Provide Patients Electronic Access to Their Health Information

This measure reports the number of patients who have timely access to view, download and transmit their personal health information after every visit during the performance period. Additionally, the practice must make it possible for the patient to access health information, using any application of their choice, through an application program interface (API).

In this section, we will abbreviate the title of this measure to Patient Electronic Access.

Measure Overview
Denominator The number of unique patients who had at least one non-voided face-to-face visit during the performance period.
Numerator

The numerator includes all patients who were given:

  • Timely access to their protected health information (PHI) through the Greenway Patient Portal.
  • Timely access to a Clinical Visit Summary and test results, if registered for the patient portal at the time.
  • A token they could use to access their personal health information using a third-party application.
Medicare Goals

At least 1 patient in the numerator

See the following sections for more information about the Patient Electronic Access measures

Denominator Criteria

To qualify for the denominator, a patient must have at least one non-voided face-to-face visit checked-in during the performance period. Additionally, the best practice is to ensure the visit is also checked-out during the performance period.

Numerator Criteria

You must specify in Prime Suite Reporting 2019 which state and federal holidays your practice will be closed. Otherwise, the timely access calculations used to qualify a patient for the numerator may be inaccurate for your practice.

Qualifying numerator actions must occur during the performance period. For example, if the performance period begins on January 1, 2019 and ends on December 31, 2019, the numerator must be met on or before December 31, 2019. This is true even if the qualifying visit for the denominator occurs on December 31, 2019.

Patients who qualified for the denominator count in the numerator if all the following are met:

  • The patient was offered access to the patient portal. This must be indicated in Prime Suite within 4 business days of the visit.

The patient does not have to register for and use the portal; you only need to invite the patient to use the portal or document the patient declined access. See Inviting Patients to the Patient Portal and Documenting Declined Portal Access for details.

  • The patient was given a token to use with a third-party application of their choice to access their PHI through the Prime Suite Application Programming Interface (API) within 4 business days of the visit. This is indicated by the Patient Token flag which is automatically added when the token is generated through Patient Registration.

OR

The patient declined the token. In this case, the API Opt-out flag must be manually added to the patient’s chart within 4 business days of the visit.

The patient does not have to use the API token to access their data; you only need to provide the token or document the patient declined the token. See Providing a Token to Access the Prime Suite API below for details.

  • The provider signed the visit note within 4 business days of the visit.
  • If the patient is registered for the portal, the Clinical Visit Summary is made available in the patient portal within 4 business days of the visit. If the patient is not registered for the portal, this step is not necessary to qualify for the numerator.

If the patient’s preferred method of communication is not the patient portal, the Available in Portal check box must be selected to make the Clinical Visit Summary available.

Amending a note removes access to the clinical visit summary. Because of this, amending a note and resigning it outside of the 4 business day time frame removes the patient from the numerator for this measure.

Measure Changes for 2019

Name Changes The measure name changed from Provider to Patient Exchange to Provide Patients Electronic Access to Their Health Information.
Measure Changes

The following have been added to the information that is available:

  • Encounter diagnosis
  • Immunizations
  • Functional status, including activities of daily living, cognitive and disability status
  • Unique device identifier(s) for a patient’s implantable device(s)
  • Additional care plan fields: health concerns, assessment, plan of treatment

Practices are responsible for ensuring these items are added to the Clinical Visit Summary.
Workflow Changes
  • You must now set a portal flag AND either generate an API token or set the API Opt-out flag. In previous years, you only needed to set a portal flag OR generate an API token for the patient.
  • Practices must configure their Holiday Schedule in Prime Suite Reporting 2019 to define their state and federal holidays.
  • Providers must sign visit notes and select the Available in Portal check box if the patient is registered for the portal within 4 business days of the visit.
  • Providers must sign all lab and imaging reports within 4 business days of the report being saved to the chart.

About Timely Access

CMS defines Timely Access for this measure as within 4 business days of the visit or receipt of a lab result or diagnostic imaging report.

For Prime Suite Reporting 2019, the first business day starts at midnight of the next working day after the event and considers the holiday schedule of your practice. For visits, the event date is the day of check-in; for lab results and imaging reports, the event date is the day the result or report is saved to the patient's chart. For example, if the patient is checked in at 8:15 AM on Friday, your office is closed on weekends, and Tuesday is a holiday, the action that makes the Clinical Visit Summary available to the patient must be completed by 11:59 PM on the following Friday.

Holiday Schedule: You will need to specify in Prime Suite Reporting 2019 which state and federal holidays, your practice will be closed. Prime Suite Reporting 2019 will apply this schedule when calculating timely access for MIPS.

The end of the performance period takes precedence over the 4-business day allowance. If the event takes place close to the end of the performance period, the qualifying action must take place before 11:59 PM on the last day of the performance period, regardless of the number of business days.

