Frequently Asked Questions

General Background | HIEA Data | Participation Agreement Questions | Technical Questions | Patient Questions

General Background

What is a health information exchange and who is the NC HIEA?

A health information exchange is a secure and electronic network that gives authorized health care providers the ability to access and share health-related information across a statewide information highway. It exists to improve health care quality, enhance patient safety, improve health outcomes, and reduce overall health care costs by enabling health information to be available securely whenever doctors, nurses and patients need it.

The North Carolina Health Information Exchange Authority (NC HIEA) was created by the North Carolina General Assembly to oversee and administer the state-designated HIE (NCGS 90-414.7). We will receive input and advice from an Advisory Board consisting of patients, hospital systems, physicians, technology experts, public health officials and other key stakeholders to continuously improve the HIE Network, now called NC HealthConnex, and move towards more efficient and effective care.

The new law also requires that as of February 1, 2018, all Medicaid providers must be connected and submitting data to NC HealthConnex in order to continue to receive payments for Medicaid services provided. By June 1, 2018, all other entities that receive state funds (e.g. State Health Plan) for the provision of health services, including local management entities/managed care organizations, also must be connected. (NCGS 90-414.4)

How do I contact the NC HIEA?

You can contact us via email hiea@nc.gov or by phone: 919-754-6912.

I already signed a contract with the NC HIE when it was operated in part by Community Care of North Carolina (CCNC). Why do I need to sign a new contract?

In 2015, the General Assembly decided to change the direction of then current Health Information Exchange and directed the NC Department of Information Technology to establish a new HIE network, now called NC HealthConnex, that would be operated by a new State agency called the NC Health Information Exchange Authority (NC HIEA). In order to comply with the statute and legal requirements, all the contracts you signed with the former HIE organization were terminated on February 29, 2016. In order for you to connect your practice or organization to the new HIE, new contracts between your organization and the NC HIEA must be executed.

Who is “required” to use NC HealthConnex and why?

Recently passed legislation requires that as of February 1, 2018, all Medicaid providers must be connected to the HIE in order to continue to receive payments for Medicaid services provided. By June 1, 2018, all other entities that receive state funds for the provision of health services (e.g. State Health Plan), including local management entities/managed care organizations, also must be connected. (NCGS 90-414.4)

Providers who do not receive state funding for the provision of health care services may also connect to NC HealthConnex on a voluntary basis.

What does connected mean?

To meet the state’s mandate, a Medicaid provider is “connected” when its clinical and demographic information pertaining to services paid for by Medicaid and other State-funded health care funds are being sent to the NC HealthConnex at least twice daily – either through a direct connection to NC HealthConnex or via a hub (i.e. a larger system with which it participates, another HIE with which it participates, or EHR vendor).  Participation agreements signed with the designated entity would need to list all affiliate connections.

I am a behavioral health or substance abuse treatment provider in North Carolina. Am I required to connect to NC HealthConnex?

If you are a behavioral health provider that bills NC Medicaid for reimbursement for behavioral or mental health services, you are required to connect to the HIE Network, now called NC HealthConnex, by February 1, 2018. If you are a health care organization that receives State funds for providing health care, such as a practice that serves patients insured by the State Employee Health Plan, or you are a Managed Care Organization or Local Management Entity, you are required to connect to NC HealthConnex by June 1, 2018.

What is the cost of subscribing to the new state-operated HIE network, now called NC HealthConnex?

Currently the NC HIEA is funded by the State of North Carolina with a goal to be receipts supported in the future. The NC HIEA, in consultation with the Advisory Board, decided in December 2016 not to charge a fee for the submission of data to meet N.C.G.S. 90-414.4. The General Assembly believes in the value of a robust state-operated HIE and has committed $8 million annually to this endeavor. The NC HIEA’s focus for the next 12-18 months is on building connections and helping providers meet the mandate. As we develop a roadmap for future sustainability, fees related to the consumption of value-added features will be vetted thoroughly with all stakeholders and recommended to the General Assembly before any final decisions are made.

