NC HIEA June 2021 Update June 2, 2021 NC HealthConnex June and October Deadlines Extended to January 2023 Governor Roy Cooper signed House Bill 395 (now NCSL 2021-26) into law on May 27, 2021, to allow additional time for providers to connect to the state-designated health information exchange NC HealthConnex, among other things. The North Carolina Health Information Exchange Authority (NC HIEA) Advisory Board and the North Carolina Department of Information Technology led a collaborative effort to bring additional relief to health care providers who have been on the front lines of the COVID-19 pandemic. Extending the deadline until January 2023 will allow additional time for health care providers to complete their technical onboarding process without being out of compliance with the HIE Act. Please note that there are more than 5,000 facilities in onboarding at this time. Providers should continue to connect as we have no guarantees of additional extensions and, as noted below, the General Assembly is requiring compliance reports by March 1, 2022. Among other changes to the HIE Act, the NC HIEA Advisory Board has been tasked with developing final recommendations regarding appropriate features or actions to support the Statewide Health Information Exchange Act and to report on the status of entities and providers not connected to the HIE Network as identified under subsection (b) of this section, to the Joint Legislative Oversight Committee on Health and Human Services on or before March 1, 2022. Additionally, the NC HIEA has been directed to work with the State Health Plan Division, Department of State Treasurer, and the Division of Health Benefits, Department of Health and Human Services, to identify providers and entities who have not connected to the HIE in accordance with G.S. 90-414.4 and to contact each entity or provider to ascertain their connection status and to inform them of the connection requirements. By November 1, 2021, the Department of State Treasurer, Department of Health and Human Services, and licensing boards, shall assist the NC HIEA with contact information and addresses for providers and entities. Additional Changes and Additions to the HIE Act Per NSCL 2021-26 (HB395 Bill Analysis): Section 1 provides that the N.C. Department of Information Technology; Department of State Treasurer, State Health Plan Division; and N.C. Department of Health and Human Services, Division of Health Benefits; have an affirmative duty to facilitate and support participation by covered entities in the Statewide Health Information Exchange Network. Section 2 allows the N.C. Department of Health and Human Services, if authorized by the NC HIEA, to submit data on behalf of Prepaid Health Plans and local management entities/managed care organizations (LME/MCOs). The section also extends connection deadlines as follows: Extends the connection deadline for most providers of Medicaid and State-funded health care services, and affiliated entities, until January 1, 2023 (currently October 1, 2021). Extends the connection deadline for physicians who perform procedures at ambulatory surgical centers, dentists, psychiatrists, and the State Laboratory of Public Health until January 1, 2023 (currently June 1, 2021). Extends the connection deadline for pharmacies and State health care facilities operated under the Secretary of the Department of Health and Human Services (State psychiatric hospitals, developmental centers, alcohol and drug treatment centers, neuro-medical treatment center, and residential programs) until January 1, 2023 (currently June 1, 2021). Sections 2 and 4 remove ambulatory surgical centers, as defined in G.S. 131E-146, from the requirements to submit demographic and clinical data but require a physician who performs a procedure at the ambulatory surgical center to be connected to the HIE Network and to submit the data. Section 5 prohibits balance billing when an in-network provider or entity with the State Health Plan for Teachers and State Employees does not connect to the HIE Network. The section specifically provides that under the State Health Plan an in-network provider or entity who renders health care services, including prescription drugs and durable medical equipment, and who is not connected to the HIE Network, is prohibited from billing the State Health Plan or a Plan member more than either party would be billed if the provider was connected to the HIE Network. Note: Providers participating in the State Health Plan network should reach out to the State Health Plan with questions regarding this provision at BCBSNC Provider Services at 1-800-777-1643 or providerupdates@BCBSNC.com. Section 6 prohibits the NC HIEA from fulfilling requests for electronic health information from an individual, individual's personal representative, or an individual or entity purporting to act on an individual's behalf and requires the Authority to provide educational materials on accessing this information from other sources. Section 7(a) requires the Health Information Exchange Advisory Board to submit recommendations regarding appropriate features or actions to support the Statewide Health Information Exchange Act and to report on the status of entities and providers not connected to the HIE Network as identified under subsection (b) of this section, to the Joint Legislative Oversight Committee on Health and Human Services on or before March 1, 2022. Section 7(b) requires the HIE Authority to work