NC HIEA Part of a Multistakeholder Approach to Improving Health Care Services for Rural Providers
Three business units within the N.C. Department of Information Technology (NCDIT) are working together to improve the connectivity of rural health care providers in order to improve care delivery for North Carolina residents.
The NCDIT Division of Broadband and Digital Equity is dedicated to enabling high-speed Internet access across the entire state, especially in rural areas where access is lacking. Broadband is important for patients who need to access telehealth services and for rural hospitals and clinics that often lack the technical resources and connectivity necessary for connection to the state-designated health information exchange, NC HealthConnex.
Reliable Internet access is critical to helping providers meet the state mandate to connect to NC HealthConnex and access important information such as a patient’s medical history and medications.
Governor Roy Cooper is very committed to closing the digital divide in North Carolina by investing more than $1 billion in federal funds from the American Rescue Plan Act. The NCDIT Broadband Infrastructure Office (BIO) is administering several grant programs to distribute this funding for building the necessary infrastructure to bring high-speed Internet access to underserved and unserved areas.
Internet Service Providers (ISPs) may apply for these grant programs when available, but the first step is to verify that the area is actually lacking access and that another ISP isn’t already providing adequate service.
The Federal Communications Commission’s (FCC) National Broadband Map program initially estimated a little more than 250,000 locations in North Carolina were unserved (lacking access) and almost 300,000 were underserved (lacking high enough access speeds). However, the FCC encouraged states to challenge these numbers with their own maps.
Figure 1: FCC Broadband Data Collection – June 2022 Data
While many states lack the resources to challenge the FCC data effectively, North Carolina has been investing in Geographic Information Systems (GIS) technology for decades. That investment is now paying off in several ways thanks to the work of the N.C. Center for Geographic Information and Analysis (CGIA) and the N.C. Geographic Information Coordinating Council (GICC). Like the NC HIEA, the CGIA is part of the Data Division of NCDIT and supports the GICC and its initiatives, with the goal of using geospatial data to serve North Carolina residents.
The Division of Broadband and Digital Equity, with the aid of CGIA, successfully challenged the FCC estimates to the tune of 115,000 additional locations, both residential and commercial, without Internet access or adequate speeds. North Carolina’s challenge added more unserved locations to the FCC’s data than any other state in the country. The additions will affect eligibility for future broadband deployments and funding.
Figure 2: FCC Broadband Data Collection – December 2022 Data
“We’re getting funding from the federal government because we have made these investments in GIS. The positive return on investment is not just monetary, but also an improved quality of life for our citizens. Having that data infrastructure in place for something like this paid off immensely for NC,” said Colleen Kiley, GIS coordination program manager for the CGIA.
The team used datasets from NC OneMap and Address NC, including addresses, parcels and building footprints, to analyze broadband availability. NC OneMap catalogs and makes the state’s geospatial data available to the public. Address NC serves as the state’s most reliable source of precise physical sites for nearly six million locations.
“Our job at CGIA is to make sure that there is no duplication of effort and that accurate, up-to-date geospatial data exists to support the citizens of North Carolina. This project is a prime example of doing that, recognizing that we’ve got these datasets that can be used to get services to the citizens exactly where needed,” said Kiley.
“It’s important to know exactly where people still need help in getting good high speed internet service,” said Governor Roy Cooper. “This more accurate picture will help us more effectively and efficiently close the digital divide to help North Carolinians get online for telemedicine, education, services and business."
Community anchor institutions, such as schools and rural health care centers, were given a lot of attention when creating these datasets. This is important because a recent GAO report found that electronic health record (EHR) adoption in rural areas is still lacking significantly behind more urbanized areas with large hospital systems. Much of the reason lies in the cost and difficulty for smaller organizations to implement or customize EHR software, but the lack of a reliable Internet connection means that even the most well-designed EHR won’t be able to connect to NC HealthConnex or cannot connect in real time.
Broadband Internet access is necessary if rural providers are to meet the mandate for connecting to NC HealthConnex for those treating patients who use state funds such as Medicaid to pay for their care. In these rural areas, a large number of these patients are using these funds.
But beyond meeting the mandate, this connectivity can improve patient care, prevent medical errors and duplication of tests, and even help providers save money. If a patient should need intense care at a larger hospital system, NC HealthConnex can notify their primary care provider of what treatment they received or what medications they were prescribed. Their provider can find access to lab results and clinical notes within NC HealthConnex that can help them devise treatment plans for follow-up care.
NC*Notify can alert a provider of admission, discharge, and treatment if their patient presents at an Emergency Department in another town. Through eHealthExchange and the Patient Centered Data Home, they can even be alerted if their patient received care at a facility out-of-state. And if their primary care provider is connected, those external facilities can also see the patient’s history and medication allergies without the patient needing to remember or be alert enough to inform care staff.
NC*Notify also helps rural providers reduce readmission and meet interoperability requirements, helping them receive more in Medicaid reimbursement.