Note: While there are currently no fees charged by the State for the connection to or use of NC HealthConnex, some EHR vendors may charge fees (technical build, maintenance etc.) to their customers for this connection. 

Are there fees to obtain a Direct Secure Message (DSM) Account?

There are no fees to obtain a DSM Account [DSM is a secure, scalable and standards-based method for the exchange of Protected Health Information (PHI)]. However, medical providers will need to sign a Participation Agreement in order to receive credentials. Note: DSM credentials are part of the package of HIE value-added features that includes a technical connection to submit data.

How do I connect to NC HealthConnex?

1) The first step in connection is reviewing and signing the Participation Agreement. If you have questions regarding this process, please contact Alice Miller via email alice.miller@nc.gov or by phone 919-754-6912.

2) The second step is to have the technology in place. The NC HIEA Participation Agreement requests EHRs that are minimally capable of sending HL7 messages, version 2 and higher. EHR products that are ONC certified for Meaningful Use for the for Centers for Medicare & Medicaid Services (CMS) Incentive Programs are preferred.  

3) The third step is to identify three points of contact within your medical practice that will collaborate with the NC HIEA and our technology partner, SAS, to complete a successful connection.

For more information, visit How to Connect.

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HIEA Data

What type of information can we expect to receive from NC HealthConnex on the patients that we serve?

Participants will receive information pertaining to patient care housed within provider organizations such as laboratory results, diagnostic studies and clinical documents. Users with the highest level of access can receive notifications about significant patient events once a patient/provider relationship is established. These are:

• Inpatient Admission
• Inpatient Discharge
• Patient is admitted to ER
• Final Laboratory Result  
• Final Microbiology Result
• Final Radiology Report

Current data elements available in NC HealthConnex include:

• Allergies
• Encounters
• Immunizations
• Medications
• Problems
• Procedures
• Results

Are there restrictions on submitting substance abuse data to NC HealthConnex?

Alcohol or substance abuse programs that receive any type of federal assistance as outlined in 42 C.F.R. 2.12 cannot generally disclose data through an HIE if the data would: 1) identify a patient as an alcohol or substance abuser, and 2) if that data was obtained by an alcohol or substance abuse program for the purpose of treating, diagnosing, or making a referral for the patient’s alcohol or substance abuse problem. Providers can disclose that information in the event of an emergency if the requesting physician needs the information to treat the emergency condition pursuant to 42 C.F.R. 2.51, or if the patient has authorized the specific disclosure in writing in compliance with 42 C.F.R. 2.31. Please review 42 C.F.R. Part 2 before disclosing any alcohol or substance abuse information through NC HealthConnex.

Can I share data related to a patient’s behavioral health through NC HealthConnex?

Yes. Most behavioral health information is permitted to be shared through NC HealthConnex.  However, the HIPAA Privacy and Security Rule requires that providers receive written authorization from a patient before psychotherapy notes can be disclosed to another party, with some exceptions (45 C.F.R. 164.508).  The written authorization form must comply with 45 C.F.R. 164.508(c) and must accompany any disclosure of psychotherapy notes through NC HealthConnex.  The Rule defines “psychotherapy notes” as follows:

Psychotherapy notes means notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individual's medical record. Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: Diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.

Can the NC HIEA sell the data that providers submit about patient care?

No. All data is protected, stored and accessed only for purposes permissible under federal and state law. The NC HIEA takes patient health data privacy and security very seriously. In accordance with HIPAA regulations and state law, the NC HIEA has entered into and will enter into Business Associate Agreements with all organizations that will receive personal health information (PHI) from the HIE.

What happens to the information that was in the old HIE?

Up until February 29, 2016, existing providers had the option to grant the Authority access to all historical data.

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Participation Agreement Questions

We recently signed an agreement for the health information exchange with NC HIEA. Why is there a new agreement to sign?

NC HIEA has developed new Participation Agreements that are more aligned with the Restatement I of the Data Use and Reciprocal Support Agreement (DURSA) that is used by the nationwide eHealth Exchange.  This move to align our PA with the DURSA is required by NC statute and was also suggested by key stakeholders in the health care community.

