NC HealthConnex: Secure Health Information Exchange in North Carolina

1. North Carolina Health Information Exchange Authority Alliance Behavioral Health Alice Miller, NC HIEA

2. North Carolina Health Information Exchange Authority Overview of Topics Health Information Exchange Overview What is NC HealthConnex Work to date Connection Process Value of Integrating Behavioral Health & Primary Care Data Questions

3. What is Health Information Exchange (HIE)? A Health Information Exchange (HIE) is a secure, electronic network that gives authorized health care providers the ability to access and share health-related information across a statewide information highway. Pharmacy Providers Hospitals Long-term Care HIE Labs & Diagnostics Payors Behavioral Health Public Health

4. How Does Health Information Exchange Work? Electronic Health Record Clinicians enter data into EHR and that data is pulled into HIE Data Provided Clinicians who have care relationships with their patients are able readily access that data Data Provided Clinicians who have care relationships with their patients are able readily access that data Electronic Health Record Clinicians enter data into EHR and that data is pulled into HIE Elements Available Security in Place 1 2 . Alldataisprotected,storedandaccessedonlyforpurposespermissibleunderfederalandstate law. Current data elements available in NC HealthConnex include: Allergies, Encounters, Immunizations, Medications, Problems, Procedures, Results

5. What are the clinical benefits of an HIE? • A full “picture” of a person’s health, including visits, hospitalizations and medications • Improved, more accurate and timely medication reconciliation that reduces errors and avoids unnecessary tests • Instant access to a full panel of test results, reducing errors and gaps in treatment

6. We connect health care providers to safely and securely share health information through a trusted network to improve health care quality and outcomes for North Carolinians. STATE DESIGNATED North Carolina’s state-designated health information exchange SECURE PARTNERSHIP Housed within the Department of Information Technology’s Government Data Analytics Center (GDAC). Our technology partner is SAS Institute. Secure statewide network for physicians and other health care providers in North Carolina to share important patient health information to improve patient care

7. Value-Added Features Communicate | Direct Secure Messaging Accounts provided by NC HealthConnex allow connection with other providers by sending and receiving secure, encrypted messages. Connect | Access to DSM Provider Directory with over 16,000 (and growing) secure messaging addresses of health care providers. Contribute | Public Health Reporting via Registries – Diabetes Declaration of Readiness, December 1, 2017. Convey | Utilize the clinical data an organization captures with timely analytics and reporting about patient population via Clinical Notifications.

8. Current State of Connectivity 27 200+ 35+ 400+ County Health Departments and Federally Qualified Health Centers Hospitals & Health Systems Primary Care Providers Ambulatory Sites, including specialty providers For a list of all connected Participants visit our website nchealthconnex.gov

9. Data Security The NC HIEA takes patient health data privacy and security 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. The NC HIEA follows the highest information security standards available. Information is always encrypted at rest and in transit. Additionally, the environment is SOC 2 compliant. Alldataisprotected,storedandaccessedonlyforpurposespermissibleunderfederalandstate law. TheStatedoesnotallowdataitreceivestobeusedordisclosedforcommercialpurposesorforany other purpose other than those set forth in G.S. 90-414.4(a) or G.S. 90-414.2. 2015-241, s.12A.5(d). The NC HIEA is working with an industry leader, SAS Institute, to build the technical connections to NC HealthConnex and to ensure the highest level of patient and data security.

10. NC HIEA takes the Patient’s right to Opt-Out very seriously. Once a Participation Agreement is signed by a health care provider, Patient Education materials are provided to that organization via email. • Providers and patients also have easy access to Patient-Opt out materials on the NC HealthConnex website. • All Security, Opt-Out and Sensitive Data Policies are posted on our website, nchealthconnex.gov. Patient Education & Opt-Out

11. What Does the Law Mandate? Hospitals as defined by G.S. 131E-176(3), doctors (licensed to practice under Article 1 of Chapter 90 of the General Statutes), and mid-level practitioners who provide Medicaid services and who have an electronic health record shall connect by June 1, 2018. All other providers of Medicaid and state-funded services shall connect by June 1, 2019.

12. Deadlines & Operations Above and beyond our proof of concept we have begun to vet Behavioral Health EHR vendors and engage them in the onboarding process if they can meet our current minimum data standard. 2018 2019

13. NC HealthConnex Extension Process Provide additional connection time for those providers who have been unable to connect to NC HealthConnex by their statutory deadline and have demonstrated intent to connect to NC HealthConnex • Your organization can only request an extension if your connection deadline is within the next six (6) months. That is, if your deadline is June 1, 2019, the first day that you can submit an extension request form is December 1, 2018. • Extensions received prior to the permitted period will be rejected and the provider must resubmit the extension request within 6 months of their deadline. • Extensions will last until the next connection deadline provided by law. Your organization can request additional extensions if you are unable to connect to NC HealthConnex by your extended deadline. • All health care providers must connect law, so no extension deadlines will be set beyond June 1, 2020. .

