Post on 04-Oct-2020
NORTH CAROLINA HEALTH
INFORMATION EXCHANGE AUTHORITY
Primary Care Conference
June 27, 2019
Jessica Brehmer
Development & Outreach Specialist
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• Overview HIEA
• NC Mandate
• HIE Updates
• What is HIE?
• How Does HIE Work?
• Patient Education and Opt-Out
• NC HealthConnex Suite of Services
North Carolina Health Information Exchange Authority
Objectives
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We connect health care providers to safely and securely share health information through
a trusted network to improve health care quality and outcomes for North Carolinians.
S T A T E D E S I G N A T E D
S E C U R E
P A R T N E R S H I P
NC HealthConnex, By the Numbers:
• Over 40,000 providers with contributed
records
• 4,500 plus health care facilities live submitting
data, including 97 hospitals
• 5,000 plus health care facilities in onboarding
• 52 million+ continuity of care documents
(CCDs)
• 7M+ unique patient records
• Over 150 unique EHRs engaged
• 6 border and intra-state HIEs connected
Who Are We?
See Who’s Connected
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Mandate Overview and HIE Updates
What Does the Law Mandate?
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*2019
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Extension Process Update
• Participants who are in the queue to connect and are moving forward in the
technical process, will automatically receive an extension and remain in
compliance.
• New participants who are mandated to connect by June 1, 2019, will
automatically receive an extension if they are still in the queue to connect on
their deadline.
• Please note: Participants must remain responsive with the NC HealthConnex
technical team and continue to move forward in the connection process. The
extension is not a waiver, but simply an extended period of time to finish the
connection build.
What is HIE?
How does HIE Work?
NC HealthConnex will be able to support health plans as beneficiaries transition from plan to plan
Payers
Key to value-based care model and needs visibility from all other
providers treating their patients
Primary Care
A crucial part of managing patient populations will be the care provided by these providers
Behavioral Health/IDD This group has lagged in data sharing
initiatives but provide critical insight into patient monitoring and care coordination
Long-Term Care
Many hospitals are able speak with each other, but lack ability to
communicate from outside system
Hospitals and Ambulatory Sites
Specialty registries are essential for physicians as health care transitions to value-based payment models
Health Registries
Health Information Exchange in North Carolina facilitating data exchange to improve care
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Electronic Health
Record
Clinicians enter data
into EHR and that
data is pulled into
HIE
Data Provided
Clinicians who have
care relationships with
their patients are able
readily access that data
. 1 2 Elements Available Security in Place Current data elements available in NC HealthConnex include: Allergies, Encounters, Medications, Problems, Procedures, Results
Electronic Health Record
Clinicians enter data into EHR and
that data is pulled/pushed into HIE
Data Provided
Clinicians who have care
relationships with their
patients are able to readily
access that data
How Does Health Information Exchange Work?
All data is protected, stored and accessed only for purposes permissible under federal and state law.
The NC HealthConnex Data Target
SC
OP
E
Patient ID Name Date of Birth Address/ Phone
Language Race/
Ethnicity Gender
Date of Visit Visit Number Reason for Visit Level of Care Visit Location Care Team Members
Vital signs (height, weight, BP, BMI)
Immunization Referrals Care plan field(s),
including goals and instructions
Problems Medication Allergies
Medications Laboratory Test(s) Laboratory
Value(s)/Result(s) Smoking Status
Discharge Summary
Procedures
Data Elements
We will aim to collect all Meaningful Use Data Elements
Patient Education and Opt-Out
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Patient
Education
& Opt-Out
Patient Education materials provided to organization via email (welcome packet). Includes:
• Sample Notice of Privacy Practices
• Fact Sheet
• Tri-fold Brochure Order Form
• Talking Points
• FAQs
• Employee Education Materials
• Employee Newsletter
• Leadership Emails
*Patients have the right to opt out of having their information shared between providers through NC HealthConnex.
All NC HIEA Policies are posted on our website, nchealthconnex.gov.