with the State Health Plan Division, Department of State Treasurer, and the Division of Health Benefits, Department of Health and Human Services, to identify providers and entities who have not connected to the HIE in accordance with G.S. 90-414.4 and to contact each entity or provider to ascertain their connection status and to inform them of the connection requirements. By November 1, 2021, the Department of State Treasurer, Department of Health and Human Services, and licensing boards shall assist the NC HIEA with contact information and addresses for providers and entities. For information on who is currently connected to NC HealthConnex, visit the NC HealthConnex Participant Map. For providers who would like to inquire about their organization’s connection status, please email HIESupport@sas.com. For questions regarding the State Health Plan network, please contact BCBSNC Provider Services at 1-800-777-1643 or providerupdates@BCBSNC.com. For questions regarding Medicaid, please contact Medicaid.ProviderOmbudsman@dhhs.nc.gov. All other questions may be directed to email@example.com. Since 2016, NC HIEA has been working with the health care community to build a statewide health information exchange. See NC HealthConnex by the Numbers. NC HealthConnex by the Numbers (As of April 2021) 83.1% of patients eligible for Medicaid have clinical data in the HIE 92.5% of State Health Plan members have clinical data in the HIE 78.7% of physicians, certified nurse midwives, nurse practitioners, physician assistants, and dentists participating in the Meaningful Use/Promoting Interoperability program are onboarded to NC HealthConnex 1.5 million notifications delivered in the month of April via NC*Notify, the HIE’s event notification service to support Medicaid managed care/value-based care and close gaps in care. 126 hospitals connected and submitting data; additional 19 in onboarding 6,800+ ambulatory practices submitting patients’ medical records including primary care, county health departments, federally qualified health centers, free and charitable clinics, behavioral health, etc.; additional 5,000+ in onboarding 13 million unique patients in the HIE network NC HealthConnex in the World of HIEs Health information exchange systems have been in development nationwide since a federal law was passed in 2009 to promote the electronic movement and use of health information among health care providers. In a recent, wide-ranged study of health information exchanges from across the U.S., researchers noted improvements and benchmarks within the health IT industry. The study, conducted by Julia Adler-Milstein, Ph.D., a professor of medicine and director of the Center for Clinical Informatics and Improvement Research, School of Medicine, at the University of California San Francisco (UCSF), and others at UCSF and the Office of the National Coordinator for Health IT (ONC), was published in the May issue of Health Affairs. According to an article published by Healthcare Innovation, researchers found that “achieving broad-based electronic health information exchange (HIE) is proving one of the most difficult components of the Health Information Technology for Economic and Clinical Health Act of 2009 and has required ongoing policy making. Successful HIE at scale involves coordination between many stakeholders, including federal and state policy makers, a diverse array of health care delivery organizations, electronic health record (EHR) and HIE vendors, and specific organizations supporting HIE, such as state and local health information organizations (HIOs) as well as national-level HIE networks.” In the five years of its existence, NC HealthConnex has grown to develop mature capabilities and a robust clinical data repository for the health care provider community in North Carolina. The state-designated health information exchange has built a strong foundation and is well-positioned for exponential growth by participating in TEFCA. The study showed that 56% of HIEs plan to participate in the government’s Trusted Exchange Framework and Common Agreement (TEFCA) framework. TEFCA is a set of policies, procedures, and standards to support and build on existing health information networks (HINs) to create a single on-ramp for health data exchange for health care provider organizations, EHR systems, and other stakeholders. TEFCA will promote and enhance network-to-network connectivity amongst HIEs and support value-added services for sustainability and growth. “Meanwhile, the researchers sought also to determine the level of maturity of currently operating HIEs. “We examined several measures of maturity,” they write. “The largest group of HIOs had been operational for six to ten years (57 percent). HIOs achieved scale in terms of the number of participants: The median number of hospitals providing data to the HIO was 24, and the median number of providers able to use the HIO was 3,000 (with an estimated 73 percent considered active users, on average) (appendix exhibit A2). HIOs also achieved scale in connecting to multiple EHR vendors (median: 12) and in facilitating data exchange for a large population of patients (estimated median number of patients in the Master Patient Index: 2,490,000).” Curious how NC HealthConnex compares to other HIE benchmarks in the study? Take a look at the table below! Average HIE, According to UCSF Study NC HealthConnex Median of 3,000 providers able to use the HIE 5,000+ clinical portal users, plus 200+ bi-directional organization users Median of 2.49 million patients in the HIE’s master patient index 13 million+ unique patients in the master patient index, with an average of 16 CCDs per patient with clinical records present in the HIE Median of 12 connected EHR vendors 80+ connected EHR vendors 57% reported connecting to other HIEs in the same state. 