Patients can also benefit from efforts to close the digital divide. Increased Internet access means the ability to fill out intake forms, saving time during appointments, and the ability to access telehealth services.
With the help of the CGIA, updated datasets are showing where Broadband access is lacking, thereby giving North Carolina access to additional funding for infrastructure expansion. With the help of the Division of Broadband and Digital Equity, that funding is going towards bringing the Internet to North Carolinians that need it most. And with the help of the NC HIEA, that access is bringing health information to providers’ fingertips, further improving the safety of patients across the North Carolina care continuum.
NEW! Office Hour Sessions
The NC HIEA is offering new online “Office Hours” sessions. This quarterly webinar series is a chance for participants to guide the discussion with their questions for our provider relations team. Questions could be pertaining to data connections, the legislative mandate, opt-out procedures, services available, or any other topic that participants would like to discuss.
In addition to general connection and administrative questions, we will have one subject matter expert on hand for specific rotating topics. Our first session will include an expert on NC*Notify.
Registration for these sessions is limited. Please fill out the registration form with your name, email, and question for either our provider relations team or attending subject matter expert. We will do our best to answer as many questions as we can in the hour-long listening session.
COVID-19 Vaccine Management System Integrating into N.C. Immunization Registry
The NC HIEA is working with the Division of Public Health to incorporate Covid vaccine reporting into the electronic submission to the North Carolina Immunization Registry (NCIR), the state’s existing immunization information system used to manage and report all other vaccines. This transition will enable providers to manage COVID-19 vaccines in the registry via electronic submission from their EMRs or logging into the NCIR portal.
To meet mass vaccination demands during the initial rollout of the COVID-19 vaccine, the N.C. Department of Health and Human Services leveraged NC HIEA’s infrastructure and services to enable direct reporting from providers' electronic health records CVMS. This allowed tracking of vaccine supply and administration in accordance with Centers for Disease Control and Prevention requirements.
As the COVID-19 vaccine is becoming part of routine care, the state has made great strides in incorporating COVID-19 vaccine administration reporting into NCIR. Over the next few months, the NC HIEA and NCIR teams will be working with providers to transition their COVID reporting to the NCIR.
This transition will assist in preparing for COVID-19 vaccine commercialization, minimize system disruption during expected periods of higher vaccine demand in the fall and streamline documentation procedures across all routine immunizations.
To learn more about NCIR, including instructions on how to connect, please visit this page on our website. If you have any questions about electronically reporting COVID vaccines through the HIEA to NCIR, please contact us at hiea@nc.gov.
Executive Director Christie Burris Speaks at InterSystems Conference
NC HIEA Executive Director Christie Burris recently spoke on a panel of subject matter experts and leaders in health care data at the 2023 InterSystems Global Summit: Building the Data Infrastructure to Care for the Future. The panel shared their views on the value of interoperability and HIE use and models for building out the infrastructure of health data exchange nationwide.
View additional messages from keynote speakers and breakout sessions from the summit on the InterSystems website.
The InterSystems Global Summit is an event where industry leaders, executives, developers, and subject matter experts gather to learn more about InterSystems technology. Attendees have a chance to connect with other industry professionals and learn best practices and upcoming features and innovations from InterSystems.
Employee Spotlight – Sonali Bhadoria, Application Systems Analyst
Sonali has been working as an Application System Analyst in HIEA since April 2023. She earned her doctorate in Engineering with a specialization in Medical Imaging in 2015. Her research focused on the identification and analysis of Malignancy in Breast Cancer nodules using (CBIR) Content Based Image Retrieval. This sparked her interest in healthcare and developing data-driven actionable strategic insights to solve real-world problems.
Sonali started her career as faculty in an electronics engineering program and gradually pivoted to becoming a data analyst. She has been living in RTP since 2019 with her husband Nimesh and three kids. In her free time, Sonali is fond of engaging in creative outlets such as drawing and painting. She is also an avid practitioner of Yoga and Meditation in her daily routine.
Connex Kudos
“Last year, we did a study looking at all the cases that we did using ADT notifications through NC*Notify and discharge summaries available in NC HealthConnex, and we found that our readmission rate was half of the national average. We saw around 70 patients that had been discharged from the hospital per month, so we saved around $1 million. This is one application of the HIE that had immediate impact and was easy to measure.” – Dr. Siu Tong
More information on how Cary Medical Management achieved significant savings using the HIE will be featured in next month's article.
Upcoming Events
• Teletown Hall: 2023 Quarter Two – Wednesday, July 12, 2023 – 12 p.m. to 1 p.m. Register here.
• How to Connect Call – Monday, July 31, 2023 – 12 p.m. to 1 p.m. Register here.
• NC HIEA Office Hours – Wednesday, August 16, 2023 – 12 p.m. to 1 p.m. Register here.
• How to Connect Call – Monday, August 28, 2023 – 12 p.m. to 1 p.m. Register here.
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