In Raleigh, North Carolina’s HIE Moves Forward—under a State Government Mandate | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

In Raleigh, North Carolina’s HIE Moves Forward—under a State Government Mandate

September 28, 2017
by Mark Hagland
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Christie Burris of the NC HIEA articulates her HIE’s vision of statewide capabilities—and usefulness

Many in U.S. healthcare are under the impression that health information exchanges (HIEs) are, as a group, stumbling these days, given the petering out of federal and state grant funding to support HIE development in the past couple of years. And yet, in many cases, that impression couldn’t be further from the truth. Indeed, there are a number of statewide HIEs that are doing very well, and proving themselves in a broad number of areas.

One HIE organization that is moving forward with the robust backing of its state government is the North Carolina Health Information Exchange Authority (NC HIEA), located in Raleigh, the state’s capital. In fact, the NC HIEA is operating under a direct mandate from the state government of North Carolina.

As Christie Burris, NC HIEA’s acting director explains it, “In North Carolina, we are on the third iteration of health information exchange in the state. In 2015, the North Carolina General Assembly passed legislation that brought the existing state HIE back under state control. When HITECH [the federal Health Information Technology for Electronic and Clinical Health Act, a component of the American Recovery and Reinvestment Act of 2009] was passed, the HIE was under the governor’s administration; then it got pulled out. And in 2015, it got bulled back under the Department of Information Technology,” a cabinet-level agency charged with managing the state’s data. The NC HIEA resides within the Department of Information Technology, and Burris reports to John Correllus, North Carolina’s chief data officer.

NC HIEA has been moving very quickly since its 2015 chartering by the General Assembly. With a state government mandate to connect 98 percent of North Carolina’s healthcare providers to the HIE by specific dates in 2018 and 2019, NC HIEA’s leaders in the first year of operation signed 89 percent of its hospitals and health systems, 87 percent of its county health departments and 100 percent of its federally qualified health centers (FQHCs) to the HIE, with more than 800 sites live in production, including more than 20 hospitals and health systems, more than 30 county health departments and federally qualified health centers, more than 200 primary care providers, and more than 400 ambulatory care sites, including specialty providers.

Meanwhile, as of August of this year, already, 684,704 CCDs (continuity of care documents) were exchanged, including 522,474 outgoing CCDs and 162,230 incoming ones. Also as of August, the NC HIEA’s repository contained 3,899,519 patient records tied to unique patients, representing 36 percent of the total population of North Carolina, of 10.1 million people.

And, though the NC HIEA’s own staff is relatively small—10 staff members, a number that should double in the next year, according to Burris—the staff’s efforts are amplified considerably by the work of the organization’s technology partner, the Cary-based SAS Institute.

Numerous topics related to healthcare and healthcare IT issues in North Carolina and the region of the Southeast U.S., will be discussed October 19 and 20, during the Health IT Summit in Raleigh, sponsored by Healthcare Informatics, and held at the Sheraton Raleigh Hotel Downtown.

Christie Burris spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

Could you share with us a bit about the level of connectivity you’ve achieved so far, and are further working on at NC HIEA these days?

Certainly. A really important part of why we are where we are right now, is because of a second part of the law that authorized our creation and brought the HIE back under state control and fully funded it. A second provision says any providers that receive any state funding of any kind, must submit data to the HIE. The mandate we operate under encompasses all of the state’s hospitals and 98 percent of the providers—pharmacy, behavioral health, dental, specialty care, and hospitals—any organization that receives Medicaid payments or a state health grant—is encompassed by this, so the scope of this is very broad, and our team is working diligently with stakeholders to understand their capabilities. What are their technological capabilities to connect? Where can we provide value back to them, to improve the quality and cost of patient care? We’re spending a lot of time working with providers to really gain an understanding of what’s involved.

What kind of governance structure have you developed at NC HIEA?

We have an 11-member, legislatively appointed advisory board, which meets quarterly. And we have participation agreements governing exchange of the data, modeled on the DURSA under the National eHealth Exchange [the Data Use and Reciprocal Support Agreement, “a comprehensive, multi-party trust agreement entered into voluntarily by public and private organizations (eHealth Exchange participants) that desire to engage in electronic health information exchange with each other as part of the eHealth Exchange,” according to The Sequoia Project, as articulated on its website]. So when we think about what’s happening in NC, it’s very complex. When I think about the hard but good work ahead of us, the state passed this law because they had a vision for aligning with Medicaid reform, which is also happening here. As we move towards managed care and value-based care, we really wanted to create a technological foundation to support that, and to connect providers and support care.

You’re already exchanging CCDs and other data live. Can you share about that?

