1. Beacon Community Program Build and Strengthen – Improve – Test innovation Beacon-EHR Vendor Full Affinity Group May 17, 2013

2. Roll call – Lynda Rowe User Stories Update VDT User Story review – Kim & Alan (Displayed on Webex) Outline MU 2 Numerator/Denominator Tracking Responsibilities – Lynda Rowe Pilot Scenario Discussion – Lynda Rowe Outline of Possible Pilots – Lynda Rowe Beacon Pilot Form (Displayed on Webex) – Lynda Rowe Identification of Beacons/Vendors that will fit into each Transport Use Case – Lynda Rowe Paul Tuten Presentation Update – Chuck Tryon HealtheWay Update – Chuck Tryon/Lynda Rowe WIKI Development Update – Greg Dengler (Displayed on Webex) Work Plan Progress – Chuck Tryon Wrap up/Next Steps – Lynda Rowe Today’s Goals 1

3. Possible Pilot Scenarios 1 - 5 2 Pilot # Query OR Push Provider A Transport Method Certified Transport Entity Transport Method To Provider B C-CDA Generation MU 2 Metric Reporting Description Pilot 1 PushDirect (SMTP + S/MIME) EHR TechnologyTransport is directly from provider A Provider A EHR EHR Supports all aspects of DIRECT Transport Pilot 2 PushAny Edge Protocol HISP /HIE/HIODirect (SMTP + S/MIME)HISP/HIE/HIOHISP/HIO/HIEHISP/HIE/HIO must be certified to the TOC objective, i.e. support The Direct Applicability statement/produce a C-CDA Pilot 3 PushAny Edge Protocol EHR module Certified with Associated HISP/HIO (relied upon software) Direct (SMTP + S/MIME)EHR Vendor and relied upon software EHR vendor + relied upon software must meet MU2 criteria Pilot 4 PushDirect (SMTP + S/MIME)+ XDR/XDM EHRTransport is directly from provider A Provider A EHR Same as Pilot 1, except adding the optional XDR/XDM transport Pilot 5 PushAny Edge Protocol HISP /HIE/HIODirect (SMTP + S/MIME)+ XDR/XDM HISP/HIE/HIOHISP/HIO/HIEHISP/HIE/HIO must be certified to the TOC objective, i.e. support The Direct Applicability statement/produce a C-CDA

4. Possible Pilot Scenarios 6 - 10 3 Pilot # Query OR Push Provider A Transport Method Certified Transport Entity Transport Method To Provider B C-CDA Generation MU 2 Metric Reporting Description Pilot 6PushAny Edge Protocol EHR module Certified with Associated HISP/HIO (relied upon software) Direct (SMTP + S/MIME)+ XDR/XDM EHR Vendor and relied upon software EHR vendor + relied upon software must meet MU2 TOC criteria Pilot 7PushSOAP + XDR/XDM EHR – Must be certified for optional SOAP transport Transport Directly From Provider A Provider A EHR EHR Hosted SOAP + XDR/XDM Pilot 8QuerySOAP + XDR/XDM EHR – Must be certified for optional SOAP transport Any Transport via an HIE/HIO/HISP Provider A EHRHISP/HIO/HIEContent may be repackaged by HISP/HIO for provider B Pilot 9Push OR Query Any TransportHIO as an eHealth Exchange participant Query or push to provider via eHealth Exchange certified protocol Provider A EHRHIO eHealth exchange participant HIO must be a certified eHealth Exchange participant Pilot 10 QueryAny Certified Transport CEHRT natively or with relied upon software None- Query basedProvider A EHRHIO/HIE/HISPProvider A must be using CEHRT

5. Numerator/Denominator for TOC measure #2 Measure 2: The EP, EH or CAH that transitions or refers its patient to another setting of care or provider of care provides a summary of care record for more than 10% of such transition and referrals either: – Electronically transmitted using CEHRT to a recipient; or – Where the recipient receives the summary of care record via exchange faciliated by an organization that is an eHealth Exchange participant Denominator: Number of transitions of care and referrals during the CEHRT reporting period for which the EP or eligible hospital’s or CAH’s inpatient or emergency department (Place or Service 21 or 23) was the transferring or referring provider Numerator: Number of transitions of care and referrals in the denominator where a summary of care record was a) electronically transmitted using CEHRT to a recipient or b) where the recipient receives the summary of care record via exchange facilitated by an organization that is an eHealth Exchange participant. The organization can be a thrid-party or the senders own organization. Of Note: – EP/EHs may only count transmissions in the measures numerator if the are accessed by the provider to whom the sending provider is referring or transferring the patient – An EP or EH may only count in the numerator transitions of care that first count in the denominator – Receipt by the provider occurs when either the clinician receives/queries or the practice/facility at which the clinician works receives/queries the summary of care 4

6. Numerator/Denominator Calculations 5 Key Points EPs/EHs must use one of two methods to calculate their denominator: Minimal denominators provided by CMS in the Stage 2 Final Rule http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore _15_SummaryCare.pdf http://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_EPCore _15_SummaryCare.pdf Minimal denominators PLUS criteria defined and consistently documented by the EP/EH such as all self referrals not just self referrals reported by the HIO

7. Numerator/Denominator Calculations 6 Counting Concepts Unit of measure for ToC measure 1 and 2 is transition/referral and not individual patient 1:1 relationship between transitions/referrals in the EP/EH’s denominator and numerator. An EP/EH cannot count more than one pull/query in the numerator for just on TOC in the denominator All EPs/EHs contributing data to a patient’s CCDA may receive credit when that document is exchanged/pulled only if the transfer is in the EP/EHs denominator It is likely that an HIO will not have easy access to a particular EP or EH’s denominator unless the HIO is also the EHR vendor, and EHR vendor provides a list of denominator transitions or referrals to the HIO, or the EP or EH provides a list of denominator transitions or referrals to the HIO Approach to calculating the denominator for ToC measure 1 and 2 must be the same

8. HIO ToC Measure 2 Support 7 EP/EH Calculates NumeratorHIO or eHealth Exchange Calculates Numerator Audit Log Provided by HIO or eHealth Exchange participant Containing: List of patients for which the EP/EH contributed data Dates when data was contributed List of providers that queried the patients’ records The date of each query/view Information reconciled against EHR reports Denominator Documentation Provided by EP/EH Containing: The EP or EH’s denominator, as defined by the EP/EH Which patients the EP/EH contributed data for in the reporting period Which providers queried the patients’ records The date of each query/view so HIO knows the information was pulled after the EP/EH referred/transitioned the patient Actions: Associate each contribution with referrals/transitions in the EP/EH denominator Reconcile date of each query/view to ensure data was pulled after the referred/transitioned date Actions: Match the referrals/transitions in the EP/EH’s denominator to appropriate queries/pulls to count numerator

9. Wrap Up/Next Steps 8 Final comments All attendees Co-Chairs: Chuck Tryon, Tone Southerland Next steps Conclusion