Understanding MIPS: What is the Promoting Interoperability Score

Understanding the Promoting Interoperability (PI) score and how to maximize it in MIPS 

For healthcare organizations participating in Merit-Based Incentive Payment System (MIPS), the Promoting Interoperability (PI) category plays a pivotal role in performance scoring and care delivery improvement. With the right workflows and technology, organizations can streamline reporting, reduce manual processes, and make better use of clinical data — all while maximizing their score. 

Under the Centers for Medicare & Medicaid Services (CMS) Merit-Based Incentive Payment System, the PI category accounts for 25 percent of the total MIPS score. It assesses how clinicians use certified electronic health record technology (CEHRT) to support patient access, care coordination, and clinical data exchange. 

A clear understanding of the PI category, how it is scored, and the steps healthcare organizations can take to improve performance is essential for earning full credit under MIPS, supporting value-based care, and driving better outcomes for both patients and care teams. Here’s how to make the most of the Promoting Interoperability category and position your organization for long-term success.  

What is the PI category and why it matters

Promoting Interoperability (PI) is one of four weighted performance categories under MIPS, alongside Quality, Cost, and Improvement Activities. It’s designed to encourage clinicians to use certified electronic health record technology (CEHRT) like athenaOne® in ways that improve patient access, care coordination, and public health reporting. 

At the heart of the PI category is interoperability — the ability of different health information systems to access, exchange, and use data in a coordinated way, regardless of vendor or platform. True interoperability ensures that patient information can follow the patient across settings, enabling better-informed decisions and reducing administrative burden. 

To participate in the PI category via MIPS, clinicians must first use EHR technology certified to the 2015 Edition Cures Update, which remains the current certification standard required by the Office of the National Coordinator for Health Information Technology (ONC).

Eligible clinicians must report on the following PI objectives: 

• E-prescribing
• Health information exchange (HIE)
• Providing patients electronic access to their health data
• public health and clinical data registry reporting 

In addition to reporting these measures, clinicians must attest to three required elements that are not scored individually but are necessary to receive a PI score: 

• Completion of a security risk analysis
• Completion of the SAFER Guides self-assessment
• Confirmation of compliance with information blocking regulations 

An optional measure — querying a Prescription Drug Monitoring Program (PDMP) — is also available for bonus points. PDMPs are state-run databases that monitor controlled substance prescriptions. Reporting on this measure demonstrates responsible prescribing behavior and further supports secure, informed clinical decision-making. 

Practices that meet PI requirements and go beyond them, with strong data-sharing capabilities and patient-centered technology, stand to benefit, not just financially but from better clinical outcomes and improved efficiency. 

On the other hand, fragmented systems and burdensome workflows can make it harder to earn points, increasing the risk of payment reductions and clinician burnout. The right tools don’t just check compliance boxes – they drive real performance. 

How the PI score is calculated

Each measure within the PI category carries a maximum point value. Scores are based on actual performance percentages. Bonus points are available through optional measures such as PDMP use or participation in additional registries.

Here’s how scoring works: 

• Raw performance across measures is added up (maximum of 100 points)
• Divide your total by 100 to get a performance percentage
• Multiply that by 25 — the PI category’s weight in the overall MIPS score 

For example, a raw PI score of 92 becomes 92 ÷ 100 × 25 = 23 MIPS points. If your EHR is built for value-based care programs, it will likely handle this calculation for you — displaying real-time PI performance in a dashboard that feeds directly into your final submission. It can also automatically identify and submit your best-performing 180-day reporting window. 

Promoting Interoperability isn’t just a mandate—it’s a response to what clinicians are asking for.

Sample MIPS PI Calculation, Dr. Maya Thompson, a hypothetical pediatrician 

Practice Size: Solo practitioner 
Annual Patients: 863 
EHR: ONC-certified EHR for 12 months 
Reporting Period: 180 days 

Goal: Maximize PI score for MIPS to earn full incentives.

Step 1: Identify Required Measures 

Dr. Thompson ensures her EHR supports all required PI measures, including: 

• e-Prescribing (10 points) – She sends 80% of prescriptions electronically.
   
• Health Information Exchange (40 points total) – She shares clinical data with specialists and receives referrals electronically, with 80% of referrals and care transitions using the electronic summary of care.
   
