1. Transition of Care Summary Configuring RPMS-EHR for Meaningful Use Resource Patient Management System

2. Presenters: Alex Mikhaylov Lead Consultant General Dynamics Company (GDIT) Cecelia Rosales Meaningful Use Requirements Manager (Contractor – DNC) Amanda Histia RCIS Requirement/Test Coordinator (Contractor-CAS) Transition of Care Summary

3. Training Objectives Understand the MU Objective and the Measure Understand the relationships amongst the Patient Merge, MPI, HIE, and C32 Define the C32 – what it is, what it is used for & how it is tied to Meaningful Use Identify the RCIS Processes and it’s Benefits Compare and Contrast RCIS vs. Consults Print Summary of Care from the RCIS and C32 button Examine Applicable Policies and Procedures Transition of Care Summary

4. C32 document Define the C32 – what it is, what it is used for and how it is tied to Meaningful Use

5. C32/MPI Terminology CCD - Continuity of Care Document (standardized patient health summary record) C32 – CCD in special C32 format HIE – Health Information Exchange NHIE – Nationwide Health Information Exchange, the IHS version of HIE MPI – Master Patient Index, only required when a site becomes a part of the NHIE Summary of Care

6. Relationships Explain the relationships between the Patient Merge, MPI, HIE & C32

7. MPI and C32 Architecture Central MPI servers (ALB) RPMS EHR GUI MPI messages are not needed fro MU Request C32 Sample C32 document Central C32 servers (ALB) MPI data

8. C32 and MU Have to demonstrate that a C32 can be retrieved from RPMS, printed and saved Different RPMS security keys control the ability to display, print and save C32s Have to upload a sample C32 for a random patient to the NHIE – there is a document with instructions which walks you through the process and shows what needs to be printed out as proof of a successful upload. Summary of Care

9. MU Objective and Measure The EP, eligible hospital, or CAH that transitions their patient to another setting of care or provider of care, or refers their patient to another provider of care should provide summary of care record for each transition of care or referral. The provider who transitions or refers a patient to another setting of care or provider of care during the EHR reporting period provides a summary of care record for more than 50% of transitions of care and referrals. Transition of Care Summary

10. MU Measure Type of Measure: Rate The number of transitions of care and referrals in the denominator where a summary of care record was provided. >50% The number of transitions of care and referrals during the EHR reporting period in which the provider transferred or referred a patient. Transition of Care Summary

11. RPMS Reporting Logic Denominator Inclusions (EPs) : COUNT: each transfer of care or referral WHERE: the requesting provider is the EP for whom the report is being run AND WHERE: the referral has a Date Initiated between the first day of the EHR reporting period through 14 days before the last day of the EHR reporting period AND WHERE: the status of Referral is equal to "A" (active) or "C1" (closed completed) Transition of Care Summary

12. RPMS Reporting Logic Denominator Inclusions (eligible hospitals and CAHs) : COUNT: each RCIS referral HAVING: Status of Referral equal to "A“ or "C1” AND HAVING: an Initiated Date occurring from the date of admission through the date of discharge FOR: A hospitalization during the EHR reporting period OR FOR: An emergency department visit during the EHR reporting period Transition of Care Summary

13. RPMS Reporting Logic Numerator Inclusions: COUNT: each event in the Denominator WHERE: the Summary of Care (C32) was printed within 14 days of the referral initiated date Transition of Care Summary

14. RPMS Reporting Logic Measure Exclusion: EPs, eligible hospitals, and CAHs that do not have any eligible transitions of care or eligible referrals are excluded from this measure. Transition of Care Summary

15. What HIM Needs to Know Difference between Consult & Referral processes and the EHR/RPMS applications Referred Care is not always covered by Contract Health What is available on the RCIS tab Print & Monitor RCIS report – print C32 for each patient Discuss the RCIS process and who will disseminate C32’s for referrals Transition of Care Summary

16. Configuration RCIS and C32 must be configured RCIS package owner can configure templates for end user Transition of Care Summary

17. Consults vs. RCIS CONSULTS Text-based information No interface with RCIS application Requires double data entry for CHS referrals RCIS Data is readily available to CHS application Reports can be pulled based on referral information PCC Visits created when referrals are completed

18. All Referrals for all Providers

19. All Referrals for Selected Patient

20. Add Referral Dialog

21. Referral Template Selection

22. Vendor Lookup – First 3 Characters

23. Print the C32

24. Summary of Care

25. Transition Of Summary Of Care Summary of Care

26. RCIS Reports In RPMS Summary of Care

27. Select RPT > ADM Summary of Care

28. Select ARC Summary of Care

29. Select Time Range Summary of Care

30. Report of C32 Not Printed Summary of Care

31. Policy and Procedure Review Transition of Care Summary

32. Questions & Discussion Demonstration Transition of Care Summary