Author: Jessica Hagins
Health Care Organization Leverages NC HealthConnex Data for Significant Cost Savings and Improved Patient Care
The state-designated health information exchange, NC HealthConnex, is helping one North Carolina management service organization (MSO) achieve significant cost savings and improve their care delivery.
Cary Medical Management (CMM) manages a patient population of 40,000 individuals across 48 clinics through commercial and government value-based care contracts.
By utilizing the data within NC HealthConnex and near real-time admission, discharge and transfer (ADT) alerts with the event notification service NC*Notify, CMM achieved an average cost savings of 21.75%. This is compared to the national average of 5.6%, according to a 2018 report, for other providers with value-based care programs.
Dr. Siu Tong, CEO of CMM, credits a significant portion of these savings to three uses of the tools available through NC HealthConnex that their clinics have implemented.
First, clinics used the NC HealthConnex Clinical Portal to fill in critical missing clinical information and incorporated it into their EHR before patient visits. This ensured they had the correct medical history and diagnosis upfront. Providers could see that a patient had a health condition, such as kidney disease or an allergic reaction, which was not accurately reflected in their medical records.
The data in NC HealthConnex helped clinicians know a patient’s potential risks of interacting diseases, allowing providers to take preventative measures for treatment and avoid complications, such as adverse medication interactions.
This, Dr. Tong says, is the second use of NC HealthConnex that improved their standard of care. Being able to see via the Clinical Portal what medications their patients were taking meant less mistakes, saving lives and preventing adverse reactions.
According to the FDA, there are approximately two million serious adverse drug events (ADEs) in U.S. hospitals annually, and around 7,000-106,000 of those are fatal. In nursing homes, there are 350,000 ADEs annually.
During one pilot test, Dr. Tong followed 769 patients visiting one of their nine clinics. He found that their EHR data showed only 11 patients flagged for 16 drug-to-drug interactions. After incorporating the data from NC HealthConnex, they showed 143 patients with 357 potential drug-to-drug interactions. This meant the potential to not only save a patient a visit to the Emergency Department but to save their life as well.
“We’ve been treating patients with incomplete information not knowing all the serious diseases and medications which could interact with each other. After we incorporated HIE (NC HealthConnex) data into our care delivery, we were able to see the full problem for the patients. We saw a 16% increase of savings from one commercial payor after incorporating HIE data, which is a pretty important value from NC HealthConnex.”
Currently, the data in NC HealthConnex show what medications patients have been prescribed, but in the next 12-18 months medications that have been dispensed will also be available as a result of integrations with pharmacy claims systems, allowing providers to know whether their patients are following recommended treatment.
Finally, Dr. Tong also credits NC*Notify, NC HealthConnex’s event notification service, with reducing their readmission rates to Emergency Departments. One government study showed that 17% of Medicare patients are readmitted to EDs within 30 days of being discharged, at a cost of $15,200 per readmission. The study showed that approximately 65% of those are avoidable with physician intervention post-discharge.
CMM began following data on their Transitional Care Management patients’ readmission rates for one year after they began using the ADT alerts available through NC*Notify. Practices in CMM’s system submit patient panels to NC*Notify and are alerted when these patients are admitted to or discharged from an ED or transition to other care settings. These alerts allow providers to follow up with the patient faster and help them understand their treatment plan and get them any needed medications right away.
The result was a readmission rate of 8.3%, nearly half the national average of 17%. The savings for their Medicare Transitional Care Management patients was around $1 million.
“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 brought in around 70 patients per month who had been discharged from the hospital to our clinics, so we saved around $1 million. This is one application of the HIE that had immediate impact and was easy to measure.”
When asked what advice he would give to other providers who may not be fully utilizing the state-designated HIE, he said, “The common barrier is time, but if you can invest the time, you will reap the benefits. If you do nothing but ADT, you will get the financial reward and better outcomes for your patients. You won’t have as many readmissions.”
National Dapper Your Data Day – the Privacy and Security Measures the NC HIEA Takes to Secure Protected Health Information
How to Observe National Dapper Your Data Day
National Dapper Your Data Day is observed on July 18 and was founded in 2020 by a data scientist to raise awareness of issues regarding data management, privacy and security. The word “dapper” means “stylish,” but it can also mean “neat and well-organized”. In observance, here are some tips for your practice, as well as some ways that the NC HIEA keeps your data dapper.
Data Management
The best place to begin with good data is at the point of data entry. Good patient registration practices can ensure that the data coming from your EHR into NC HealthConnex is accurate. Double check that a patient’s name is spelled correctly, that their phone and address are up-to-date, and that numerical items such as a date of birth are formatted correctly.
This patient information comes into NC HealthConnex and is used to assign the patient a unique identifier called MPIID (Master Patient Index ID). Their MPIID is used to combine the clinical data received from all of their health care providers into a longitudinal patient record. This gives providers who have a treatment relationship with patients a well-organized view of the patient’s clinical data.
Certain datasets cannot be ingested if they are not formatted properly, such as patient panels uploaded to NC*Notify. Check the scoping checklist or Onboarding Packet and Technical Specifications document the to make sure you know which target elements must be included in the data being sent to NC HealthConnex. This checklist is the first step on the way to connecting to NC HealthConnex.
Certain elements are used to ensure proper patient matching can take place. Every patient should have only one medical record number (MRN) or patient identification number for the EHR used at your practice. We can use information such as the patient’s name, DOB, and address to match patients across EHRs.
Data Privacy
Patients have certain rights to the privacy of their medical data, and we take protected health information (PHI) very seriously.
The NC HIEA encourages providers to make sure they follow good data privacy practices in their own facilities. The NC HIEA provides sample Notice of Privacy Practices to participants that includes language about the data sharing with the state-designated HIE. Additionally, it is important that participating providers take advantage of the patient education materials provided by the NC HIEA to educate your patients on the benefits of health information exchange to improve their quality of care.
Make sure patients are aware that they can choose to opt-out of having their information shared with other providers through NC HealthConnex. In addition, there are prohibitions on sharing certain types of data with NC HealthConnex including psychotherapy notes and C.F.R. Part 2 data related to substance user disorder treatment.
Only authorized personnel have access to the data within NC HealthConnex. Providers who wish to view patient records must attest to having a treatment relationship before they can “Break the Seal” or view information on that patient. This access is also reviewed quarterly in our Quarterly User Audit.
Authorized individuals within the Division of Public Health are also granted access to use certain datasets for public health purposes.
Data Security
While privacy involves restricting the sharing of data to authorized personnel for HIPAA-approved use cases, security involves making sure that unauthorized individuals cannot gain access through illegal means.
The N.C. Department of Information Technology Enterprise Security and Risk Management Office has a number of tips to help you keep the patient information entrusted to your practice safe and secure, including:
- Conducting a risk assessment to identify potential cybersecurity vulnerabilities and improvements, including a cyber resilience review and cyber hygiene vulnerability scanning.
- Creating a culture of security by educating all employees on basic security practices and policies.
- Backing up your data on an external hard drive or cloud storage solution and storing paper files securely on a regular basis.
- Using strong passwords and authentication measures such as multi-factor authentication.
The NC HIEA’s privacy and security safeguards are based on federal and state requirements, including the:
- HIPAA Privacy Rule,
- HIPAA Security Rule, and the
- Health Information Technology for Economic and Clinical Health (HITECH) Act.
Employee Spotlight
Tim Taylor
Business Relations Manager
Tim Taylor is the new NC HIEA Business Relations Manager overseeing the Provider Relations and Outreach team. Tim formerly served as the lead analyst for NC*Notify, the event notification service. With nearly 10 years of health care operations leadership and management experience, Tim serves as a liaison for health care providers and organizations across North Carolina.
Tim holds a Master of Healthcare Administration from Winston-Salem State University and supplemental education and training in Lean Healthcare Management, Six Sigma, Naval Medicine Clinic Management, and data analytics.
He currently serves as vice chair for the Federally Qualified Health Center of Craven County, NC, an advisory board member of Healthcare Management at Winston Salem State University, and a board member for the Arapahoe Community for Education Foundation.
Connex Kudos:
“After we connected to NC HealthConnex, we worked through the process to complete our enrollment for NC*Notify. It gives us more real-time notification when kids go to the ER or when inpatient events occur, and it also gives us some insight into ongoing outpatient events that our population is having.
And as you can imagine, because we're getting that information, we're able to intervene quicker. That allows us to call the family right after an ER visit or to call the family and the hospital after a youth has been admitted. Right away, we can start that transition planning and get them out of the hospital and back into lower levels of care so they're returning back to the community setting. Ultimately that's been a great resource for us.” – Carolyn Spence, CIO, Alexander Youth Network
Hear more from Carolyn and Dr. Siu Tong in this video about how NC HealthConnex improves patient care and providers' work.
Upcoming Events:
- 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.
- Advisory Board Meeting – Monday, September 11, 2023 – 2 p.m. to 5 p.m. Register here.
In The News:
NC Works to Boost Broadband Access to Support Rural HIE Connectivity - Efforts to improve broadband access are underway in North Carolina to help rural providers connect to the state-designated HIE, NC HealthConnex.
White House Issues National Cybersecurity Strategy Implementation Plan - Recently, the White House published its National Cybersecurity Strategy Implementation Plan (NCSIP), which involves initiatives to protect critical infrastructure sectors, including health care.
CMS Proposes Payment Cuts in CY24 Medicare Physician Fee Schedule - In addition to payment cuts, the agency proposed changes to the Quality Payment Program and the Medicare Shared Savings Program. The agency also proposed increasing the quality data completeness threshold and the performance threshold score that MIPS participants must achieve to see positive payment adjustments.
HIMSSCast: Interoperability - HIEs and Other Frameworks Beyond TEFCA (Video) - How health information exchanges, regional health networks and others are collaborating to build out the interoperability ecosystem and enable more effective sharing of critical clinical and public health data.
Google Cloud Teams with CareCloud to Bring Generative AI to Small Practices – They are aiming to help ambulatory practices gain insights with help from artificial intelligence by surfacing key information to help develop plans of care based on recommended diagnoses, patient insurance and other information.