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Support Electronic Referral Loops by Sending Health Information

Updated June 8, 2026 2 minute read

Measure: For at least one transition of care or referral, the MIPS EC that transitions or refers their patient to another setting of care or health care provider — (1) creates a summary of care record using CEHRT; and (2) electronically exchanges the summary of care record.
DenominatorNumber of transitions of care and referrals during the performance period for which the MIPS eligible clinician was the transferring or referring clinician.
NumeratorThe number of transitions of care and referrals in the denominator where a summary of care record was created using CEHRT and exchanged electronically.
ExclusionAny MIPS eligible clinician who transfers a patient to another setting or refers a patient fewer than 100 times during the performance period.
What is a Transition of Care?

CMS defines a transition of care as the movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory, specialty care practice, long-term care, home health, rehabilitation facility) to another. At a minimum, this includes all transitions of care and referrals that are ordered by the MIPS eligible clinician.

Denominator

To be included in the denominator:

  • Patient must have a referral documented during the performance period

OR

  • Patient’s clinical summary must be sent electronically during the performance period
Create a Referral
  1. From the Referrals tab in the chart or the Orders/Referrals tab in the encounter, click Add
  2. Populate the following sections:
    1. Date Requested (chart level only)
    2. Requested By
      1. Requested By must be EC
    3. Refer To
      1. Refer To must be a secure contact
    4. Reason for Referral/Notes
    5. ICD Code or CPT/HCPCS
  3. Click Add
Send a Clinical Summary
  1. From the patient chart go to Chart Tools > Send Clinical Summary
  2. Populate the Provider, To, Subject, and Message fields
    1. Provider selected must be EC
  3. Select Summary of care record or Clinical summary from selected encounter
    1. If Clinical summary from selected encounter is chosen, a patient encounter must be selected to continue sending the clinical summary. Click Add in the Patient Encounter section to add an encounter
    2. Optional: Click Add in the Labs section and select the lab result(s) to be sent
  4. Click OK to send
Numerator

To be included in the numerator:

  • Patient referral must be sent electronically during the performance period

OR

  • Patient’s clinical summary must be sent electronically during the performance period
Send a Referral Using PPDX
  1. From the Referrals tab in the chart or the Orders/Referrals tab in the encounter, select the referral to be sent
  2. Click Send
  3. Populate the Subject and Message fields
    1. Select a message favorite from the Subject selection list or click Custom and type a subject and message
  4. If sending from the patient chart, click Add in the Past Encounter section to select an encounter to send with the referral
    1. If sending from the encounter, the patient information from the open encounter will be included with the referral
  5. Optional: Click Add in the Labs section to attach one or more lab results
  6. Click OK to send

A clinical summary can be sent electronically by following the steps outlined in the denominator.

Additional Information
  • The electronic transmission of the clinical summary or referral must be successful in order to count toward the numerator
    • Transmissions that are not successful will generate an “Undeliverable” message in the PPDX Inbox

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