Leveraging the power of North Carolina’s health information exchange to improve patient outcomes

1. Leveraging the power of North Carolina’s health information exchange to improve patient outcomes Organization Name Date

2. What is NC HIE? • NC HIE operates North Carolina’s statewide health information exchange, a secure, standardized electronic system in which providers can share important patient health information. • The use of this system promotes the access, exchange, and analysis of health information. • Enables participating organizations to: • Save time and reduce paperwork • Facilitate more informed treatment decision-making • Leads to improved care coordination, higher quality of care, and better health outcomes ACCESS EXCHANGE ANALYSIS

3. What is NC HIE? • NC-based: The Board of Directors are active and prominent in the North Carolina medical community and represent a variety of organizations and interests. • Independent:NC HIE is independent and is not owned by insurance companies, health care organizations, associations, employers or government. • Nonprofit: NC HIE is a private nonprofit organization. It is funded by many sources including North Carolina health care organizations and grants. • Multi-stakeholder:Involves Consumers, Providers, Payers, Business, and Government.

4. How does it work? • NC HIE’s network combines information from separate health care sites to create a single virtual patient health record. • Patient health information is automatically uploaded or linked from a provider’s electronic medical record system. • The information is standardized and aggregated across care sites. • Clinicians can seamlessly access their patient’s information in NC HIE from within their EMR.

5. Why use NC HIE? • Healthier patients:Fewer medical errors, improved patient safety, improved continuity of care, and better patient outcomes • More efficient: Automated sharing of information, less paperwork, reduced time to access clinical information at the point of care, fewer repeat tests and procedures • Informed treatment decisions: A more complete and up-to-date patient medical record, including information from all a patient's health care providers • Supports public health: Automates process of reporting mandatory reportable conditions to the NC Department of Public Health

6. Why do patients care? • Care is more coordinated • Less duplicate tests and procedures • Less paperwork • Fewer errors and safer care • Lower out-of-pocket costs • Important health information is accessible when care is administered

7. What is in the network? In the NC HIE Network: • Patient Identifier and Demographics • Encounter History • Laboratory and Microbiology Results • Radiology Reports and Images • Adverse Reactions/Allergies • Medication History • Diagnosis/Conditions/Problems (primary and secondary) • Immunizations • Dictated/Transcribed Documents

8. What is not in the network? Not in the HIE Network: • Information created by a substance abuse facility or psychotherapy notes Please note that information indicating a sensitive health condition may be referenced to in certain situations: • Medications for these conditions are included if paid for by Medicare/Medicaid or commercial insurance • Visit notes from a non-mental health provider may include reference to one of these conditions

9. What does it look like? Every provider can customize the look and feel of their interface. The process for this is covered during HIE training. Here is an example interface. • Every provider can customize the look and feel of their interface. The process for this is covered during HIE training. Here is an example interface.

10. Security Processes • Connection to the HIE network is secured through the use of a Virtual Private Network (VPN) and is protected by a dedicated Firewall. • All access to NC HIE is password protected. Some organizations may facilitate access through their EHR and under those circumstances, a new password is not required. • Data is encrypted at all times (in motion and at rest). • Provider activity logs are audited by NC HIE and patients may request a report on the access of their health record. • Users can only access patient information with whom they have a relationship. In emergency situations, physicians can access a record for a new patient.

11. Consent Policy • Consumers are automatically part of NC HIE if their health care provider is a participant. North Carolina law requires NC HIE follow an opt-out consent policy allowing patients the choice of not participating. • This policy was written with input from stakeholders representing patients, providers, employers, payers, and government. • Consumers may opt-out by mail using the opt-out form or by phone. In the future, consumers will be able to opt-out online. • State law requires participating providers give the patient a state-approved form the first time they visit that provider location.

12. Mandatory Opt-Out Disclosure Per North Carolina State law, participating organizations must give an Opt-Out Form to all patients at point of initial contactfollowing connection to NC HIE. • Opt-Out Forms will be provided to participants by NC HIE and can be re-ordered at any time by contacting NC HIE’s call center • NC HIE can provide participants with a sample “Notice of Privacy Policy” to help explain NC HIE procedures

13. Opt-Out Three opt-out options are available to patients: • By physician – health records ascribed to the physicians identified by the patient will not be part of the patient’s health record in the HIE network. • By organization – health records collected and maintained by the organizations identified by the patient will not be part of the patient’s health record in the HIE network. • Full Opt-Out – no health records will be in the HIE network. • What if a patient changes their mind? • Rescind Opt-Out – a patient who has previously opted out can rescind their decision at any time and participate in the HIE by filling out the opt out form or calling NC HIE’s call center. Please Note: Opting out will not prevent caregivers from sharing health information with authorized entities when necessary for public health or research purposes that are permitted or required by NC and federal law. In cases of medical emergency, a caregiver doctor may request to view a health record to diagnose or treat an emergency medical condition. NC HIE audits such requests and makes records available to patients.

14. How to inform your patients • Communication Tools: • Talking points for all staff • Scripts for registration and patient relations areas • Patient hand-outs (Opt-Out and Brochure) • Detailed FAQs • Call NC HIE for support and to answer questions from patients

15. Sample Go-Live Experience(conducted by HealthInfoNet, Maine’s HIE) • Primary care multi-site practice sent mailing to their 39,000 patients • Total calls to telephone number indicated: 62 • Gender: Male - 26, Female - 33, Anonymous - 3 • Age: Generally over 40, with 61% being over age 60  • 43 of the 62 chose to opt-out

16. Patient Reactions • Most patients have no questions and choose to remain in the system • Some patients have a few questions (answered in 30-90 seconds) and choose to remain in the system • A few patients have extensive questions and require extra time or a call to NC HIE • NC HIE estimates that 1%-5% of patients will opt-out

17. Patient Questions and Concerns • Recurring questions: • What is this and what is the point? • Is my information on the Internet? • Is my information going to be sold? • Who has access to this system? • General concerns: • Feel privacy violated • Do not trust that the system is secure • Worried their information will be available to insurance companies, government or their employer

18. Questions