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.