Setup Requirements

You can configure what lab results will be available on the Greenway Patient Portal. Based on the setting you select, the results automatically go to the portal on the patient's Ambulatory Summary when you sign them.

This setting does not affect imaging reports. Your notes on diagnostic imaging reports are sent to the portal when you sign the report and mark it as reviewed.

To set the Lab Results setting for the practice:

1. Select System Defaults in the System menu.
2. Select the Greenway Patient tab.
3. In the Lab Results section, select the desired choice in the drop-down list:
  • All Results - all lab results are sent to the portal when you sign them and mark them as reviewed. This is the default setting.
  • Normal Results Only - only lab results that are marked as normal are sent to the portal when you sign them and mark them as reviewed.
  • Abnormal Results Only - only lab results that are marked as abnormal are sent to the portal when you sign them and mark them as reviewed.
  • Send No Results - no lab results are sent to the portal.

Selecting Send No Results prevents any patients from qualifying for the numerator. Consequently, this setting will make your entire practice out of compliance for reporting on this measure.

See the Configure Greenway Patient Defaults section in the System Defaults topic in the Prime Suite help for more information.

Patient Electronic Access Workflows

In Prime Suite, you provide electronic access to a patient's health information using the patient portal feature. The sections below provide information on:

Viewing a Patient's Current Electronic Access

You can determine the type of electronic access the patient has from their current flag settings. This includes both their access to the patient portal as well as the API.

To determine whether a patient has been given electronic access:

1. Search for and select the patient.
2. Select the Patient Flags icon to open the Patient Flags dialog box.

3. Scroll down in the General list to see the flags related to electronic access. Selected flags are displayed in bold.
  • API Opt-out: The patient has declined access to the API token.
  • Patient Portal Invite: The patient has been invited to the Patient Portal; also used when the patient declines the invitation.
  • Patient Portal: The patient has registered for the Patient Portal. This flag is set automatically when the patient registers and cannot be changed manually.
  • Patient Token: An API token was generated for the patient. This flag is set automatically when the token is generated and cannot be changed manually.

The patient must have either the Patient Portal Invite or Patient Portal flag AND either the API Opt-out or Patient Token flag to qualify for the numerator. Additionally, these flags must be set within 4 business days of the visit.

Inviting Patients to the Patient Portal

Your practice can be set up to use the Greenway Patient Portal. After your practice is set up to use the portal, you need to invite patients to use it.

If the patient declines access to the portal, let the patient know that they can request access in the future. Then, you can document the patient declined access in Prime Suite to still qualify the patient for the numerator.

If all authorized portal users are removed from a patient's account and the patient did not initially receive an invitation to the portal, the practice must send a portal invitation to the patient to reinstate the Patient Invite flag in the system for the patient's account. If the invitation is not sent to the patient after all authorized portal users are removed from the account, the patient will not qualify for this measure.

To ensure that the patient qualifies for the measure, in the cases where the removal of an authorized user is requested, the best practice is to remove the authorized user’s access to a patient from the authorized user’s account instead of removing the authorized user from the patient's account.

For example, if the patient is a child that becomes emancipated from his or her parents, the practice should remove access to the child’s portal from the parents’ accounts and not remove the parents’ portal access from the child’s account.

 

To invite a patient to the Patient Portal:

1. Select the patient that needs portal access.
2. On the Registration Information page in Prime Suite (Registration > Information), ensure the following demographic data is recorded:
  • Email Address: A valid email address must be entered in the Email field.
  • DOB: The patient's date of birth must be entered in the DOB field.
  • ZIP Code: The ZIP code for the patient's home address must be entered in the Zip Code field.
  • You may also need to enter the Social Security Number if your practice has required SSN validation in the Sign Up Process section on the Portal Settings Admin tab on the PrimePATIENT Admin page.
3. Scroll down to the Patient Portal section on the Demographic Information tab.

CHC practices can find this information on the Patient Portal Info tab.

All individuals listed as a responsible party on the patient's account are listed as a possible account holder. Note that each patient can have multiple account holders, and each account holder may have their own portal account. Account holders for patients can be themselves, other patients, or persons who are associated parties to the patient.

4. Select the account holder by selecting the check box next to their name, and then select OK in the confirmation dialog box to confirm the patient portal account holder for the patient.
5. Select Save.
6. Return to the Patient Portal section of the Registration Information page and, in the Status column, select the Send Invite link for all the account holders who need portal access. Prime Suite sends an email to the account holder and assigns the Patient Portal Invite flag to the patient.

If an account holder registers for an account through the Greenway Patient Portal, Prime Suite assigns the Patient Portal flag to the patient. The patient does not need to register and use the portal to qualify for this measure.

Making the Visit Summary Available in the Portal

When the patient (or caregiver) registers for a portal account and their preferred method of communication is set to Patient Portal, the Available in Portal check box is enabled by default for their account. This means that signing off on a Note automatically makes the Clinical Visit Summary available in the portal.