Benefits | Vision of NC HealthConnex
A full “picture” of a person’s health, including
ambulatory visits, hospitalizations and medications
Improved, more accurate and timely medication
reconciliation that reduces errors and avoids
unnecessary tests
Access to test results, reducing errors and gaps in
treatment
Proactive monitoring of patient panels to alert
physicians where their patients show up outside
their system or network
Timely event notifications of admits and discharges
to improve the coordination of care and support
reductions in readmission to ER
Benefits of NC HealthConnex
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Health Care Communications Without NC
HealthConnex
Vision for Health Care Communications With NC
HealthConnex, 2021
Suite of Services
Suite of Services
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• Clinical Portal
• Direct Secure Message
• Provider Directory
• Notification Service
• NC*Notify
• Registries/Integrations
• NCIR
• ELR
• Diabetes
• CSRS
Foundation
Exchange
Notifications
Pop Health & Analytics
Access a Patient’s Clinical Record • Clinical Portal
• EHR Integration
Communicate PHI Securely • DIRECT Secure Messaging
Neighboring Connections via
eHealth Exchange • Coastal Connect HIE (Wilmington, NC)
• ETHIN (East Tennessee)
• GaHIN (Georgia’s state-designated HIE)
• MedVirginia (Richmond, Va.)
• SCHIEX (South Carolina)
• Veterans Administration (VA HIE)
• Dept. of Defense (2019)
Exchange
Foundation
Exchange
Notifications
Pop Health & Analytics
Integrations • CSRS
Expanding Exchange Reach & Capabilities
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Hurricane Florence Made Landfall at Wrightsville Beach, NC 9/14/2018
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SITUATIONAL AWARENESS:
In the days leading up to landfall…
Communicated with Advisory Board,
DHHS, and NC HealthConnex participants
(specific messages to county health depts
and hospitals) on the availability of HIE
data in the clinical portal during power
outages
Hospitals across the region were
decompressing; some facilities closed
More than 100 shelters set up
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Hurricane Florence Emergent Connections
Impact
• Set up bidirectional eHealth Exchange Connections within 72 hours:
• Created an emergency data use agreement for portal credentials only; worked with CMS
• HIE needs to be part of state and regional disaster plans to ensure patient information is
readily available during and after storm; in beginning stages of planning a pilot this spring
with the DHHS Division of Health Regulation’s Office of Emergency Medical Services
• Received considerable media coverage from national HealthIT media; presented at ONC
Annual Meeting in November and at HIMSS19 last week.
Improves coordination of care between health care providers and their
patients by providing the ability to communicate with other health care providers
securely.
Messaging can be used:
• Transitions of Care (CCD, CCD‐A documents)
• Lab Tests/Results
• Referrals
• Reports
Direct Secure Message Exchange
• NC HealthConnex will help providers meet the STOP act
requirement
• Single sign-on to the NC HealthConnex clinical portal will
query the Appriss/CSRS database
• Create an additional pathway for providers to access the state’s
prescription drug monitoring program
STOP Act
Controlled Substance Reporting System Exchange
Proactively Monitor Patient Activity • Provider/Payer defined attribution drive
notifications of ED, Inpatient, Ambulatory
encounters
• Enhanced Clinical Intelligence Engine notification • Immunization Gap
• Critical HbA1c lab value for diabetic
• High risk patient with controlled substance fill
Notifications
Foundation
Exchange
Notifications
Pop Health & Analytics
Notifications NC*Notify – How It Works
Step 1Participant Submits Patient File for NC HealthConnex to
Monitor
Step 2NC HealthConnex
monitors the network for qualifying events
Step 3Participant Receives
Notification File
V1.0 V2.0 V3.0 V4.0
Frequency of Notifications
Daily Realtime
Format/method File via sFTP DSM SMS Text Notification
EHR via HL7 FHIR API
Triggers Generating Notifications
ED, Inpatient, Ambulatory Admissions & Discharges
Immunization administered; Patient monitored by another organization
Disease registry addition; Critical lab value received
Panel Details Participant defined; Multiple files per panel
Use health plan member file
Computed real time via message flow and attribution methodology
Subscription Configuration
Defined in Panel; Self-service portal
Content Basic visit details (date, visit type, location)
Chief complaint and diagnosis
Provider details (admitting, attending, etc.); Immunization gaps
CCD Social data Disease state data CIE data
Roadmap
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Advancing Notification Services Notifications
v 1.0
Oct 2018
v 2.0
April 2019
v 3.0
April 2020
v 4.0
Oct 2020
Help Meet
Tier 3
Requirement
Classify & Measure Your Patient
Population
• Registries & Integrations
• Diabetes
• Immunization
• Future Possibilities: Stroke, Asthma
• Controlled Substance Reporting
System (CSRS)
• Measurement
• Future Possibilities: eCQM
Pop Health & Analytics
Foundation
Exchange
Notifications
Pop Health & Analytics
• Tool for tracking the clinical care and outcomes
of the patient population in North Carolina.
