Friday, July 7, 2023

N.C. Department of Information Technology Employs Multistakeholder Approach to Improve Health Information Exchange Access for Rural Health Care Providers

Three business units within the North Carolina Department of Information Technology (NCDIT) are working together to improve the connectivity of rural residents and health care providers in order to improve care delivery for the state’s residents.
Jul 7, 2023

Three business units within the North Carolina Department of Information Technology (NCDIT) are working together to improve the connectivity of rural residents and health care providers in order to improve care delivery for North Carolina residents.

Governor Roy Cooper is committed to ensuring all North Carolinians have access to affordable high-speed internet and can utilize online resources to work, learn, get health care and connect. This effort is especially important in rural areas where access is lacking for patients who need to utilize telehealth services and for rural hospitals and clinics that often do not have the technical resources necessary to maintain an electronic health record (EHR) or connect to a health information exchange (HIE).

Reliable internet access is critical to helping North Carolina providers meet a state mandate to connect to NC HealthConnex, the state-designated HIE, where they can access important information such as a patient’s medical history and medications.

The NCDIT Division of Broadband and Digital Equity is administering several grant programs that fund the necessary infrastructure to bring high-speed internet access to underserved (lacking access) and unserved (lacking high enough access speeds) areas). Internet Service Providers (ISPs) may apply for these grant programs, but the first step is to verify that the area is actually lacking access and that another ISP is not 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 and almost 300,000 were underserved. The FCC, however, encouraged states to challenge these numbers with their own maps.

Figure 1: FCC Broadband Data Collection – June 2022 Data

A map of North Carolina with red and yellow portions showing broadband accessiblity.

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).

The Division of Broadband and Digital Equity, with the aid of CGIA, successfully challenged the FCC estimates, which helped uncover 115,000 additional locations, both residential and commercial, without internet access or adequate speeds. This was possible due to the robust datasets in Address NC and NC OneMap, two tools that include parcel, address and building data in North Carolina.

North Carolina’s challenge added more unserved locations to the FCC’s data than any other state in the country. These additions increased North Carolina’s funding allocation through the federal Broadband Equity, Access, and Deployment (BEAD) program to more than $1.5 billion.

Figure 2: FCC Broadband Data Collection – December 2022 Data

Updated map of North Carolina with red and yellow portions showing broadband access.

“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 North Carolina,” said Colleen Kiley, GIS coordination program manager for the CGIA.

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 report by the Government Accountability Office found that EHR adoption in rural areas is still lagging 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 will not be able to connect to NC HealthConnex or cannot connect in real time.

Beyond meeting the state’s connection mandate, this connectivity can improve patient care and prevent medical errors and duplication of tests. If a patient should need intense care at a larger hospital system, NC HealthConnex can inform their primary care provider of what treatment they received or what medications they were prescribed.

Through the HIEA’s event notification service, NC*Notify, providers are alerted of admission, discharge and transfers if their patient presents at an emergency department in another town. Through national networks such as eHealth Exchange and the Patient Centered Data Home, they can even be alerted if their patient received care at a facility out of state.

Patients can also benefit from efforts to close the digital divide. Increased internet access means the ability to fill out intake forms in advance, 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 high-speed internet access 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.

Learn more about NC HealthConnex at For more information about the NCDIT Division of Broadband and Digital Equity or Governor Cooper’s plan to close the digital divide in North Carolina, please visit