Understand the 2026 Promoting Interoperability performance category — objectives, required measures, bonus opportunities, and how to maximize your PI score using a certified EHR.
The Promoting Interoperability (PI) category measures meaningful use of certified EHR technology (CEHRT). It replaces the former Meaningful Use program and focuses on patient access, care coordination, and public health data exchange.
| Category | Traditional MIPS | MVPs | APP / APP Plus |
|---|---|---|---|
| PI Weight | 25% (standard) 0% small practices 30% APM Entities | 25% (standard) 0% small practices 30% APM Entities | 30% (standard) 0% small practices |
| EHR Required | Yes — 2015 Edition CEHRT | Yes — 2015 Edition CEHRT | Yes — 2015 Edition CEHRT |
| Reporting Period | Minimum 180 continuous days | Minimum 180 continuous days | Minimum 180 continuous days |
| Small Practice | Automatically reweighted to 0% | Automatically reweighted to 0% | Automatically reweighted to 0% |
| Hardship Exceptions | Available (by Dec 31, 2026) | Available (by Dec 31, 2026) | Available (by Dec 31, 2026) |
The PI category is organized into four objectives. Each has required measures and optional bonus measures. Missing a required measure can result in a score of zero for that objective.
| Objective | Measure | Status | Points | Notes |
|---|---|---|---|---|
| e-Prescribing | e-Prescribing | Required | Up to 10 | % of prescriptions sent electronically. Exclusion: no drugs requiring e-Rx |
| Query of Prescription Drug Monitoring Program (PDMP) | Bonus | +10 | Querying PDMP prior to prescribing controlled substances | |
| Health Information Exchange (HIE) | Support Electronic Referral Loops by Sending Health Information | Required | Up to 20 | Sending summary of care records electronically |
| Support Electronic Referral Loops by Receiving and Reconciling Health Information | Required | Up to 20 | Receiving and reconciling incoming care records | |
| Health Information Exchange (HIE) Bi-Directional Exchange | Bonus | +10 | Demonstrating bi-directional HIE with a network or exchange | |
| Enabling Exchange Under the Trusted Exchange Framework and Common Agreement (TEFCA) | Bonus | +10 | Connecting to TEFCA-enabled network | |
| Provider to Patient Exchange | Provide Patients Electronic Access to Their Health Information | Required | Up to 25 | Patient portal access rate. Exclusion: all patients are unable to participate |
| Support Electronic Referral Loops by Sending Health Information | Required | Up to 25 | Sending care records to patient requests | |
| Patient-Generated Health Data | Bonus | +10 | Incorporating patient-submitted health data into EHR | |
| Public Health & Clinical Data Exchange | Immunization Registry Reporting | Required | Up to 10 | Active engagement with immunization registry. Exclusion: no immunizations administered |
| Electronic Case Reporting | Choose 1 | Up to 10 | Reporting reportable conditions to public health agencies | |
| Public Health Registry Reporting | Choose 1 | Up to 10 | Reporting to a public health registry beyond immunizations | |
| Clinical Data Registry Reporting | Choose 1 | Up to 10 | Reporting to a clinical data registry | |
| Syndromic Surveillance Reporting | Choose 1 | Up to 10 | Reporting syndromic surveillance data to public health agency |
Bonus measures can push your PI score above 100 points (capped at maximum per category). Source: CMS QPP 2026 PI Measure Specifications.
PI scoring is performance-based. Each required measure is scored as a percentage of eligible encounters, then converted to points within the 100-point PI score range.
Required measures are scored based on the percentage of eligible encounters meeting the measure numerator. Higher performance rates yield higher PI points within each measure's range.
Attesting YES to bonus measures (PDMP, HIE Bi-Directional, TEFCA, Patient-Generated Data) adds up to 10 bonus points each. Bonus points can push your score above 100.
If your practice qualifies for a measure exclusion (e.g., no controlled substances prescribed, no immunizations administered), you may exclude that measure without penalty — points are redistributed.
Practices with 15 or fewer clinicians (or meeting other small practice criteria) are automatically reweighted. PI = 0%, with those points redistributed to the Quality category instead.
If you cannot meet PI requirements due to a qualifying reason, you may apply for a hardship exception or automatic reweighting. Applications are due by December 31, 2026.
Clinicians in areas without sufficient broadband or internet connectivity may qualify for PI reweighting. Documentation of internet access limitations is required.
If your certified EHR vendor loses certification during the performance year, you may qualify for a PI hardship exception for the affected reporting period.
Practices with 15 or fewer clinicians are automatically reweighted — no exception application needed. The 25% PI weight redistributes to Quality automatically.
Natural disasters, public health emergencies, or other extraordinary circumstances may qualify your practice for PI reweighting without manual attestation.
Dagger Healthcare Solutions helps practices configure EHR workflows, identify measure exclusions, and achieve maximum PI performance scores.
