+ One Connection, Many Data Sources One connection to NC HIE means access to provider electronic health record systems, State systems, pharmacies, labs, behavioral health and long-term care entities, disease registries and other sources of patient data. VA, DOD, SSA, etc.
+ Currently, more than 700 sites are participants of NC HIE. We build connected communities that include clinics, local health departments and long-term care and behavioral health providers. A complete list can be accessed on our website: http://nchie.org/providers/our- providers/http://nchie.org/providers/our- providers/ Current Footprint Legend: Hospitals Physician Practice – Primary Care Physician Practice – Specialist Long-Term Care
+ Current Hospital Participation Ashe Memorial Hospital Blowing Rock Rehabilitation & Davant Extended Care Center Cannon Memorial Hospital CaroMont Medical Center Carteret General Hospital Hugh Chatham Hospital Davie Medical Center Granville Medical Center Halifax Regional Medical Center High Point Regional Medical Center Hugh Chatham Memorial Hospital Johnston Medical Center Lenoir Memorial Hospital Lexington Medical Center Maria Parham Medical Center Morehead Memorial Hospital Nash General Hospital Our Community Hospital Person Memorial Hospital Rex Hospital UNC Caldwell UNC Chatham UNC Hospitals UNC Pardee UNC Wakebrook Wake Forest Baptist Medical Center Watauga Medical Center Wilson Medical Center
+ Current Ambulatory Participation Primary Care Practices Specialist Practices FQHCs Free Clinics Long-Term Care Home Health NC HIE ambulatory participation includes more than 700 sites encompassing a variety of provider types:
+ Enabling Meaningful Use and State Reporting Objective/Measure Core or Menu Stage 1 Core or Menu Stage 2 Immunization Registry Reporting Submission of electronic data to an immunization registry Menu for EPs and EHs Core for EPs and EHs Electronic Lab Reporting (ELR) Submission of electronic reportable laboratory results to the State public health agency Menu for EHsCore for EHs Transitions of Care For 50% a Summary of Care document must be provided, 10% of which must be electronically provided - Core for EPs and EHs Electronic Clinical Quality Measures (CQMs) Electronic Clinical Quality Measures (CQMs) reporting (NC HIE enables for Medicaid Eligible Professionals) - Required for EPs and EHs Specialized Registry Reporting Identify and report specific disease cases to a specialized registry (other than a cancer registry) - Menu for EPs Cancer Registry Reporting Identify and report cancer cases to a public health cancer registry -Menu for EPs EPs- Eligible Professionals EHs- Eligible Hospitals
+ Improving Care and Population Health NC HIE with its partner, Community Care of North Carolina (CCNC), is building value-added applications to enhance patient care. Current projects include: Complete Medication Management PHARMACeHOME Chronic Disease Registries Population Health Analytics Incorporation of multi-sourced information, both clinical and claims data, into comprehensive view of evidence-based population health dashboards/utilities to facilitate systematic approaches to improve care. Development of chronic disease registries: Diabetes Asthma Heart Failure Hypertension Reporting of Clinical Quality Measures Development of aggregated reports, currently exploring: PQRS* HEDIS* UDS* Ad-hoc to allow user to generate and save frequently used reports* *At an additional cost
+ NC HIE and State Reporting Wake Forest Baptist Health System is piloting the connection to submit immunization data to NCIR. Expected pilot completion is Q2 2014. CaroMont Health is piloting the connection to submit reportable lab results to NC EDSS and NC LEAD. Other hospitals have begun the onboarding process. NC HIE and NC Medicaid are building connectivity to enable electronic clinical quality measure reporting directly to NC Medicaid. Service availability is scheduled for Spring 2014. In 2014, to comply with the NC Health Care Cost Reduction and Transparency Act, hospitals will begin reporting Medicaid demographic and clinical data to NC Health and Human Services via NC HIE.
+ Privacy and Security Framework A unique feature of NC HIE is its strict patient privacy, security and data use policies built on existing federal regulations, and a statewide consent management process allowing for maximum patient choice with regard to the sharing of their health data. Components of the framework include: Guiding Principles: Established by the NC HIE Legal and Policy Workgroup in 2010. The Workgroup’s guiding principles for developing the framework are: Implement Core Privacy Principles Adopt Trusted Network Design Principles Establish Oversight and Accountability Principles NC HIE Participation Agreement: In compliance with HIPAA. User Access and Authentication: Only authorized users who provide health care services to patients may access a patient’s health information. Audit Logs: User access and all user activity is logged and audited. Data Security: NC HIE’s system is protected by intrusion prevention devices. NC HIE utilizes Orion Health’s Direct Secure Messaging (DSM) solution for sending sensitive information in a secure, encrypted manner between participants and other entities. Patient’s Consent and Right to Opt Out: In compliance with the NC Health Information Exchange Act.