• Electronic submission to the Diabetes Registry
via the NC HealthConnex interface supports
your organization’s Meaningful Use attestation
for Meaningful Use Stage 3 and Modified
Stage 2.
Pop Health & Analytics
Foundation
Exchange
Notifications
Pop Health & Analytics
Diabetes Registry
Company Conf ident ia l – For Internal Use Only Copyr ight © SA S Inst i tute Inc . A l l r ights reserved.
Public Health Registries Hotspot gaps in care, by disease groupings
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1. Physician administers
immunization for patient
2A. Physician logs immunization
in NCIR Portal
NCIR
2B. Physician logs
immunization in EMR
CCDs & HL7s
3B. NC Health
Connex data
targets passes
through NC
HealthConnex
secure connection
4B. Data populates
NC HealthConnex
data repository
HL7s
3A. Immunization
data passes
through NCIR
secure connection
4A. Data populates
NCIR data repository
Pre NCIR-NC HealthConnex Integration
5A. Physician
accesses patient’s
immunization history
via NCIR
NCIR
5B. Physician
accesses patient’s
clinical history via NC
HealthConnex
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Post NCIR – NC HealthConnex Integration
4. Data
populates NCIR
data repository
1. Provider administers
immunization for patient 2. Provider logs immunization
in EHR
HL7s
3. Immunization data passes
through NC HealthConnex
secure connection
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*NOTE: This workflow is applicable to provider’s and/or healthcare organizations who have a bi-directional data connection to the NC
HealthConnex. Providers/healthcare organizations leveraging a unidirectional connection must access NCIR via the NCIR web portal.
Use Case
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Meet John
• 35 Year Old Male
• Overweight
• Type 2 Diabetes
• High Cholesterol
• Not currently taking medication and is
having SOB upon exertion and chest
pain
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Meet John
• John has been really stressed:
• Helping his sick mother
• No money for meds
• No time to make healthy meals
• No time to workout
• Having a hard time remembering
• Taken to ED for SOB and Chest Pain
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John’s Relationship to NC HealthConnex
• Attending ER physician able to gain a more
holistic view of John’s medical history prior to
being admitted to the hospital
• Follow up-appointments and referrals are
made
• John is stabilized and is released
• John’s primary doctor uses NC*Notify and
follows up with John
• Primary Care doctor able to see test results
and notes about John’s encounters
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NC HealthConnex Portal Clinician View
Disclaimer: All patients in today’s presentation are demo patients
Clinical Viewer
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Clinical Viewer
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Clinical Viewer – Home Page with Recent Patients
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Clinical Viewer – Patient Search
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Clinical Viewer – Break the Seal
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Clinical Viewer – Patient Summary
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Clinical Viewer - Alerts
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Clinical Viewer - Allergies
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Clinical Viewer - Allergies
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Clinical Viewer – Patient Encounters
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Clinical Viewer - Medications
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Clinical Viewer - History
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Clinical Viewer – Conditions
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Clinical Viewer – Procedures/Results
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Clinical Viewer – Vaccines
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Clinical Viewer – Continuity of Care Document
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Clinical Viewer – Messages
Clinical Viewer – Direct Secure Message
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Clinical Viewer – Direct Secure Message
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Clinical Viewer – Clinician Tools
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Clinical Viewer – Clinician Tools
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Clinical Viewer – Print
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NC Community Health Center Association
&
NC HealthConnex
NCCHCA Initiatives for FQHC HIE Clinical Integration
1. Assistance to FQHC’s with enrollment and training for NC-HIEA services.
2. Assistance with preparation, submission, maintenance of patient lists.
3. Support for analytics and reports related to NC-Notify and registry data.
4. Assistance with clinical integration of HIE data into practice-based EMR and clinical work flows.
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NCCHCA Support Getting into NC-Notify
1. NCCHCA is developing and testing procedures with SAS ( technical
vendor to HIE) to enroll FHQC health centers into NC-Notify
2. Essential steps include:
– NC-Notify enrollment
– Designation NCCHCA as third party
– Establish and test FTP portal with SAS
3. NCCHCA will provide information to health centers about special
procedures shortly.
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Questions?
For more information visit: www.nchealthconnex.gov
Tel: 919-754-6912
E-mail: hiea@nc.gov
919-754-6846 Jessica.Brehmer@nc.gov