NC HIEA June Update

Thursday, June 29, 2017

Poised for Growth

2017 Appropriations Act Addresses HIE Legislation

The North Carolina Senate and House of Representatives worked together to provide adjustments to the HIE Act in the 2017 Appropriations Act, North Carolina’s State Budget, based on input from the NC HIEA, NC DHHS, stakeholder trade associations and providers impacted by the law. Both the House and Senate have passed the budget, and it now heads to the Governor’s Office for further action.

Changes to the HIE Act are outlined below.

Connection Timeline Revisions:

  • Hospitals as defined by G.S. 131E-176(3), physicians licensed to practice under Article 1 of Chapter 90 of the General Statutes, physician assistants as defined in 21 NCAC 32S .0201, and nurse practitioners as defined in 21 NCAC 36 .0801 who provide Medicaid services and who have an electronic health record system shall connect by June 1, 2018.
  • All other providers of Medicaid and state-funded services shall connect by June 1, 2019.
  • Prepaid Health Plans (PHPs), as defined in S.L. 2015-245, will be required to connect to the HIE per their contracts with the NC Division of Health Benefits (DHB). Clarifies that PHPs are required to submit encounter and claims data by the commencement of the contract with NC DHB.
  • Clarifies that Local Management Entities/Managed Care Organizations (LMEs/MCOs) are required to submit encounter and claims data by June 1, 2020.

Other Changes:

  • Allows NC DIT to establish an extension process in consultation with NC DHHS to grant limited extensions of time for providers to establish connectivity to the HIE network if such providers can “demonstrate ongoing good faith effort to take necessary steps to establish such connectivity.” More information on this process will be available in a future update.
  • Clarifies that 42 C.F.R. Part 2 programs (i.e., federally assisted substance use disorder treatment facilities) are exempt from sending data pertaining to substance use disorder treatment services, pursuant to federal law. Providers who participate in these programs will still be required to send clinical data that is not subject to these restrictions.
  • Repeals the emergency opt out provision (G.S. 90-414.10(e)). When a patient opts out of the HIE, his/her data is sent to the HIE, but it is blocked from being shared with any of the HIE’s authorized users (those accessing the HIE for treatment, payment, or other HIPAA-covered purposes). The former law allowed for a treating provider to access the record of a patient who had opted out in the case of a medical emergency. The NC HIEA requested the repeal of this provision because the current HIE technology only allows for a privacy officer at the NC HIEA or SAS to open a patient record that had been blocked due to an opt out request. For example, an ER physician would not be aware that a patient record exists in the HIE for a patient who has opted out. The NC HIEA expects the impact of this change to be minor, as the current opt-out rate is >0.1% of patients with records in the HIE.
  • Requires a joint study to be conducted by NC DHHS, NC DIT, and the State Health Plan to better understand which data elements providers other than hospitals, doctors, and mid-level practitioners collect electronically, and whether those data elements have clinical meaning for HIE users. This is a priority for the NC HIEA and our partner agencies to provide clarity to these provider types impacted by the mandate. Final findings and recommendations will be submitted to the Joint Legislative Oversight Committee on Health and Human Service and the Joint Legislative Oversight Committee on Information Technology by April 1, 2018.
  • Provides funding in the amount of $3M non-recurring funds (one year) to upgrade the existing HIE environment and $9M annual recurring funds (two years) for staffing, operations, analytics environment deliverables, and technical integrations.

Participation and Connection Update:

Duke Health, Novant Health, Carolinas HealthCare System, and the Coastal Connect Health Information Exchange Sign Agreements to Connect to NC HealthConnex: The NC HIEA is pleased to announce the addition of three of the state’s largest health care systems to its growing list of participants. They join UNC Health Care, who is a foundational participant, and 26 additional hospitals who are currently connected to or in the connection process with NC HealthConnex.

The Coastal Connect Health Information Exchange will bring an additional five hospitals and 100+ data contributors, acute and ambulatory, to the growing State-designated HIE.

In addition to hospital and health system integrations, the NC HIEA is in process with hundreds of connections to physician practices, health departments, federally qualified health centers, rural health clinics, and other ambulatory facilities that use cloud-based and on-premise electronic health/medical record (EHR/EMR) solutions.