We went live with data exchange March 2016. Since then, we’ve connected over 800 facilities to exchange data, and we have another 400 facilities in the onboarding process now. And our priorities in our first year were hospitals and health systems, county health departments, and FQHCs. Those were our first-year priorities in terms of outreach and onboarding. We’ve signed 89 percent of the hospitals, 87 percent of the county health departments, and 100 percent of the FQHCs. So now we’re finishing up that process and turning our focus to the state’s primary care providers and behavioral health providers.

We’ve also developed a behavioral health workgroup to determine what kinds of data a behavioral health provider would like to exchange with a primary care provider, and in reverse. We’re working on a proof of concept, because as you know, behavioral health was left out of MU. And we’ll follow the same process with skilled nursing and long-term care. We call it a data target, because not everyone collects the same clinical information, even as they collect the demographic information.

What has been the qualitative response among providers, their reaction, to the live exchange of data, and the processes involved, so far?

Because we are charged with essentially connecting with an entire state full of providers, and they all have different specialties and areas of focus, there’s not one simple answer to that question. With regard to hospitals and health systems, we’re a large Epic state and have two regional HIEs already, so a lot of exchange was already happening. So we’re working to onboard them and help them leverage innovative technologies to better do their jobs. And some of what they want is simply to have us simplify the process of sending data, and helping to consolidate the data feed requirements for the health systems.

Can you talk about the volume of data flowing right now?

Yes, we receive ADTs, CCDs and HL7 data.  And as of August of this year, already, 684,704 CCDs (continuity of care documents) were exchanged, including 522,474 outgoing CCDs and 162,230 incoming ones. In terms of qualitative, from a primary care or county health or behavioral health standpoint, what providers and public health officials really want to know is where their patients touch the system. We’re doing a pilot focused on ADT right now, and beyond that, when there’s more data and a wider variety, we’ll provide broader alerts.

So right now, the alerts involved are admission and discharge alerts?

Yes. The two pilot organizations are with the [900-bed] UNC Health System [based in Chapel Hill] and an ACO. Two separate pilots. The ACO is Piedmont Community Health Collaborative (based in Statesville). Right now, it’s admission and discharge.

When will live data be flowing within the two pilot projects?

Go-live is planned for the end of the year.

Have you been communicating with the leaders of some of the other statewide HIEs? So many are innovating now in different ways.

Absolutely. We attended the SHIEC Annual Conference in Indianapolis [sponsored by the Strategic Health Information Exchange Collaborative, SHIEC] last month, which provided such a collaborative environment for our team. We really appreciated having that camaraderie with people from other statewide HIEs. We’ve developed a number of relationships with other statewide HIEs.

Do you have any broad thoughts about your plans for the next year or two that you’d like to share?

Absolutely. Our primary focus over the next two years will be in assisting providers in meeting the mandate, and building the integration and getting the data flowing, because they have to submit the data to the state. There is a central repository for that data to reside in. Second, we have so many initiatives going, we’re trying to focus so that we can dig into a few projects and do those well, and not spread ourselves too thinly.

Is there anything else that you’d like to add?

This might tie into the themes to be discussed at the Summit. In addition to the mandate that the HIE is operating under and that many providers are aware of, there are two other state mandates that we have been asked to participate in; we’ve been asked to integrate with the state’s controlled substances program; and to support the state’s Medicaid program.




2018 Raleigh Health IT Summit

Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

September 27 - 28, 2018 | Raleigh


Regional New York HIE, Hixny, Adds Nine Counties to Its Territory

September 17, 2018
by Heather Landi, Associate Editor
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Hixny, a regional health information exchange (HIE) based in Albany, has added nine counties to its territory, committing a significant amount of funding over the next 18 months to connect local providers.

Hixny is one of the state’s eight qualified entities (QE) connected by the Statewide Health Information Network for New York (SHIN-NY) – a “network of networks” that allows the electronic exchange of clinical information and connects healthcare statewide – overseen by the New York State Department of Health.

“The success of the SHIN-NY hinges on meeting the needs of providers based on complete, accurate and up-to-date data,” Mark McKinney, CEO, Hixny, said in a statement. “At Hixny we’ve demonstrated the effectiveness of our model – and want to do the same for the providers and patients in our neighboring regions.”

The region in the Hudson Valley and Southern Tier has historically lagged in connecting providers to one another and collecting patient consent.

Hixny’s territory encompasses 28 counties north and west of the Capital District and south of Hudson Valley. In its existing region, 100 percent of hospitals and three out of every four providers are connected via Hixny. Ninety-two percent of adult patients have given consent to their physicians, a number that increases each month. Additionally, it offers the only patient portal in the state called Hixny for You, allowing patients to view their own medical history, with data that spans the entire state.

“Their reputation precedes them,” Yuk-Wah Chan, M.D., a family practitioner in Pleasant Valley, NY, part of Hixny’s new territory, who recently signed-up, said in a statement. “More than ever, physicians need to deliver higher quality and more personalized care to their patients while lowering costs – to do that, you need access to the best, most reliable data. And that’s Hixny.”

