Six Months In … a Time of Reviewing, Researching and Rebuilding
Since January, the North Carolina Health Information Exchange (NC HIE) has been in transition. As you may be aware, the NC HIEA was created in Session Law 2015-241 s. 12A.4 and 12A.5 in September 2015 to oversee and administer North Carolina’s HIE. The legislation requires that as of February 1, 2018, all Medicaid providers must be connected to the NC HIE in order to continue to receive payments for Medicaid services provided. By June 1, 2018, all other entities that receive state funds for the provision of health services, including local management entities/managed care organizations, also must be connected.
In the first six months, the state of North Carolina has taken ownership of the HIE and has committed to fully funding it for two years. To date, the newly formed North Carolina Exchange Authority (NC HIEA) housed within the North Carolina Department of Information Technology has:
- contracted with SAS Institute, a North Carolina-based leader in innovative analytics, business intelligence and data management software and services, as its technical contractor;
- hired in-house staff for day-to-day operations;
- conducted a thorough review of the functionality of the portal technology currently being utilized by the NC HIE;
- met with stakeholders in the health care industry; and
- begun the process of re-connecting providers around the state who were previously connected via Community Care of North Carolina (CCNC)*.
The first months have been focused on reviewing, researching and rebuilding. Although the NC HIE has a complex history, we’re now moving full steam ahead on a broadened, more functional and more secure information network that can positively transform the way health care is delivered. Our team of 20, comprised of state employees and SAS employees, is working diligently to earn your trust and deliver a modernized HIE that will be more robust and supply value to you – the provider community.
One of our primary goals in Phase One is to communicate clearly and frequently with the provider community in North Carolina. This update includes information on where we are to date and where we are going as we move into Phase Two.
Reviewing
In April, our operations and technical teams met with Orion Health, the company that provides the portal technology for the NC HIE. From this two-day meeting, the team learned more about the current business rules and configuration for the NC HIE, as well as possible enhancements to the technology. The current functionality of the NC HIE includes:
- a clinical portal to view a comprehensive longitudinal record;
- Direct Secure Messaging (through a separate portal); and
- consent management tools.
We’ve heard from many of you that the previous HIE did not provide enough value to constitute the time and resources for a connection. As part of this review process, the NC HIEA team has actively sought feedback on enhancements to the HIE platform that would expand its clinical value. These include:
- adding options to simplify breaking the privacy seal;
- integrating single sign-on for direct secure messaging via the portal;
- providing access to public health data (NC Immunization Registry, electronic lab reporting, and chronic disease registries);
- connecting to eHealth Exchange;
- enabling clinical notifications; and
- providing a statewide provider directory.
Researching
In April and early May, our staff contacted several state and regional HIEs to determine best practices around the country and learn from others who have been building slowly and steadily over the last nine years. Their expertise and experience has provided great insight into the short- and long-term strategies for the NC HIEA.
Additionally, the NC HIEA team has spent considerable time researching various national initiatives that will help build a more robust HIE at the state level. We are currently in conversations with the Sequoia Project, Carequality Initiative, DirectTrust, and Surescripts to leverage their existing knowledge base and to position the HIE for future success.
Rebuilding
In March, providers who were previously connected to the HIE via CCNC were given the first opportunity to reconnect to the new NC HIE. Our legal and technical teams have been in close contact with these 300-plus providers across the state to establish a new connection. These connections are ongoing and should be complete by the end of the year.
It’s important to note that these connections are complex and require research with participants and their EMR vendors, involve multiple technical resources, multiple testing cycles, and much more. We discovered that many past participants were connected in non-standardized ways which meant that each integration required several potential translations and transformations. The previous set-up resulted in an inconsistent set of clinical information with varying levels of relevance to NC HIE participants.
Another area of focus is onboarding and training. The team is standardizing the onboarding process to deliver a valuable tool that minimizes impact on existing provider workflows. In order to facilitate this process, the technical team is working on minimum data standards to enable a standards-based conversation of rich and relevant data that can be useful for all providers who view a patient record in the network.
We know that training is a priority, and we sincerely appreciate your patience as we work toward delivering efficient, effective, and informative onboarding and training materials for you. The team is developing a user training guide and recording training sessions for participant administrators and users to facilitate ease of use. Current participants should receive notification to access the training very soon.
Beyond establishing a vision for the technical capabilities of the NC HIE, we’re also working to rebuild trust in the provider community. The team has considered at great length what the organization needs to balance operational, technical, financial and governance responsibilities to ensure future sustainability. We will be helped further with this effort with the state-appointed Advisory Board that is expected to be finalized next month.
It is our goal to make the NC HIEA a relationship-based, technology-focused entity that will include you – our stakeholders – in all stages of the development of the HIE. Together, through collaborative efforts, we can meet the mandates set out by the North Carolina General Assembly and will improve health care outcomes for the citizens of North Carolina.
Feel free to reach out to our team at any time for comments, questions or to introduce yourself. We look forward to the conversation!
Web: Phone: E-mail:
http://hiea.nc.gov/ (919) 754-6912 hiea@nc.gov
* It has come to the attention of the North Carolina Health Information Exchange Authority (NC HIEA) that providers are in receipt of information from several EMR vendors that may be inaccurately describing their technical connection to the new, state-led HIE. We apologize for any confusion and/or disruption that the transition has caused for your practice. In order to share clinical data with other HIE participants and comply with a new state law, providers must sign a Participation Agreement (PA) with the NC HIEA and direct their EMR vendors to enter into technical conversations with the NC HEIA’s technical vendor—SAS Institute—to enable the new data connection.