Cloud-based EHRs: The NC HIEA is working to build multi-tenant connections to the following cloud-based EHR vendor hubs:

  • Allscripts – pilot completion expected June 30; will enable 178 hosted sites
  • athenahealth – pilot completion expected June 30; will enable 331 hosted sites
  • CureMD – technical kick-off in progress; will enable 37 hosted sites
  • eClinical Works – technical discussions underway; will enable 130 hosted sites
  • Additional agreements in process include DAS Health (Aprima), Greenway, Quest Care360, Office Practicum, and Amazing Charts, together enabling 200+ hosted sites

Health care providers who are customers of these cloud-based EHR vendors will need to have a Participation Agreement (PA) in place with the NC HIEA to utilize the multi-tenant connection. If you have not already signed a PA, a form-fill version is available on the website at https://hiea.nc.gov/providers/how-connect. The complete list of EHR vendors with whom we are working is also available on the same web page. If you do not see your vendor on this list, the submission of your PA will kick off the process with that vendor.

For a complete list of NC HealthConnex participants click here.

The NC HIEA is hosting monthly “How to Connect” calls with prospective participants to walk through the onboarding process and answer questions. These will be held the last Monday of every month at 12:00 pm. To participate in this month’s call held on July 31, 2017, click here to register.

Value-Added Features:

  • eHealth Exchange – The NC HIEA is pleased to announce that its first connection via the nationwide eHealth Exchange, to the Georgia Health Information Network (GaHIN), will be live this summer. The eHealth Exchange framework will allow the NC HIEA to connect to out-of-state HIEs and federal agencies, including the Department of Defense, Veterans Affairs, and the Centers for Medicare and Medicaid Services, enabling participants to access patient records in these databases within NC HealthConnex.
  • Provider Directory – The Provider Directory is made available in MS Excel format to participants and includes provider organization, name, address, phone, specialty, NPI, and secure email address. The directory is updated multiple times per year and currently includes information for over 11,000 NC providers. Participants will receive instructions on how to make updates to their current listings in August 2017.
  • NCIR and ELR – The NCIR/NC HealthConnex bidirectional connection went live with its first UNC Health Care clinic in January. This connection allows for automated immunization reporting from the provider EHR to the NCIR, and enables providers to query the NCIR from within their EHR. The NC HIEA and NC Immunization Branch are working to onboard UNC’s pediatric clinics in 2017, and will determine the provider onboarding queue for 2018 this fall. The NC Division of Public Health is still working through the last stages of testing on the ELR/NC HealthConnex connection with its pilot hospital.
  • Disease Registries – The Specialty Registry work group has made positive strides on the first disease registry, focused on diabetes. The work group has developed a prototype dashboard, and discussed the capability of an HIE participant to submit a patient list to NC HealthConnex and receive a patient file with diabetes care data in return. A sub-group of the work group will soon begin working to define registry use cases and actionable patient file data elements. The next Specialty Registry work group meeting will be held in July.
  • Clinical Notifications – The HIE Taskforce and a smaller sub-group recently met to better understand the use cases for clinical notifications. The NC HIEA will begin a pilot of this functionality this fall.

Note that the above value-added features are available to participants that sign a full participation agreement with the NC HIEA, and are not available for participants who sign a submission-only agreement.

Frequently Asked Questions

What are the permitted uses of the data that is being provided to NC HealthConnex?

The NC HIEA takes very seriously the responsibility of protecting the data that is being entrusted to NC HealthConnex for the purposes of health information exchange and as outlined by the General Assembly. As a State entity, health care providers can rest assured that the State is prohibited from using HIE data for commercial purposes. SAS, the State’s technology vendor, is also prohibited from using HIE data for commercial purposes, and can only use, disclose or access the data as directed by the State.

Permitted uses of HIE data include only those allowable under HIPAA and applicable law, including patient treatment, payment, health care operations, as well as public health activities and reporting. These permitted uses are listed in each participation agreement as well.

Questions? Call the NC HIEA business office at 919-754-6912 or send an email to hiea@nc.gov.