NC HealthConnex Pushes for Recognition as a Health Data Utility
The General Assembly established NC Health Information Exchange Authority in 2015 to oversee and administer North Carolina’s state health information exchange, NC HealthConnex.
Exchanges like NC HealthConnex helps reduce clinician workload, testing duplication and overall health care costs. They increase patient safety – especially for patients with multiple medical conditions who need many specialists and providers to access their records.Access to patient information on an exchange can prevent up to 18% of overall patient safety errors and approximately 70% of adverse events due to medication errors.
The NC HIEA is now looking to gain formal classification for NC HealthConnex as a health data utility. A health data utility shares health data beyond health care providers to a broader range of stakeholders, including public health and government agencies, hospitals, laboratories, health plans and social service organizations.
Within this definition, NC HealthConnex is already serving as a health data utility for North Carolina in many ways. It enables reporting that helps providers meet requirements for communicable disease reporting to the N.C. Division of Public Health and federal incentives for meaningful use of electronic health records. NC HIEA has also partnered with the N.C. Division of Public Health to build stroke and diabetes registries to provide data for identifying trends across the state and improving patient care, particularly in underserved areas.
Formal status as a health data utility in federal policy and state law would position NC HealthConnex to apply for federal funding to further the public health infrastructure in North Carolina, enabling it to serve more uses for public health.
Trusted data from many sources can create a more complete picture and enable building a more comprehensive strategy for disease testing, response and health outcomes, especially for more underserved populations. Medical facilities, public health agencies and community health providers can contribute to shared interests and goals through health data collection, sharing and analysis.
Efforts are underway to encourage federal policymakers to create, designate and fund existing health information networks, such as NC HealthConnex, as health data utilities. Civitas Networks for Health, a collaborative of health information exchanges and regional health improvement collaboratives, recently released a framework for health data utility adoption for states that includes progressive phases to allow for incremental growth and continuous improvement. Federal and state rules for data privacy and security would also need to be streamlined for access across state lines.
Classification as a health data utility would expand NC HealthConnex’s ability to serve as critical state infrastructure for both public health and medical providers.
NC HealthConnex: How North Carolina's HIE Improves Patient Care and Providers' Work
Medical providers who use NC HealthConnex, North Carolina's state health information exchange, explain how it works.
The N.C. Health Information Exchange Authority has taken great strides to achieve goals in:
- Population health and analytics
NC HIEA: Our Three-Year Journey
NC HealthConnex supports the public health response to the COVID-19 pandemic, along with the N.C. Department of Health and Human Services, N.C. Health Information Exchange Authority and NC HIEA’s technology partner, SAS. NC HealthConnex partners in multiple efforts, including data sharing, data delivery, visual dashboards and analytic tools.
"The NC HealthConnex COVID-19 Dashboard is beautiful and interesting, but more importantly, we use it on a regular basis to understand how the public health emergency is impacting Medicaid beneficiaries. ... Moreover, working with NC HIEA on the dashboard has catalyzed our engagement with NC HealthConnex analytics. The adverse circumstances have pushed our partnership to accomplish more since March than we would have in three normal years.”
— Sam Thompson, senior manager at North Carolina Medicaid
Data-Sharing COVID Labs
The N.C. Electronic Disease Surveillance System sends records for COVID-19 tests and results to NC HealthConnex. The records are then matched, and an enhanced data process is performed for positive cases to add demographics, encounters, results, medications and procedures and return these cases to NC EDSS. In addition, COVID-19 tests and results are distributed through the NC HealthConnex notification service, NC*Notify. NC HIEA has worked diligently to improve access to laboratory test results and has connections with Quest Diagnostics and LabCorp, which provide health care professionals with a more holistic view of their patients’ health status.
DHHS, NC HIEA and SAS have partnered to report COVID-19 vaccine administrations from across the state. DHHS manages the COVID-19 Vaccine Management System, a cloud-based solution that enables vaccine management and data sharing across the care continuum. This system allows vaccine providers in North Carolina to submit cases and inquiries regarding COVID-19 vaccines.
NC HealthConnex offers connectivity to CVMS and patient matching across sources to enhance vaccine data by utilizing NC HealthConnex's master patient index. NC HealthConnex receives COVID-19 vaccine administration data from points of care, such as CVS, Walgreens, hospitals, health systems and electronic health records. This significantly reduces the need to manually enter vaccine administration data directly into CVMS.
Statewide Disease Surveillance
To assist with contact tracing, NC HealthConnex has worked with the N.C. Division of Public Health to expand data sources for more complete coverage of the state. NC HealthConnex provides DPH with extracts of COVID-19 positive cases, including enhanced clinical information such as encounters, procedures, diagnosis, observations, medication and immunizations.
COVID-19 Medicaid Dashboard
NC HealthConnex maintains a robust repository of clinical data within the state’s health information exchange. The data provides insights about who is impacted by COVID-19, where the virus is spreading, who should be tested and who is at the greatest risk. Partnering with DPH and the N.C. Division of Health Benefits, NC HIEA was able to leverage this infrastructure to develop the NC HealthConnex Medicaid COVID-19 Dashboard.
The dashboard presents information about the Medicaid population using a variety of data sources, including Medicaid beneficiary files, census data, social vulnerability index and vital statistics data. The dashboard includes data points on positive COVID-19 tests, recovered cases, deaths, symptoms, social vulnerabilities and comorbidities, telehealth use and path analysis.
