Interoperability is required for success within many key areas of Meaningful Use Stage 2 (MU2). Particularly MU2 Core Measure 15: Summary of Care. Interoperability in this context means connecting with other providers running either the same or different electronic health record (EHR) and practice management systems. In essence, interoperability drives your ability to provide the Summary of Care reporting required for Meaningful Use Stage 2 (MU2) so it’s important that you get more familiar with this functionality.

The exchange of Summary of Care documents requires clinical connectivity through a network effect – where the more providers in the network, the more valuable it becomes to all network providers. You’ll need to investigate what local health IT connectivity initiatives may be developing in your area so that you can create data, and/or capture data, from other providers in your area/region. This is a requirement to meet MU2 Core Measure 15: Summary of Care.

There are three distinct items that a provider must satisfy to successfully attest for Core Measure 15: Summary of Care.

  1. Eligible providers (EPs) who refer/transition their patients should provide a summary of care record for more than 50 percent of referrals.
  2. More than 10 percent of all such referrals/transitions should be done through a Direct Interface.[1] [Direct interface refers to a “Direct” provider-to-provider electronic transmission where “Provider A” {sender} conducts successful electronic exchange of a summary of care record with “Provider B” {recipient}.]
  3. Conduct one or more successful document exchanges with a provider using another EHR vendor [part of which can be counted in “Measure 2” above, or, conduct a test with a CMS designated test EHR.]

[Note: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period is excluded from all three measures.]


[1] These transitions of care can also be completed through a connection to an eHealth Exchange (formerly NHIN) participant. Click here for a full list of current participants.

The 10 percent requirement to provide transitions of care through a Direct Interface [“Direct”] should encourage coordination with many of the providers in your community. Generating success with referrals and transitions of care through Direct requires a workflow change in your practice. Rather than faxing documents to other providers or organizations, consider Direct as an option to send and receive clinical information.  Find out which EHRs are most popular and talk to your colleagues to see if they are ready for Direct. Become knowledgeable about attaining new levels of interoperability within your office and across your community.

Those Pesky Details

For the Direct component of this measure, a referral or a transition of care is only counted as a success when it has been “received by the provider to whom the sending provider is referring or transferring the patient.” Similar to a “read receipt” in email, this means that the EHR must definitively know if your message transmissions are actually received by the down-stream provider—you cannot just send your messages into the ether and hope for success. Additionally, in order for a Direct message to count toward your 10 percent minimum, it must be sent over Direct to a provider who would otherwise not have access to the patient’s record.

The Network Effect of Direct

The aforementioned requirements compel you and the providers within your community to support the technology necessary to generate, transmit, and receive Direct messages. The more providers connected, the more valuable the provider network becomes for each sender and receiver. A disconnected node (a hospital or a large practice with a legacy EHR) can bring down the success rates for other providers within the community ready to support MU2 standards.

Additionally, those EHRs that make transactions cumbersome (or those that charge a transaction fee to send or receive messages) may inadvertently squelch a provider’s interest in participation.

Watch for Part two of “Interoperability and Transitions of Care” in the coming weeks.