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Transition of Care document does not populate with important referral info

Enhancement Requests

Last Post by Anonymous 1 second ago

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kbedee

(@kbedee)

Posts: 10

Eminent Member

Topic starter

We are using CEMR 9.8. When I generate a Transition of Care document associated with a referral order it does not populate with important referral information such as; patient insurance info, prior authorization number, duration or max visits. Also the referral form does not exist as a document in the patients chart meaning it can't be sent through direct messaging. This has created a dual workflow where the referral form is faxed as we always have and then the TOC is sent through direct messaging. GE states that there are no plans to add the missing referral info to the TOC document and that I can submit an enhancement request, which I will do shortly. Has this been a problem for anyone else out there and if so have you found any solutions/workarounds?

Thank you.

Posted : January 19, 2015 9:26 am

dduschel

(@dduschel)

Posts: 207

Reputable Member

We havn't even really figured out this work-flow..... but did you really expect a process to be created that is meaningful and useful for this? Some how the real reason for creating all these work-flows has been lost and is neither meaningful or usefull. I think some day it will be but right now it is just get it done. We will probably continue to send what we always have and add this piece on until the information contained in it is more useful.

Posted : January 19, 2015 11:15 am

wwalecka

(@wwalecka)

Posts: 40

Trusted Member

I have been trying to find an answer for this as well...

Wendy A. Walecka, MS, RN

Affinity and Ministry Health System

Appleton, WI

[email protected]

Posted : January 20, 2015 11:11 am

bruins1986

(@bruins1986)

Posts: 233

Reputable Member

Unfortunately due to the shortcomings related to the summary of care and the referral module in general we are instructing our users to maintain all current workflow related to referrals and just do this in addition. I am sure you all know how well that is going over right now but unfortunately those are the cards we have been dealt.

Posted : January 29, 2015 8:36 am

ljburnham

(@ljburnham)

Posts: 331

Reputable Member

Is anyone actually sending the EMR generated TOC out document to the referring Provider? If so what is your workflow? We were told by GE that we could save the TOC to a file and then just send the last OV note to the referring provider and it would count for the measure.
Thanks
Laurie

Posted : January 29, 2015 11:26 am

kbedee

(@kbedee)

Posts: 10

Eminent Member

Topic starter

My understanding is that saving the TOC to file will count toward the first portion of measure 15 where a TOC has to be provided for %50 of outgoing transitions of care. Saving to chart does not meet the second portion of measure 15 where %10 of outgoing transitions of care need to be transmitted through a CEHRT or where the exchange is facilitated by an organization that is an NwHIN exchange participant.

Currently we are sending the TOC using the manual workflow where we save the TOC to chart and send using the embedded messaging center, this may be different depending on your HISP or who is supplying your patient portal. Automated (or more automated) processes are available but we are not currently using those processes. If you are interested in the automated processes GE should be able to supply more info on QIE or Automated Clinical Messaging.

I have submitted an enhancement request to GE to have the referral info added to the TOC document, but GE does not provide a time line on if/when the request will be addressed. I would encourage everyone out there to submit an enhancement request as well, maybe then it will be taken more seriously. Also, for anyone out there using Kryptiq for their Secure Messaging and Patient Portal you can ask to be added to bug#51171. That is the case that Kryptiq has open with GE for this issue and anyone adding their organization will hopefully add more weight to the case.

Good luck to everyone, I know we need it.

Posted : February 4, 2015 1:04 pm

searingf

(@searingf)

Posts: 1

New Member

Any clue how CQR is tracking that 10% electronic transmition? We are currently using a NwHIN exchange and sending TOC documents through that but I have no idea if CQR documents transmission. Suggested best practice workflow from GE is to generate the TOC document and send using the Secure Messaging system (Kryptic). It would make sense if CQR tracked it that way but nothing about MU2 seems to make any sense at this point. Has anyone tested this?

Posted : February 19, 2015 8:36 am

bruins1986

(@bruins1986)

Posts: 233

Reputable Member

Hi Searing,

We testing this with the Qvera solution - it updates the MUACTIVITYLOG which is a table present in the cEMR database. If you attach the MUACTIVITYLOG to the MUACTIVITYLOGTYPE table via the MUACTIVITYLOGID then the description of the event is TOC/Referral Summary Received by HISP.

Using Qvera we get this when our channel confirms we have a valid sending and receiving direct address for both the EP sending and the service provider. We have not been able to test this with Kryptic yet as we are still awaiting the Kryptic update and we have been told our current version does not update the MUACTIVITYLOG.

Thanks,

Mike

Posted : February 20, 2015 9:50 am

wwalecka

(@wwalecka)

Posts: 40

Trusted Member

I just had a call with my GE folks today. Also, please check the GE Portal for 020916 Meaningful Use Notice_Health Information Exchange ToC vF. It is the latest on the TOC ruling:

Summary of Rule Changes:
Previous rules stipulate that eligible providers meet three measures for Summary of Care for Stage 2.
1) The EP who transitions or refers their patient to another setting of care or provider of care, provides a Summary of Care record for more than 50 percent of transitions of care and referrals.
2) The EP who transitions or refers their patient to another setting of care or provider of care, provides a Summary of Care record for more than 10 percent of transitions and referrals either (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 a NwHIN Exchange participant or in a manner that is consistent with the governance mechanism ONC establishes for the NwHIN.
3) Exchange a Summary of Care with a provider or third party who has different CEHRT (and different vendor) as the sending provider as part of the 10 percent threshold for measure #2, allowing the provider to meet the criteria for measure #3 without the CMS Designated Test EHR (for EPs the measure at §495.6(j)(14)(ii)(C)(1) with a recipient who has EHR technology from a different EHR technology developer than the sender's EHR technology certified to 45 CFR 170.314(b)(2).

Or
If unable to exchange Summary of Care documents with recipients using a different CEHRT in common practice, retain documentation on circumstances and attest “Yes” to meeting measure #3 if using a certified EHR that meets the standards required to send a CCDA (§ 170.202).

The Final Rule eliminates the first and third measures. It also stipulates that the second measure can be met by sending Summaries of Care electronically in a HIPAA compliant manner without leveraging the Direct Protocol or another certified transport method. GE Healthcare has determined from CMS that practices can count the send of a ToC via secure messaging using the Centricity Clinical Messenger (CCM) product.

I know we need to change our current process, but it will be much better in the long run.

Wendy Walecka
[email protected]

Posted : February 25, 2016 1:40 pm

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