Eight total locations have already signed participation agreements with Hixny: Dialysis Clinic, Inc.’s three locations in Elmsford, Hawthorne and Yorktown; Hurley Avenue Family Medicine’s three locations in Kingston, Stone Ridge and Saugerties; Premier Dialysis Center in Goshen and Dr. Chan’s practice.

All participating organizations will have access to patient information across the state through the SHIN-NY.

“We are pleased to welcome these new providers to Hixny; their decision proves that providers who have a choice will choose better data,” McKinney stated. “Hixny is changing the game and this news is only the first of many announcements that demonstrate why Hixny is the best option.”


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The Power of Data Exchange as Disaster Strikes: How HIE Leaders Have Prepared for Hurricane Florence

September 14, 2018
by Rajiv Leventhal, Managing Editor
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The executive directors of GRAChIE and NC HIEA say building HIE-to-HIE connections throughout the region, in preparation for a natural disaster, speaks to the power of health information exchanges

As the nation—particularly the Southeast U.S.—braces for the force of Hurricane Florence, which as of the time of this publishing has made landfall in North Carolina, just a day after Georgia’s governor declared a state of emergency for every county in the state, healthcare and health IT leaders continue to work in overdrive to help those in need.

Indeed, major disasters such as Hurricane Florence have an effect on healthcare information needs—even before they make landfall. This particular hurricane has already resulted in the evacuation of millions who have left the places where they normally receive care and where their healthcare records are housed. In these situations, electronic health records (EHRs) and health information exchanges (HIEs) can certainly play a large role in disaster relief efforts.

For instance, the Georgia Regional Academic Community Health Information Exchange (GRAChIE), which serves healthcare organizations and providers across Georgia, is currently working to connect to eHealth Exchange participants in South Carolina, North Carolina, Virginia and Florida in preparation for displaced evacuees. The idea is for GRAChIE to expand its connectivity to HIEs throughout the Southeast via the eHealth Exchange—a health data sharing network that is part of the Sequoia Project, inclusive of provider networks, hospitals, pharmacies, regional HIEs and many federal agencies, representing more than 75 percent of all U.S. hospital and 120 million patients—as quickly as possible before Hurricane Florence hits the coast, according to the organization’s officials.

Tara Cramer, GRAChIE’s executive director, says that her organization learned from what happened last year during Hurricane Irma, in that Florida was evacuating patients who ended up being displaced to Georgia. So even though GRAChIE used the eHealth Exchange to build out connections through Florida, the problem was that they had to do it so quickly, and at the time Florida was already under evacuation. As such, there weren’t HIEs on the other side of those connections to help with testing and validation, explains Cramer. “This time, we started very early to build out functional connections on both sides. This is the power of HIE, and it’s very technically possible, although it does require some magic to pull it off so quickly,” she says.

Tara Cramer

Meanwhile, in North Carolina, where the storm is hitting hardest right now, leaders at the NC Health Information Exchange Authority (NC HIEA), which is based in Raleigh, and has only been fully functional since March 2016, have also been working throughout the week to establish and build connections with other HIEs.

Christie Burris, NC HIEA’s executive director, says she owes “a debt of gratitude” to Cramer and other GRAChIE other top executives, since on Tuesday morning Cramer alerted Burris that these connections were possible via the eHealth Exchange. “Shortly after that [conversation], we got together with the East Tennessee Health Information Network (eTHIN), I got my team together and said let’s talk with our vendors, so we can figure out the feasibility in doing these out-of-state connections,” recalls Burris. “And at that time, we weren’t sure when the storm was hitting, so we spent Tuesday through Thursday working with these different HIEs, and we pulled [those connections] off successfully,” she says.

Indeed, in addition to the connection with GRAChIE, NC HIEA signed agreements with four other HIEs this week so that bi-directional exchange could occur: Coastal Connect HIE (Wilmington, N.C.); eTHIN; MedVirginia (Richmond, Va.); and SCHIEX (South Carolina Health Information Exchange). NC HIEA also already had an established connection with GaHIN (the Georgia Health Information Network, based in Atlanta) and the VA HIE (Veterans Administration). “We signed agreements with five of those HIEs last night at 9 p.m.,” Burris says.

Christie Burris

As it stands right now in North Carolina, explains Burris, more than 20 counties in the state have been evacuated, leading to numerous displaced citizens. What’s more, many pharmacies, hospitals, clinics and doctor’s offices have been closed, and prescribing patterns disrupted, leading to many patients having to reconnect with their care regimens, often in new settings.