• Patient Access (40 points total) – She ensures 90% of parents/guardians have given electronic access their children’s records through the patient portal.
   
• Public Health & Clinical Data Exchange (10 points) – She reports immunizations to the state registry.
   
• Security Risk Analysis – Completed and documented annually.  

Step 2: Calculate Performance 

Base Score: 50 points (all required measures met). 
Performance Score: 45 points (high eRx, HIE, and patient access rates). 
Bonus Points: +5 points for Public Health Reporting. 
Total PI Score: 100/100 (25% of total MIPS score). 

Step 3: Convert to MIPS PI Category Score 

PI is 25% of the overall MIPS score. 

• Dr. Thompson’s PI contribution: 100÷100×25=25 MIPS points

Step 4: Incentive Impact 

With strong PI performance, Dr. Thompson positions her practice to earn the full MIPS incentive payment adjustment, aligning with value-based care goals and improving family engagement in her pediatric practice. 

Five ways to improve your Promoting Interoperability MIPS score  

Because thresholds keep changing, improving your PI score in MIPS requires a focused strategy on both ONC-certified EHR use and superior data exchange. Based on current CMS guidelines and best practices (as of 2025), here are five effective ways to improve your PI score:
 

1. Use CEHRT and Confirm 180-Day Reporting Period 

• Why it matters: You must use Certified EHR Technology (CEHRT) for at least 180 continuous days to be PI-eligible.
   
• What to do:
  o    Double-check that your EHR version is on the ONC’s CEHRT list for 2025.
  o    Choose your reporting period wisely to ensure full compliance and allow time for data improvement. 

2. Report on All Required Measures and Avoid “Zeroes”

• Why it matters: Most PI measures are required, and missing any results in a score of 0 for that category.
   
• What to do:
  o    Use a certified EHR (CEHRT) that supports all required PI measures.
  o    Ensure staff is trained to consistently capture data for measures like e-prescribing, HIE (health information exchange), and provider-to-patient exchange or better yet, use an EHR that automates this for you like athenaOne. 

3. Maximize Performance-Based Measures 

• Why it matters: Certain measures (like e-Prescribing and HIE) are scored based on performance rates.
   
• What to do:
  o    Improve workflows to increase the percentage of e-prescriptions.
  o    Use your EHR’s Direct Messaging or similar tools to increase Health Information Exchange (HIE) with other providers. 

4. Claim Bonus Points 

• Why it matters: CMS offers bonus points for actions that show advanced interoperability or promote patient engagement.
   
• What to do:
  o    Enable and promote Public Health Registry Reporting (e.g., Immunization Registry).
  o    Implement PDMP (Prescription Drug Monitoring Program) queries if available.
  o    Provide patient access to their health information via a portal or app, such as athenaOne’s online patient portal and app, athenaPatient®. 

5. Review and Optimize Security Risk Analysis 

• Why it matters: A complete Security Risk Analysis (SRA) is mandatory for any PI score.
   
• What to do:
  o    Complete the SRA annually (or more frequently).
  o    Document and address any risks identified.
  o    Make sure the SRA aligns with HIPAA compliance and is done within the reporting year. 

athenaOne is an example of CEHRT designed for this level of optimization. Its built-in MIPS dashboard helps practices track and improve performance across all categories — including PI — without manual calculation or extra admin effort. 

In fact, MIPS data from Performance Year 2022 shows how technology can impact outcomes: Providers using athenaOne averaged a PI score of 96.94, outperforming the national average of 94.94.¹ Their overall MIPS performance also reflected this edge: 90.6 percent of athenahealth users earned a positive payment adjustment, compared to 79.3 percent nationally. ² Quality scores outpaced benchmarks as well. These results underscore how technology that supports interoperability, performance tracking, and regulatory alignment can make a measurable difference. 

Interoperability is the path to better care and stronger performance

Interoperability is foundational to value-based care. It touches every part of the MIPS framework, but especially the Promoting Interoperability category. It impacts physician satisfaction, patient outcomes, and organizational performance.

The good news? Healthcare organizations have the tools and the mandate to build something better. 

Learn more about how you can make the most of MIPS.