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