NC HIEA December 2023 Update

NC HIEA Highlights of 2023; First Health Networks Receive QHIN Designation

Author: Jessica Hagins

Happy Holidays and a Look Back at 2023

The N.C. Health Information Exchange Authority would like to wish all of our participants, staff, partners, board members and incredible network of health care providers a very happy holiday season.

As we say goodbye to 2023, we are proud of everything we achieved and look forward to continuing to serve our participants in 2024 as we fulfill the vision of a connected North Carolina.

Here is a look at a few of this year’s major highlights:

1) The NC HIEA initiated a new use case as the data partner for the Accountability for Care through Undoing Racism and Equity (ACURE4Moms) study conducted by UNC Chapel Hill and 40 full participants of the NC HIEA. Data shows that the maternal mortality rate in the United States is more than three times the rate in most other high-income countries, and it is getting worse. The rate for Black women is nearly three times higher than for white women.

The ACURE4Moms study is a five-year study funded by the Patient Centered Outcomes Research Institute that aims to:

  • Compare the proportion of Black women who deliver a low birthweight baby among study arms (Primary Outcome).
  • Reduce maternal morbidity and mortality (Secondary Outcome).
  • Compare the number of emergency department visits and hospitalizations during pregnancy and up to one year after delivery among study arms.
  • Explore trends in self-reported racism during pregnancy and up to four months after delivery among study arms through patient surveys.

2) The N.C. Stroke Registry was launched in February 2023 as the culmination of Phase 2 of the Stroke Registry project in partnership with SAS Institute, the Division of Public Health and the NC Stroke Advisory Council. The registry leverages demographic and clinical data on stroke patients from health care facilities connected to NC HealthConnex.

Some of the goals of the Stroke Registry project are to improve the system of care for stroke patients in North Carolina, to address disparities in care and to identify areas in the stroke care continuum where interventions may be needed, whether that involves stroke prevention or post-stroke care measures.

The data in the registry is used to create a visual dashboard of the prevalence of stroke by county and zip code, track analysis on comorbidities and identify trends based on demographics such as race and age. This data is aggregated at the population level, meaning that it is not possible to identify specific patients in the dashboard data. The dashboard supports the Division of Public Health and only certain individuals within that division have access to it through their NCID.

3) The NC HIEA is experiencing significant growth as we continue to add new participants and new users of our value-added services. Some of our key metrics include:

  • New executed Participation Agreements: 808
  • New Clinical Portal users: 5,029
  • New NC*Notify Subscribers: 46


First Networks to Receive QHIN Designation Represents Major Milestone in Health Care Interoperability

Earlier this month, five nationwide health information networks signed the Trusted Exchange Framework and Common Agreement, known as TEFCA, to become officially approved as Qualified Health Information Networks or QHINs.

The signing event was held in Washington, D.C. on December 12, 2023, and attended by members of the U.S. Department of Health and Human Services (HHS) and the Sequoia Project, the Recognized Coordinating Entity of the Office of the National Coordinator, which developed TEFCA and supports its implementation.

Several health information networks were approved as applicants for QHIN status earlier this year, with a 12-month timeframe to go live with TEFCA exchange. Five of these networks, eHealth Exchange, Epic Nexus, Health Gorilla, KONZA National Network and MedAllies, have now completed their implementations and are officially designated as the country’s first QHINs. The remaining applicants continue to work to complete their implementations.

“The QHIN selection and onboarding process was necessarily arduous to ensure the pioneering organizations were prepared to be the nation’s backbone for health information sharing,” said Mariann Yeager, CEO for The Sequoia Project. “Yet, these organizations pushed through the process in less than a year, meeting the aggressive timeline laid out by [HHS] Secretary Xavier Beccera in February 2023.”

This designation marks the culmination of years of work to develop the agreement. The development of TEFCA was first mandated in 2016 under the 21st Century Cures Act. The Sequoia Project finalized its publication in 2022 and approved its first applicants in February 2023.

TEFCA is a governance agreement that supports the bi-directional exchange of health records on a national scale. It both defines the legal and technical requirements for secure information exchange and outlines a set of principles to facilitate trust between networks. These principles include standardization, openness, security, privacy and cooperation. The pillars of this agreement are the QHINs, whose networks cover most hospitals in the U.S. and connect tens of thousands of health care providers across all fifty states.

Now that these QHINs are working together under TEFCA, providers and users can connect with each other, regardless of the network to which they currently belong. The Sequoia Project will continue to onboard and designate more QHINs as time goes on, as well as to advance additional exchange purposes and oversee TEFCA governance.

The NC HIEA is currently a participant of eHealth Exchange, one of the recently approved QHINs. At this time, we have chosen to opt out of participation in TEFCA for year one. Note that this does not change our current data connections with eHealth Exchange that enable exchange with neighboring states’ HIEs and health care providers. NC HealthConnex is currently serving the needs of North Carolina health care providers with regional health information exchange services.

We are continuing to follow TEFCA as it matures and becomes a more fully realized and robust network. NC HIEA Executive Director Christie Burris was in attendance at the 2023 ONC Annual Meeting to hear about key milestones and proposed developments for TEFCA. The NC HIEA will look into future participation as it progresses.

We also welcome feedback and questions from our participants to determine if there is a large demand for TEFCA involvement from North Carolina providers. Please reach out to us at with your thoughts and questions.


Employee Spotlight

Headshot of employee

Kenya Servia

Business Development and Outreach Specialist

Kenya Servia has been a Business Development and Outreach Specialist with the NC HIEA since April 2018. She is actively working to educate health care providers about the mandate to connect to NC HealthConnex and the value that participation brings to the provider community. Kenya has over 20 years of experience serving as a social worker, health educator and program consultant. She has a Bachelor of Arts in sociology/social work from Elizabeth City State University and a Master of Public Administration from North Carolina Central University.


Connex Kudos:

"The goal is simple. It's just to make health care in North Carolina easier to deliver because there are no barriers to information exchange." 

– Dr. Jeff Ferranti, CIO Duke Health, former NC HIEA Advisory Board Chair