Do we have to sign the new Participation Agreement?

At this time, if your organization has already signed a Participation Agreement with NC HIEA, you do not have to sign a new PA in order to continue to be connected, or work towards a connection to NC HealthConnex.  If you do sign the new PA, it will replace the agreement you already have with NC HIEA. Please consult with legal counsel in determining if executing the new PA is right for your organization.

Can’t we just submit clinical and demographic data paid for with State funds?

Yes, if your practice simply wants to comply with the statutory mandate in the HIE Act by submitting the required data to NC HealthConnex, please complete the Submission Only NC HIEA Participation Agreement.  Please note, this agreement does not allow your organization to query NC HealthConnex for patient data, exchange data with other participants, submit data to registries to meet Meaningful Use, or to access any of the value-added features offered by NC HIEA.

What are Participating Entities?

Participating Entities are entities that a Participant has control over, or an entity that is under common control or that shares information systems with Participant, e.g. a subsidiary, a satellite clinic, etc. A Participating Entity of a Participant may also be a natural person or business entity with whom the Participant has a direct or indirect business or employment relationship, including any person or entity provided a license or right to access and use any of a Participant’s EHR Product, software and/or services, unless such relationship exists for the primary purpose of providing such person or entity with access to and use of NC HealthConnex.  Participating Entities may elect to submit HIE Data through NC HealthConnex to NC HIEA under a single Participant or as multiple separate Participants.

Who in our organization needs to sign the Participation Agreement, and where does he or she sign the Agreement?

The staff member who has the authority to sign contractual agreements on behalf of your practice, facility, or organization can sign the PA.

Do we need to email a signed Participation Agreement and mail a hard copy? Or can we just send the signed Agreement by email?

You can send the entire completed and signed Participation Agreement via email to HIEA@NC.gov, or you can mail it to the address below.  We do not require two copies.  The physical mailing address is as follows:

NC Health Information Exchange Authority Legal Team
Mail Service Center 4101
Raleigh, NC 27699-4101

Can we just send the signature pages of the Agreement you sent us?

No, we must receive the entire Participation Agreement and Attachments if you choose to participate in NC HealthConnex.

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Technical Questions

I am concerned about my patients’ protected health information. How can I be sure that it will remain private and secure?

The NC HIEA takes patient health data privacy and security very seriously. In accordance with HIPAA regulations and state law, the NC HIEA has entered into and will enter into Business Associate Agreements with all organizations that will receive personal health information (PHI) from NC HealthConnex. The State also has the authority to audit the activity of organizations that receive PHI from NC HealthConnex.

Do you have a list of EMR systems that support connection to the NC HIE?

Any EHR product that can send HL7 version 2.0 and higher will support the connection to NC HealthConnex. For a list of EMR vendors that are connected to NC HealthConnex currently or that we have experience with building the connection, please visit How to Connect.

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Patient Questions

I am a patient of a provider connected to NC HealthConnex. Do I have rights to access the portal to view my medical history?

At this time, patient access to NC HealthConnex is not functional. As North Carolina continues its focus on patient-centered population health to improve health care outcomes, it is possible that the NC HIEA would look to expand this functionality at some date in the future.

When can I expect my Opt-Out form to be processed in NC HealthConnex?

As soon as your Opt-Out form is received in the mail it goes into processing. Once the form is received by our office, it is processed in two business days.

Why can’t I e-mail the Opt Out form?

Unfortunately, because the Opt-Out form contains personally-identifying information (PII), email is not a secure form of submitting this information. The security of your PII is of utmost importance to the NC HIEA.

What happens if my practice doesn’t want to connect to NC HealthConnex?

Recently passed legislation requires that as of February 1, 2018, all Medicaid providers must be connected to the HIE in order to continue to receive payments for Medicaid services provided. By June 1, 2018, all other entities that receive state funds for the provision of health services, including local management entities/managed care organizations, must be connected. If you have further questions, contact the NC HIEA by email: hiea@nc.gov or call 919-754-6912.

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