53% reported connecting to other HIEs in different states. Most HIEs also reported that they participate in a national network including eHealth Exchange (67%), DirectTrust (46%), and Strategic Health Information Exchange Collaborative Patient Centered Data Home (38%). NC HealthConnex is connected to all regional and private HIEs in NC NC HealthConnex is connected to 22 additional state HIEs via the eHealth Exchange and the Patient Centered Data Home, including connections to the VA and DoD NC HealthConnex is a member of the Sequoia Project, eHealth Exchange, DirectTrust, and SHIEC/PCDH. “And, overall, it seems clear that those HIEs that didn’t crumble in the past few years, ended up becoming stronger over time, as their leaders created foundations for them that have helped them to survive the challenges of the past few years. Indeed, the statewide HIEs with the strongest foundations going into 2021 have also been among the best-positioned to leverage their strengths during the current COVID-19 pandemic, developing strong working relationships with state health departments, and plunging into biosurveillance-related activities that have brought them plaudits from state health officials.” May 2021 Teletown Hall: New CMS Health Information Exchange Bi-Directional Exchange Measure The North Carolina Health Information Exchange Authority (NC HIEA) hosted a Teletown Hall on Wednesday, May 26, 2021, covering the 2021 Quality Payment Program Final Rule. In December 2020, the Centers for Medicare and Medicaid Services (CMS) released the 2021 Quality Payment Program Final Rule that includes the Health Information Exchange Bi-Directional Exchange measure. In the webinar, Practice Consultant Terri Roberts from Area Health Education Centers (AHEC), discussed: the new QPP/MIPS measure; its meaningfulness to practices; and how NC HealthConnex can help with attestation. Measure: Health Information Exchange (HIE) Bi-Directional Exchange Measure: Health Information Exchange (HIE) Bi-Directional Exchange The MIPS-eligible clinician or group must attest that they engage in bi-directional exchange with an HIE to support transitions of care. To view Teletown Hall information and presentations, please visit https://hiea.nc.gov/providers/training-resources#webinars-teletown-halls. Live EHRs with Bi-directional Capability: Athena Cerner eClinicalWorks Epic HIS-Netsmart Meditech NextGen Thrive by Evident NC HealthConnex Highlight Reel: Check Out These Videos! Reminder: Quarterly User Audit A reminder email will be sent to participants who have not attested to this quarter’s User Account Audit. Detailed instructions can be found in the Quarterly Audit Quick Reference Guide. If you have questions or need assistance accessing your portal account, please contact the NC HealthConnex Help Desk Team at firstname.lastname@example.org or 919-531-2700. Upcoming Events NC HIEA Advisory Board Meeting Wednesday, June 9, 2021, at 2:30 p.m. To attend this meeting, email email@example.com. In the News A Janus-Like Moment for HIEs in the U.S. Healthcare System? – The leaders of those HIEs with the strongest strategic and financial foundations appear likely to do well going forward, even as key policy elements in the strategic and operational landscape remain unresolved. www.hcinnovationgroup.com The Future of Medicine is in Data and Collaboration, NC Health Care Executives Say – Top executives from health systems across North Carolina stressed that the future of medicine rests in being proactive instead of reactive to the community's health needs. www.bizjournals.com The Ever-Shifting Outlook for HIEs Shifts Once Again – Could the vital work that statewide HIEs have performed during the COVID-19 pandemic open an important door for HIE development in the future, focusing strongly on some of the data needs of public health officials? www.hcinnovationgroup.com Most Health Information Exchanges in Strong Position for TEFCA – Most state and local health information exchanges (HIEs) are supporting a vast number of services and are developing connections to each other and national networks in preparation for the Trusted Exchange Framework and Common Agreement (TEFCA), according to a study published in Health Affairs. www.ehrintelligence.com Are You Up to Speed? The North Carolina Broadband Survey is designed to gather information on locations in the state without adequate internet access and speeds. The information gathered from the survey will: Provide clear data to guide investment of funds through the state’s Growing Rural Economies with Access to Technology grant program Inform research and policy recommendations Support strategic targeting of additional funding streams The survey is a collaboration between the N.C. Department of Information Technology’s Broadband Infrastructure Office and the Friday Institute for Education Innovation at NC State University. The survey takes about 5 minutes to complete and is available in both English and Spanish. Participants are encouraged to also take the optional internet speed test to connect survey data with broadband speed information. Take the survey.