+ Patient Consent Management NC HIE manages the patient consent process from start to finish. Patients contact NC HIE, who adjusts data permissions accordingly. Opt-Out NC HIE allows several options for patients in regard to the sharing of their health data: Full Opt-Out Opt-Out by Organization Opt-Out by Provider Resources Participating organizations are provided patient education materials, including an educational brochure (English and Spanish) that is required to be made available in patient common areas. NC HIE’s opt-out form is also available in English and Spanish. For more resources, visit http://nchie.org/providers/commu nication-materials/ http://nchie.org/providers/commu nication-materials/ Educational Brochure Opt-Out Form
+ Data Phases Demographics Diagnosis Procedures Labs Medications Vitals Administrative / Claims Data Build Initial Clinical Database Build QRDA & Additional Clinical Data Additional Data Sets Infrastructure Build Claims Enrollment Scheduling Social History Asthma Management Data Screenings Meaningful Use Quality Specific Data Prenatal Foster Children Special Population Files Vital Records Referrals 1Q ‘142Q ’143Q ’144Q ‘14
+ Population Health Solutions Clinical Quality Measure Reporting Chronic Disease Registries Diabetes Hypertension Asthma Heart Failure Physician Quality Reporting System ACO Quality Measures
+ The Process Data Extraction Assignment of EMPI Review and Normalization of Targeted Data Sets Labs, allergies, race and ethnicity, medications Load into data repository and HIE (if applicable) Process through rules engine Present data in population health solutions
+ Data Normalization In order for applications to recognize, store and process data elements, data must be in a discrete format with a standard codes Procedure Codes (CPT) Diagnosis (ICD 9) Labs (LOINC) Medications (RxNorm, Multum or NDC) Med Allergies (RxNorm) Vitals (SNOMED) As we are extracting the data, we are finding the data quality varies by practices and by measure set. 18
+ Hypertension Measures 20 ReferenceName PQRS 236Controlling High Blood Pressure PQRS 295 Aspirin or antithrombotic Use PQRS 296 Complete Lipid Profile PQRS 297 Urine Protein Screening PQRS 298Annual serum creatinine testing PQRS 299Diabetes Mellitis annual screening PQRS 302Dietary and Physical Activity Modifications Appropriately Prescribed NQF 0421 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up NQF 0021 Preventive Care and Screening: Influenza Immunization NQF 043 Pneumonia Vaccination Status for Older Adults NQF 0028 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention NQF 0075 Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control NQF 0068 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
+ Hypertension Registry – Site View 22 Provider #1 Provider #2 Provider #3 Provider #4 Provider #5 Provider #6 Provide #X Ability to select different measures or dimensions Compare performance across providers
+ Hypertension Registry – Patient Level Listing 23 Facility Name Site #1Provider Name Provider #1Y - Performance Met N - Performance Not Met E - Exclusion Patient IDPatient NameGender Date Of BirthProvider Name Measure Name Blood Pressure Reading BP Date Mobile Number Aspirin or Another Antithrombotic Use BMI screening and followup(HTN) Complete Lipid Profile Performed Diabetes Mellitis Screen Dietary and Physical Activity Modifications Appropriately Prescribed Influenza Immunization(HTN) Ischemic Vascular Disease (IVD): Aspirin or Another Antithrombotic Use(HTN) Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control(HTN) Pneumonia Vaccine for Older Adults(HTN) Serum Creatinine Test Performed Tobacco Use Screening(HTN) Urine Protein Screening 123456Patient Name #1F7/10/1959Provider NameN NNNYYN YNNxxx/xx5/1/2014919-555- 1212 123457Patient Name #2M6/24/1958Provider NameN NNNYNN YNNxxx/xx5/2/2014919-555- 1213 123458Patient Name #3M3/16/1948Provider NameN NNNYNN NNYxxx/xx5/3/2014919-555- 1214 123459Patient Name #4F9/6/1958Provider NameNNNNNYNY YNNxxx/xx5/4/2014919-555- 1215 123460Patient Name #5F3/4/1977Provider NameNNNNNYNY NNNxxx/xx5/5/2014919-555- 1216 123461Patient Name #6M8/20/1941Provider NameN NNNYYNNYNNxxx/xx5/6/2014919-555- 1217 123462Patient Name #7F10/10/196 4 Provider NameN NNNYYN YNYxxx/xx5/7/2014919-555- 1218 123463Patient Name #8F11/14/195 5 Provider NameN NNNYYN NNNxxx/xx5/8/2014919-555- 1219 123464Patient Name #9F11/1/1941Provider NameNNNNNYYYNYNYxxx/xx5/9/2014919-555- 1220 123465Patient Name #10 F4/30/1958Provider NameNNNNNYNY YNNxxx/xx5/10/201 4 919-555- 1221 123466Patient Name #11 F6/28/1920Provider Name YNNN N xxx/xx5/11/201 4 919-555- 1222 123467Patient Name #12 M11/12/196 0 Provider NameN NNNYNN YNYxxx/xx5/12/201 4 919-555- 1223 Ability to download patient listing to MS Excel for care management and outreach
+ Diabetes Measures 24 ReferenceName NQF 0059HbA1c Poor Control (>9.0) HbA1c A1c Test HbA1c control (<8.0) NQF 0064Low Density Lipoprotein (LDL) Management and Control LDL-C screening Blood Pressure In Control (<140/90) NQF 0055Eye Exam NQF 0056Foot Exam NQF 0062 Urine Protein Screening NQF 0068 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic NQF 0075Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL Control NQF 0421Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up NQF 0021Preventive Care and Screening: Influenza Immunization NQF 043Pneumonia Vaccination Status for Older Adults NQF 0028Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention