NC HIEA April 2019 Update April 22, 2019 NC HIEA Roadmap 2021 is Now Available Now in its third year of operation, the NC HIEA is pleased to present a strategic guide for the next three years that highlights key focus areas to support improving the health and well-being of North Carolinians. In the NC HIEA Roadmap 2021, we detail five strategic areas for 2019-2021, an array of initiatives embedded in each one, and how we will measure progress along the way. NC HIEA Roadmap 2021 is intended to be dynamic, vision-based document, rather than an operational plan for achieving each initiative. As our team at the NC HIEA and the NC HealthConnex participant base continues to grow, we will look to this roadmap to stay focused on what's most important to our stakeholders, participants, and the health of North Carolinians. We look forward to working together to build a better NC HealthConnex and achieve our vision for connected health care communities across the state. New Legislation Could Adjust HIE Act Requirements House Bill 70 was recently passed by the North Carolina House of Representatives and is currently under consideration by the North Carolina Senate. If passed, this bill would make changes to the North Carolina Health Information Exchange Act ("The HIE Act"), some of which will affect the NC HealthConnex connection requirements and deadlines for some health care providers. A summary of the proposed change is included below: Provision of one additional year for health care providers currently falling under the June 1, 2019 deadline to connect to NC HealthConnex: the new required connectivity date for these providers would be June 1, 2020. Extension of the deadline to connect for licensed physicians whose primary area of practice is psychiatry to June 1, 2021 Clarification to require only those health care providers licensed in the State of North Carolina to connect: this language change will help those health care providers near state borders understand if the connection requirement applies to them. Providers licensed in other States may still connect to NC HealthConnex voluntarily Provides that the Department of Health and Human Services (DHHS), in consultation with the Department of Information Technology and the NC HIEA, establish a process to grant exemptions to the connection requirement for providers of Medicaid and other state-funded programs for whom acquiring and implementing an EHR would constitute undue hardship: this change would allow for state leadership to consider special situations including impending retirement or closure; lack of access to affordable broadband capacity adequate to support implementation of EHR technology and connection to the HIE Network; lack of financial flexibility to acquire and implement health information technology solutions needed to connect to the HIE Network; and whether exclusion of the provider from Medicaid would result in a lack of access to care under DHHS’ network adequacy standards Provides for an extension for health care facilities operated by the Secretary of the DHHS and the State Laboratory of Public Health: this change would allow for these facilities to connect and submit required data by June 1 of the fiscal year following the year in which they implement and EHR or other technology solution enabling connectivity to the HIE Network Make connection to NC HealthConnex voluntary for certain providers/entities: Respiratory, rehabilitative, restorative, assistive technology and intellectual and developmental disability service providers; Durable medical equipment providers; Personal care, community alternatives programs, including CAP/C and Innovations, private duty nursing, and Program of All-Inclusive Care for the Elderly (PACE) service providers; Home health providers; School-based health providers, Children’s Developmental Services Agencies, NC Infant-Toddler Program service providers, and providers of the residential behavioral health program for children operated by the Secretary of the Department of Health and Human Services at Wright School; Speech, language, and hearing service providers; Hospice service providers; Respite care service providers; and Non-emergency medical transportation services. Note: This is still a bill and has not been signed into law as of April 18, 2019. Link to the legislation to follow its path at the General Assembly. (HB 70 language) New Studies Link Increased Use of HIEs with Shorter Emergency Stays and Low Hospital Readmissions Health information exchanges have many benefits, including improving provider to provider communication during care transitions, reducing unnecessary testing and reducing paperwork and medical records gathering, but empirical study directly linking them to clinical outcomes are not widely done. Two studies released this year are showing benefits in new areas - emergency department (ED) length of stay and hospital readmission rates. ED Length of Stay Reduced up to 15% With HIE The University of Texas at Dallas recently released a study showing hospitals can improve both the patient and provider experience when an HIE is in use at that hospital. Specifically, study authors explored how the adoption of HIEs affect the length of stay in emergency departments, an important measure of operational performance. According to the study, “…the length of stay is the recorded time between when a patient signs in and leaves the emergency department. The study focuses on treat-and-release patients — those sent home after they visit the emergency department — who account for about 80 percent of all emergency visits.” The study concluded that adoption of hospital HIE is associated with a 10.2% reduction in stay and is even higher at 14.8% within an integrated health system. “Health information exchanges help mitigate the length of stay because physicians have access to information from prior visits,” one of the study’s authors said. “They will be able to make better and timelier decisions. They can avoid repeat procedures. For example, they will know what kind of drugs the patient is taking and what care they have already received.” HIE Reduced Readmission Rates in Florida Another pivotal HIE study released in Health Affairs this February concluded that health information exchanges have a direct effect on hospital readmission rates. This Florida study analyzed data from 160 hospitals to review whether HIEs can help hospitals improve quality measures. According to the study, “HIE participation was associated with a decrease in the probability of unplanned, 30-day readmissions for acute myocardial infarction (AMI, heart attack) that was 1.3 percentage points greater than that seen at non-participating hospitals.” The study’s authors stated, “These findings indicate that HIE can be leveraged to improve quality measures targeted by the Hospital Readmissions Reduction Program and may hold promise for achieving broader policy goals.” Reprinted from the CORHIO newsletter, March 27, 2019. NC HealthConnex Platform Migration Complete! As of today, NC HealthConnex has completed its migration and is running entirely on the new platform. We appreciate our participants’ support and patience through the migration process and are thrilled to start sharing the benefits of the new NC HealthConnex with you. Many of the benefits of the new HIE platform may not be immediately visible to users but will improve the function and security of NC HealthConnex as the HIE grows to support the majority of the state’s health care provider and patient populations. These include enhanced data mapping services, more sophisticated reporting tools, and better confidentiality, consent, and user access capabilities. Users of NC HealthConnex and its features can learn more about how the upgrade affects their interactions with the system through the below linked documents and upcoming training opportunities. NC HealthConnex EHR-Integrated Users: NC HealthConnex bidirectional, EHR-integrated, users will now have a consolidated patient record (in a CCD format) delivered back from the HIE. The consolidated CCD will be the primary document that is sent back to bi-directional participants via the EHR interface. This document will be built on-demand to offer the latest clinical data and demographics for the patient in a streamlined view that eliminates duplicate entries and overlapping documents. Additionally, all NC HealthConnex EHR-integrated (XDR) Direct Secure Messaging users should now have received web-based training and training documentation on the new self-service reporting tool. For more information, contact your organization's Participant Account Administrator (or if you are the PAA, contact HIESupport@sas.com with any questions or concerns). NC HealthConnex Clinical Portal Users: Participants with credentials to the former Clinical Portal should now have received an email with login information for the new Clinical Portal. If you had prior credentials but have not received new information in the month of April, please contact your organization’s Participant Account Administrator. A User Guide for the new Clinical Portal, containing screenshots and tips, is available for download on the NC HIEA website by clicking here. Users should note that the messaging capabilities in the new Clinical Portal represent an upgraded, fully integrated Direct Secure Messaging solution. To see a demo of the Clinical Portal, see the NC HIEA Calendar of Events below to register for an upcoming web-based training session. Participant Account Administrators: Participant Account Administrators (PAAs) should now have received by email login information for the new Clinical Portal. If you had prior credentials but have not received new information in the month of April, please contact the NC HealthConnex Help Desk at HIESupport@sas.com. A PAA Reference Guide for the new clinical portal, containing screenshots and tips, is available for download on the NC HIEA website by clicking here. NC*Notify Users: Enrolled users