If Patient Portal is not set as the preferred communication method, you must manually make the Clinical Visit Summary available in a timely manner after the visit. You can do this from the Note, the Superbill Summary, or the Visit History section of the Facesheet. See the following sections for detailed steps on making the Clinical Visit Summary available:

Making the Clinical Visit Summary Available from a Note

1. Access the note linked to the qualifying visit.
2. Once the note is finished, select one of the following save actions:
  • Save (Charges Ready): Select this option to save the document and set the Superbill summary status to Ready.
  • Save (Hold Charges): Select this option to save the document and set the Superbill summary status to Not Ready.
  • Save & Sign: Select this option to save and sign the document and set the Superbill summary status to Ready.
3. Select the View Clinical Summary link under Note Options in the left navigation.

The View Clinical Summary link does not become available until a save action is selected for the note. If the link is missing, return to Step #2 to ensure a save action has been completed.

4. Select the Available in Portal check box at the bottom of the Clinical Visit Summary.
5. Select Save.
6. Sign and save the Note.

Making the Clinical Visit Summary Available from the Superbill Summary

1. Access the Superbill Summary for the patient.
2. Select the Clinical Visit Summary link.
3. Select the Available in Portal check box at the bottom of the Clinical Visit Summary.
4. Select Save.

Making the Clinical Visit Summary Available from the Facesheet

1. Open the patient's Facesheet and scroll to the Visit History section.
2. Select the link for the visit to open the Clinical Visit Summary. You can access the patient's last five visits.
3. Select the Available in Portal check box.
4. Select Save.

Making Lab and Imaging Results Available in the Portal

Lab results and imaging reports must be signed and marked as reviewed in a timely manner to send them to the portal.

For lab results:

  • If the lab results are automatically parsed during the import process, they are automatically marked as returned.
  • Lab results from an outside source must be associated with the originating lab order when you import them to the patient's chart in Prime Suite.
  • Which lab results are sent to the patient portal is controlled by the portal Lab Results setting. See Setup Requirements for details on setting this option.

For imaging reports:

  • Imaging reports must be linked to the originating imaging order. The imaging order must be in the clinical note linked to the qualifying visit.
  • The provider must sign both the imaging report and clinical note.
  • The provider's comments on the imaging order will appear on the portal.

Documenting Declined Portal Access

If a patient declines to provide a valid email address, CMS allows you to manually flag the patient as having received a Patient Portal Invite as long as you have created and implemented a policy of notifying your patients about the patient portal, including providing the patient with printed information on how to access the portal in the future.

To manually document the portal invitation:

1. Select the patient that declined to provide a valid email address.
2. Select the Patient Flags icon to open the Patient Flags dialog box.
3. In the General list, select the Patient Portal Invite flag to set it. Selected flags are displayed in bold.
4. Select the Save icon.

Patients do not have to set up an account on the portal to qualify for the numerator. Once invited, the patient has access. Using the access is at the patient’s discretion.

Providing a Token to Access the Prime Suite API

To qualify for the numerator, patients must be given a way to access their personal health information using a third-party application that can interact with the Prime Suite Application Programming Interface (API).

To qualify for this measure, you must provide the patient with:

  • An API Token: This is a unique code that you generate for the patient within Prime Suite. The patient will need to provide this token to a third-party application that will then use it to access their data from Prime Suite.

Once you generate this code, you can print it out and give it to the patient. If the patient misplaces the paper, you can look up the code in their Registration Information. Also, the patient will be able to retrieve the code themselves from within the Greenway Patient Portal (My Profile > API Token page).

  • The API Documentation: The Greenway PrimeSuite Application Access page provides information on how the third-party application can use the API token for authentication to access the patient's information. You should provide the patient with the URL for this page:

https://partnerint.greenwayhealth.com/PrimeSuiteApplicationAccess/#!/rest/

  • A list of third-party applications that customers can use: At your discretion, perform an internet search for personal health record apps or similar text. Research the various apps to determine which use public API to allow other systems or databases to exchange data. Select those you might want to recommend to your patients.

Alternatively, if you offer the patient an API token, and they decline, you can record that the patient declined the token by setting the API Opt-out flag on the patient's record. Once this is done, the patient will qualify for this part of the measure. If the patient declines access to the API, you must inform them that they can change their mind and accept access at a later time.

To generate an API token for the patient:

1. Select the patient that needs API access.
2. On the Registration Information page in Prime Suite, select the Other ID link.

3. Select Generate. Once generated, the patient token displays, along with the External Mappings for the patient, when the Other ID link is selected.

A token can only be generated once per patient. The Generate button is disabled after the token has been generated.

4. Provide the token and information on using the token to the patient.

Patients registered for the Greenway Patient Portal can also retrieve their token in the My Profile > API Token page in the portal.