14. How do I apply for an extension? • First, you must meet the following criteria: • Have signed an NC HIEA Participation Agreement; and • Can demonstrate how your organization plans to connect to NC HealthConnex within one (1) calendar year • Second, log on to: nchealthconnex.gov/providers/extension-process • Complete the online application • Submit to HIEAExtension@nc.gov

15. Legislatively mandated study that requires the state to examine the feasibility for specific providers to connect to NC HealthConnex. Feasibility Study COST RESEARCH AVAILBILITY Cost estimates by provider type to connect and submit data to the HIE and any availability of federal or State funds to meet connection or submission requirements. Activity of other states and payor plans with respect to the establishment of an HIE Network . The availability of connection, exchange, and data submission standards established by the Office of the National Coordinator for Information Technology within the U.S. Department of Health and Human Services SETTING STANDARDS DIFFICULT DATA ALTERNATIVES The adoption of national standards for the connection, exchange, and data submission standards by provider type. Data captured in the treatment of patients, segmented by provider type. Alternatives to the connection and submission of demographic, clinical, encounter, and claims data through the HIE Network. NOTE: This study is underway and will be provided to the Joint Legislative Oversight Committees for Health and Human Services and Information Technology by April 1, 2018.

16. NC HealthConnex | Data Elements We will aim to collect all Meaningful Use* Data Elements within the Clinical Summary MU2 Summary Type, delivered via CCD within the CCDA: • Care Team Members • Date of Birth • Ethnicity • Patient Name • Preferred Language • Race • Sex • Care plan field(s), including goals and instructions • Problems • Medication Allergies • Medications • Laboratory Test(s) • Laboratory Value(s)/Result(s) • Smoking Status • Vital signs (height, weight, BP, BMI) * Meaningful Use is a CMS Medicare and Medicaid program that awards incentives for using certified electronic health records (EHRs) to improve patient care. To achieve Meaningful Use and avoid penalties, providers must follow a set of criteria that serve as a roadmap for effectively using an EHR. 16

17. How Do Providers Connect? • There are two steps to determine a practice’s readiness for connection. • Does your practice have an EHR that can send CCD or HL7 messages? • Technology in Place: The NC HIEA Participation Agreement requests EHRs that are minimally capable of sending HL7 messages, version 2 and higher. The first step is to have the ability to send HL7 messages (version 2.0 and higher) to enable the technical connection and data submission to NC HealthConnex.  • 2. Does your practice have a Participation Agreement in place? • The Participation Agreement is the document that governs the exchange of data between the practice and NC HealthConnex. This contract must be in place before the technical build can begin. Participation Agreements are linked on our website for providers to download, sign and return.

18. Various Ways You Can Connect

19. How Do Providers Connect: The Participation Agreement

20. How Do Providers Connect: The Participation Agreement

21. North Carolina Health Information Exchange Authority Behavioral Health Work Group Partner Understand Technology Address Paper NC HIEA took this opportunity leverage relationships with stakeholders and associations Since the Working Groups first meeting the NC HIEA has determined varying applications of technology within BH/IDD communities With so many providers in this community still on paper we worked to address standards for connectivity so those interested in an EHR.

22. Behavioral Health Landscape within NC HealthConnex 41 Participants 418 + Facilities

24. Behavioral Health Prototype Update Feedback has been collected towards minimizing the gap between clinical and behavioral health data targets A phased approach for completion of the prototype is being explored between SAS & HIEA: Background • Joint study to better understand what data elements are appropriate for collection from behavioral health providers, and what information is relevant for BH/DD providers to receive from a patient's clinical record • Prototype participants include Alexander Youth Network, Monarch, and RHA • Potential impact to 40+ PAs/400+ Facilities

25. NC HealthConnex works with EHR vendors who, at minimum, can send HL7 messages. The list of EHR vendors currently working with NC HealthConnex is available on our website at www.nchealthconnex.gov • Aprima • AYM Technologies • Credible Behavioral Health • eMed Solutions • Integrity- Checkpoint EHR • Mediware- AlphaFlex • Patagonia • The Echo Group • Therap • Other, or Custom Systems 25

26. Q. How can NC HealthConnex drive effective and efficient interoperability? A. Use Cases. Understanding what primary care providers’ need from behavioral health will help drive adoption.