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.