medication allergy, and current problem list.

MIPS Promoting Interoperability Performance Category Measures English Statement (starting in 2019):

• Numerator: The number of electronic summary of care records in the denominator for which clinical information reconciliation is completed using CEHRT for the following three clinical information sets: (1) Medication – Review of the patient's medication, including the name, dosage, frequency, and route of each medication; (2) Medication allergy – Review of the patient's known medication allergies; and (3) Current Problem List – Review of the patient’s current and active diagnoses.

MIPS Promoting Interoperability Performance Category Measure Elements (Starting in 2019):

• Numerator:
  • The number of electronic summary of care records with an indication that clinical reconciliation of medications, medications allergy, and current problem list occurred.

The tester verifies that each report, including the numerator, are created correctly and without omission and include sufficient detail to match the patients or actions in the numerator report to the measure’s denominator limitations. The tester ensures that the correct patients are included in the numerator. The tester will use the information provided in required Test 15 and use ONC Test Data Scenario(s) 1, 2, 3, and 4.