Shelters in New Bern, a riverfront city near the North Carolina coast, are at capacity as the town flooded last night, Burris notes. And shelters in Raleigh are also at capacity, so some of those folks got moved to Winston-Salem. Thankfully, Burris says that her HIE has a central repository in which it holds onto the patient data, meaning that even if a hospital has been shut down—such as in the town of Wilmington where every hospital but one has been closed—NC HIEA has those patient records up until the time the hospital stops sending them. “So we do have that historical [view of] the patient, and at this point we have over 5 million unique patient records in our North Carolina repository,” says Burris.

Cramer notes that caring for displaced citizens has been a core reason why GRAChIE has been such an advocate for standing up these HIE connections on the fly, and quickly, during the time of a disaster. On a day-to-day basis, she says, “We know that Georgia and North Carolina residents may present at an urgent care facility or the ER, but we also know that during these times, it’s heightened. So if we can equip clinicians with a patient’s allergy list and medication history, that’s still a great starting place to take care of someone who has been evacuated and is already going through a stressful time without friends and family. It is our job to broadcast that net and gather as much information as we can for when they present for care,” Cramer says.

To this end, she adds that at one of GRAChIE’s participating Georgia hospitals, 14 new patients with North Carolina addresses were registered yesterday. “And we are continuing to monitor that throughout the day to see where patients are coming from. It’s our job to watch that and make sure we are delivering quality information.” She also notes that even though Georgia has escaped the major brunt of the damage from this hurricane, the state will still get plenty of evacuees, and preparations have to be in order. “We started reaching out [to HIEs] before we knew a storm may be coming so that we could build relationships. We have built connections with GRAChIE that we don’t keep active all the time, but when we need to activate them, we can. That’s been a key for us since Hurricane Irma,” she says.

Both Burris and Cramer also expressed great gratitude to the Strategic Health Information Exchange Collaborative (SHIEC), a national collaborative of HIEs, for making these connections possible. “I would have not known Tara if not for SHIEC,” admits Burris. And even though GRAChIE and NC HIEA are not yet part of SHIEC’s patient-centered data home (PCDH) project—a model based on triggering episode alerts, which notify providers that a care event has occurred outside of the patients’ “home” HIE, and confirms the availability and the specific location of the clinical data—both HIEs have plans to link up to it quite soon.

In the end, while Burris and Cramer believe in the power of HIEs when a storm hits, they also attest that providers of all types should not wait for a natural disaster to participate. “We want there to be value in the day-to-day exchange of information,” says Cramer. “In these times, you might have a more heightened awareness, but there is every-day value in health information exchanges.”

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Connecticut Receives $12.2M Grant to Build Statewide HIE

September 11, 2018
by David Raths, Contributing Editor
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Earlier effort failed because HIE was not self-sustaining

The State of Connecticut will receive a $12.2 million grant to support ongoing work that will establish Connecticut’s first statewide health information exchange.

An earlier statewide HIE effort, the Connecticut Health Information Technology Exchange, was shut down in 2014 after spending $4.3 million in federal grant money over four years. A state auditor’s report noted that the exchange was never able to provide services to stakeholders and thus, never developed a self-sustaining revenue stream. (The State of Montana also recently decided to take a second try at creating a statewide HIE.)

The grant, awarded by the Center for Medicare and Medicaid Services (CMS) to the Connecticut Office of Health Strategy (OHS), supports efforts to develop a secure, modern HIE that facilitates the sharing of health data to further patient care, improve proper efficiency, and rein in the high cost of healthcare. The HIE is expected to be operational by early 2019.

The grant follows a $5 million federal investment the state received in 2017 that facilitated HIE planning. To qualify for the additional resources, states outlined how their health technology plan would improve disease management, serve the Medicaid population (over 800,000 Connecticut residents), combat the opioid epidemic, and improve overall healthcare through the use of clinical data.

The new round of funding launches a pilot program for the health information exchange, which was one of the nine recommendations made by the Health Information Technology Advisory Council, a statutory body tasked with a comprehensive examination of Connecticut’s current health technology needs.

“The health information exchange will improve care. Providers will be able to exchange clinical and diagnostic data in real time – efficiencies that will save time and resources for healthcare systems and patients,” said OHS Health Information Technology Officer Allan Hackney, in a prepared statement. “We engaged nearly 300 providers and consumers and 75 organizations across the health sector in Connecticut to help us understand the issues and opportunities for improving care delivery and outcomes. Technology can and should be a great partner in health reform.”

Another goal is for the HIE to enable a platform for measuring clinical quality and more quickly analyzing population health – one of the keys to improving healthcare accessibility and correcting racial, ethnic, and gender health inequities. Currently, analysts most commonly use insurance claims data, which is only a proxy for real-time clinical information. This use of the HIE dovetails with the work of OHS’s State Innovation Model Office and the Health Systems Planning Unit in their efforts to better address gaps in healthcare, improve community health, and evaluate the performance of Connecticut’s healthcare providers.


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