COVID-19 Long-Term Risk Analysis
Understanding the potential for outbreaks is essential for DHHS's prevention and mitigation strategies. A risk-based model for predicting outbreaks in long-term care facilities in the state was developed. The model included county-level disease data, DHHS outbreak data, regulatory data from the U.S. Centers for Medicare and Medicaid Services and data on COVID-19 and personal protection equipment from the U.S. Centers for Disease Control and Prevention.
NC*Notify’s real-time event notifications provide care teams with valuable information that spans geography and care settings and supports state and federal efforts to focus on patient-centered care. NC HealthConnex recently upgraded NC*Notify to be more tailored and bridge gaps in the day-to-day operations of health care delivery.
The latest version of NC*Notify is built on Encounter Notification Service, Audacious Inquiry's leading care coordination platform used by interoperability-driven organizations in 12 states, representing more than 60 million active patient subscriptions. Additionally, the service incorporates data from national networks, including the Patient-Centered Data Home, managed by the Strategic Health Information Exchange Collaborative, which has distributed 1 billion event notifications nationwide. Along with near real-time notifications, service offerings include:
- Self-service panel loader – Participants can submit whole patient panels or subsets of entire panels for monitoring.
- Auto attribution – Patient panels are automatically generated based on encounters sent to NC HealthConnex from community providers subscribed to the service.
- Multiple notification options (sFTP/DSM) – Participants have the flexibility to tailor notifications in a way that best meets their needs.
NC HIEA also offers clinical intelligence alerts, including dental alerts, chronic care management, pre-diabetes, diabetes and care team changes.
Giving providers insights to check in with patients after events and to schedule follow-up appointments for clinical interventions reduces avoidable hospital readmissions, improves coordination across the care continuum and helps providers achieve financial goals under value-based care contracts.
"We utilize NC HealthConnex for continuity of care due to post-hospitalization and post-ED visit discharges and data gathering for closing care gaps for our accountable care organization, our insurance payer programs and Medicaid meaningful use quality measure reporting."
— Dr. Jonathan Woods, Jacksonville Children’s and Multispecialty Clinic
Conditions of Participation
The U.S. Centers for Medicare and Medicaid Services released new notification guidelines for hospitals across North Carolina as part of the conditions of participation requirements for Medicare and Medicaid. Through the notification service, NC HealthConnex helps hospital participants meet CMS conditions of participation and provides timely insights for primary care, behavioral health and other community providers instrumental in care coordination for their patients.
Chronic Disease Management
Managing chronic conditions is a priority for participants in NC HealthConnex. NC HealthConnex has taken an active role in providing tools to identify at-risk populations and monitoring ongoing improvements in outcomes using chronic disease registries. Created using visual analytics, the Diabetes Registry includes an interactive dashboard in a modernized analytics environment. NC HealthConnex participants can make faster, more informed care decisions by finding all data sources and visualizing data correlations across multiple variables. Users can create customized, self-service reports with interactive, enhanced data visualizations such as trends and anomalies.
Controlled Substance Reporting System
HealthConnex has partnered with the N.C. Division of Mental Health to build a connection from the NC HealthConnex clinical portal to the state's prescription drug monitoring program, called the Controlled Substances Reporting System, utilizing the Appriss application programming interface. This integration creates an additional pathway for providers to access the CSRS to meet STOP Act requirements and helps combat the opioid epidemic in North Carolina.
Quality metrics are essential to compare the quality and cost of care. As more health care providers establish managed care programs, the ability to accurately and timely evaluate care is imperative. NC HealthConnex receives data from many different sources. This allows the N.C. Health Information Exchange Authority to provide supplemental data to the N.C. Department of Health and Human Services to report Healthcare Effectiveness Data and Information Set measures.
Patient-Centered Data Homes
North Carolina health care providers can now receive information when their patients present at out-of-state emergency rooms and inpatient stays thanks to a connection between NC HealthConnex and other participating health information exchanges nationwide via the Patient-Centered Data Home national network. PCDH is a secure health data exchange that proactively alerts health care providers when their patients have a health event away from home. Patients' health records thus are available wherever and whenever they need them.
Based on triggering episode alerts, the system proactively notifies NC HealthConnex when care events occur outside patients' home HIE. It confirms the availability and location of the clinical data, so participating full providers can initiate additional data exchanges to access real-time information across state and regional lines and the care continuum.
"When we use NC HealthConnex, we can rely on the fact that a patient's information will be there. It's important that we can refer to health information records to treat each patient properly. NC HealthConnex allows us to administer the best health care possible."
– Dr. Harriett Burns, Piedmont Health Services
This system gives patients reassurance that they can receive high-quality, personalized care regardless of location. For health care providers, PCDH eliminates potential gaps in care when patients are seen outside their normal care areas. It gives nationwide access to patient information that follows patients and facilitates better treatment. Whereas other national networks such as the eHealth Exchange or CareQuality require treating providers to initiate patient queries, PCDH pushes information based on patients' home zip codes.
NC HealthConnex continues to recognize the importance of high-quality data to support the services that its participants and stakeholders rely on. Since 2018, NC HealthConnex has completed several successful initiatives related to data quality:
- Developed and approved a Data Quality Roadmap that outlines NC HealthConnex’s strategies to measure and improve data quality, including a new data governance team focused on this topic
- Published a field-level data target that clearly communicates what data is expected from new participants
- Implemented a formal user acceptance process to review and approve that new participants’ data is high quality
- Released a data-quality dashboard and participant-facing scorecard that allows for ongoing monitoring after onboarding and facilitates a feedback loop with participants to improve data quality