Stage 2 of Meaningful Use requires that providers complete three Summary of Care measures related to sending referrals. Practice Fusion has enabled providers to complete these measures through our new referral workflows. To learn about how these referral workflows work (including Direct messaging) and how these workflows relate to Meaningful Use, review the slideshow. This detailed guide will walk you through understanding Direct and how to enable it, the variety of ways to send a referral in Practice Fusion, and how to achieve the related Meaningful Use measures.

1. Stage 2 Summary of Care Data
Exchange with Practice Fusion
Direct Messaging, Referrals, and Meaningful Use

2. + Understand how to enable Direct messaging in Practice Fusion
+ Learn how Practice Fusion’s new referral workflow functions
+ Find out how these workflows relate to Stage 2 of Meaningful Use
Objective
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3. Direct messaging is similar to secure web e-mail
and is specifically designed for the exchange of
patient health information across different health
information systems
What is Direct messaging?
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4. Enable Direct
Go to the Messages section and select Request a Direct account
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5. Enable Direct - Provide Your Personal Information
+ Your legal name: this must match
your government-issued ID
+ Your personal details: used for
performing identity check and will be
transmitted to our identity verification
partner, Experian, via secure and
regulated network
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6. Enable Direct – Agree and Confirm
+ Agree to the Direct messaging notice
and authorization
+ Confirm your identity
▪ Identity verification is conducted using
Key Information Questions (KIQ)
generated by our identity verification
partner Experian
▪ You will have 10 minutes to answer
these questions
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7. Enable Direct – Choose your preferred Direct address
+ If identity questions are answered
correctly, choose your preferred
Direct address
+ Your address must be less than 35
characters and cannot contain
special characters
+ After choosing your address, your
Direct account is pending approval
and you will be contacted within a
few business days with next steps
+ You cannot change your Direct
address after submission, so choose
carefully
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8. Three methods to meet a Meaningful Use Measure
Send a Referral
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9. Initiate a Referral
Access the referral workflow from Patient Actions or Charting Shortcuts
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10. + Click Add new connection
+ Include the following
information about the provider:
 Name
 Fax Number
 Phone Number
 Email
 Direct email (if applicable)
 Specialty
+ Click Save
Add a Connection
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11. + Ensure the referral contains either
a Chart note, clinical summary, or
a clinical document
+ Your referral must be sent within
24 hours of the patient’s date of
service
1. Send a Referral – Practice Fusion Digital Method
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12. + Make sure to check Also
send referral by fax to
include a fax
2. Send a Referral – Include a Fax
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13. 3. Send a Referral – Direct Method
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+ First, ensure you are enabled for
Direct messaging and your
colleague’s Direct address is
entered under My connections
+ Before sending a direct message,
create a Referral Summary for the
patient
▪ Under the Patient Actions drop down
menu from the chart, print the referral
summary by selecting “Create clinical
document”

14. + Select Referral Summary
from the Select a document
type drop-down
+ Include all data elements and
click Generate
+ After the Referral Summary
has generated, you can exit
the window by clicking
Dismiss
+ Then, navigate to your
patient’s chart and initiate the
referral
3. Send a Referral – Direct Method
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15. + In the referral window, select
the provider who will receive
the Direct message
+ Click on the Clinical
Document section to select a
Clinical Document for the
patient
+ Click Send to send the
referral
3. Send a Referral – Direct Method
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16. Details about the Stage 2 Summary of Care
Measure
Meaningful Use
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17. + Measure: Provide a summary of care record when you transition or
refer a patient to another setting or provider:
 1) Provide a summary of care record for more than 50% of transitions
 2) Provide an electronic summary of care record for more than 10% of transitions
 3) Conduct one or more successful electronic summary of care exchanges with a
recipient using a different certified EHR OR with a CMS designated test EHR
(completed through DIRECT messaging protocol)
+ Exclusion: Any provider who transfers a patient to another setting or
refers a patient to another provider less than 100 times during the
reporting period is excluded from all three measures
Stage 2 Core Measure 15: Summary of Care
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18. + Complete any of the following
workflows within 24 hours of the
date of service to meet this
measure
 Enroll the patient in the Patient Portal
 Print a Summary of Care record
 Send a referral within the Practice
Fusion network using the Practice
Fusion Digital Method
 Send a referral including a fax
 Send a referral outside the Practice
Fusion network using Direct messaging
Workflows to Meet Summary of Care - 50%
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Indicate your intent to refer this patient to
another provider or setting by accessing the
Finalize section of the patient’s SOAP note
and checking off “Transfer of Care –
outgoing” under Quality of Care

19. + Complete any of the following
workflows within 24 hours of the
date of service to meet this
measure
 Send a referral within the Practice
Fusion network using the Practice
Fusion Digital Method
 Send a referral outside the Practice
Fusion network using Direct messaging
 The recipient must eventually view the
referral for you to receive credit
Workflows to Meet Summary of Care - 10%
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20. + Send a successful referral
with a clinical document
attached using Direct
messaging to a provider
outside the Practice Fusion
network
+ If you do not know a provider
using another EHR who has a
Direct address, you can use
the CMS EHR Randomizer to
generate a test Direct address
Workflows to Meet Summary of Care - One-time Direct
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21. + The “EHR Randomizer” was developed by the National Institute of Standards
and Technology (NIST) and CMS
 Go to: https://ehr-randomizer.nist.gov/ehr-randomizer-app/ to create an account
+ This tool matches providers with a different designated test EHR and can be
used to achieve the electronic summary of care record exchange
CMS Designated Test EHR Randomizer
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22. + Step 1: Register on the NIST EHR Randomizer website
 Enter your contact information
 Provide the CEHRT ID for Practice Fusion (A014E01KIUMGEA3)
 This information will be used by the EHR Randomizer to match you with a Test EHR system created by a different
developer
+ Step 2: Sign Confidentiality Agreement
 This is required in order to use the EHR Randomizer
CMS Designated Test EHR Randomizer - Instructions
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23. Step 3: Receive Test EHR Information
+ Download the following information
from the Randomizer:
 Direct address
 Authorized Developer Contact Information
+ Practice Fusion has completed the
trust anchor and digital certificate
exchange with the CMS designated
test EHRs, so you should not need
to download or exchange trust
anchors or digital certificates
CMS Designated Test EHR Randomizer – Instructions
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24. + Step 4: Schedule and Set Up Test with
Authorized Developer
 Coordinate directly with your Authorized Developer using
their contact information to schedule a testing
 You will not need to submit your Trust Anchor and Digital
Certificate, as Practice Fusion has completed this for you
in advance
+ Step 5: Create Test Summary Care Record
 Using test patient data only, create a "Referral Summary"
clinical document from your Practice Fusion EHR account
 Make sure the test patient record has information entered
for demographics, diagnoses, medications, and drug
allergies at minimum
CMS Designated Test EHR Randomizer – Instructions
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25. + Step 6: Transmit Direct Message
 Follow the Direct message workflow to send the referral with a clinical document
+ Step 7: Receive Email Confirmation
 Wait to receive an email notification from the Authorized Developer indicating if a
message was successfully received by the Test EHR or if the test was a failure
 The Authorized Developer will email you at the email address you used to register
for the Randomizer with, not your Direct address
 If successful, this documentation should be retained in your records
CMS Designated Test EHR Randomizer – Instructions
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