of NC*Notify will continue to receive notifications as before the system upgrade and needn’t take any action at this time. Additional fields will be made available on the result files, including primary diagnosis, chief complaint, and visit number. The service will also begin accepting subscription files and sending results via Direct Secure Messaging (DSM). Participants currently receiving notifications that are interested in transitioning to a new delivery method should contact the HIE helpdesk. Submit-Only Participants: Those participants with submission-only agreements with the NC HIEA have had their data feeds transitioned seamlessly and needn’t take any action at this time. eHealthExchange Connections: Please note that the NC HIEA is working through additional testing activities with our border state HIEs, which may result in delays in those connections beyond the month of April. We anticipate completing these activities in the next four to six weeks. Enroll in NC*Notify Today to Beat the Queue The NC HIEA and our partners at SAS Institute are currently working to onboard over 40 participating organizations to the NC*Notify event notification service. We anticipate enrollment forms to increase this spring and summer as our participants leverage this no-cost service to improve their population health practices and prepare for meeting the new requirements under Medicaid managed care. As of April 2019, over 4,600 health care facilities across North Carolina are connected and sharing data with NC HealthConnex, and over 4,000 more are in the onboarding process. Through participation with NC*Notify, your organization can begin to receive updates as frequently as daily when your patients receive care at any of these connected facilities across the care continuum. The NC HIEA encourages full participants of NC HealthConnex to consider the benefits of NC*Notify and enroll today. Please note that there is no cost to enroll or use the NC*Notify service. For more information on how NC*Notify can help with patient care needs and to enroll, visit https://hiea.nc.gov/services/ncnotify. Still have questions? Reach out to the NC HIEA provider relations team at (919) 754-6912 or via email at email@example.com. Register Now to Leverage NC HealthConnex to Meet STOP Act Requirements Full participants of NC HealthConnex may leverage the HIE to access the NC Controlled Substances Reporting System (CSRS) and meet their legislated requirements under the Strengthen Opioid Misuse Prevention (STOP) Act of 2017, or the STOP Act (NCSL 2017-74). To begin the STOP Act compliance process, health care providers must register with the North Carolina Drug Control Unit by filling out an Integration Request Form. This form and more information about the process may be found on the CSRS website. Providers wishing to leverage their existing NC HealthConnex integration to meet the requirement, rather than build a new integration or manage additional portal credentials with the CSRS system, should select NC HealthConnex in the drop-down menu as their preference for connection within the Integration Request Form. More information about using NC HealthConnex as your partner in compliance with the STOP Act, including future plans to deliver the integration directly into NC HealthConnex participants’ workflows, can be found on the NC HIEA website. NC HIEA Calendar of Events April Teletown Hall – Wednesday, April 24, 2019 at 12 p.m. – Interested health care providers are invited to join this Teletown Hall webinar to see a demo of the new NC HealthConnex Clinical Portal, including how to navigate the system to pursue clinical use cases. How to Connect Call – Monday, April 29, 2019 at 12 p.m. – Interested health care providers are invited to join a monthly "How to Connect" call to learn about who we are, the state mandate, steps to connect, and the HIE’s value-added features. Behavioral Health/Intellectual and Developmental Disability Work Group Meeting – Friday, May 3, 2019 at 1 p.m. – =Interested parties are invited to join this work group webinar to discuss the challenges and benefits that accompany connecting this population of health care providers to NC HealthConnex. May Teletown Hall – Wednesday, May 15, 2019 at 12 p.m. – Interested providers are invited to join this Teletown Hall webinar to learn more about connection requirements under the HIE Act, the benefits of leveraging NC HealthConnex in clinical practice, and the new NC HealthConnex platform. HIE Training for Critical Access Hospitals – Friday, May 17, 2019 Questions? Contact the NC HIEA at firstname.lastname@example.org or call (919) 754-6912. In Other News How Physicians Can Control Healthcare Costs – Physicians are uniquely positioned to transform the clinical delivery system to better meet patient needs while reducing costs and improving quality. A study shows major gaps in communication between hospital and home health care clinicians. Social Determinants of Health: Can Zip Codes Define Health Outcomes?