The document summarizes a presentation given by Jeff Miller about the North Carolina Health Information Exchange (NC HIE). The NC HIE is a nonprofit organization established in 2010 to facilitate the secure exchange of health information across the state. It has a 25-member board of directors and four workgroups focused on clinical operations, governance, finance, and legal/policy issues. The goals of the NC HIE are to improve medical decision making, care coordination, health outcomes, and reduce costs by enabling the access and exchange of health data. The NC HIE provides various services like connectivity with participating systems, a clinical portal, secure messaging, and will expand offerings over time. Benefits of the NC HIE include better, safer, more

1. NC Health Information Exchange:
Example of State Health Network
February 21st, 2012
Presenter: Jeff Miller

2. Overview of Federal Health IT

3. NC HIE Overview and Governance
• Nonprofit organization established as a Statewide Designated Entity
(SDE) in April 2010
• Board of directors: 25 CEOs and health care leaders in the North
Carolina community
• Four workgroups: strategy and policy experts on
– Clinical and technical operations
– Governance
– Finance
– Legal and policy

4. Setting the Strategic Agenda – NC HIE Mission
NC HIE will provide a set of secure,
scalable information services that
• Promotes the access, exchange
and analysis of health care
information
• Enables participating organizations
to:
– Improve medical decision-making
and coordination of care
– Improve health outcomes
– Control health care costs

5. Why a NC Health Information Exchange?
Four focus areas for NC HIE initiatives:

6. NCHIE Solution Components – Detailed View
6

7. NC HIE Services Overview
• HIE Connectivity Fabric
– Connectivity with participating systems: CCD,
HL7, SSO, Web Services (Rhapsody™).
– Storage of clinical information (CDR).
– EMPI.
– Data normalization.
– Privacy and consent
• Virtual Patient Record Network
– Web-based access to the longitudinal patient
record (Clinical Portal).
– User subscribed notifications
• Data Delivery Services
–Lab results
• Direct Secure Messaging
– Ability to send/receive secure messages with
other Direct providers
– Support for Direct-enabled EMR systems

8. Timeline
Core Services Phase IA
• EMPI/provider • Medication
directory management
• Security • Immunization registry
• Privacy and consent • Practice analytics
• Clinical messaging • Lab results
• VA Gateway
• DIRECT
• Web-based clinical
portal
• Notifications
• Virtual QO services
• Hosted EMR
Phase IB and Beyond
• Lab ordering • Referrals
• Procedural results • Senior care
• Pharmacy • Mobile gateway
• Consumer portal • Medical device gateway
• Payer gateway • Clinical decision support
• Medical imaging • Vital records
• Population health analytics • Advanced directives
• Syndromic surveillance • Home health
• Public health reporting • NwHIN trading partners

9. Benefits to the Health Ecosystem
Across all insurance types,
North Carolina has an EHR sites were associated
inbound move rate of 55.4%. with significantly higher
According to Forbes, Raleigh achievement of care and
and Charlotte remain two of outcome standards and
the most popular cities for greater improvement in
relocation. diabetes care.
There are almost 200,000
deaths a year from
preventable medical errors, American patients have seen
partly because this an average of 18.7 different
information is not readily doctors during their lives.
available to specialists and
emergency rooms.
By reducing their Only 6.3% of physicians use
dependence on paper a fully-functional electronic
records, a practice seeing health record system in their
3,000 patients annually could practice.
save $24,000.
At the highest level of health Emergency Departments with
IT adoption, only 0.001% of connectivity to an HIE have
prescriptions would require a improved productivity by
phone call between a more than 20%
pharmacist and physician.

10. What’s in it for everyone?
Providing NC with better, safer,
more affordable care
• Integration
• Communication
• Insight
• Agility
• Custom

11. Comparing NC and NL situation
North Carolina Netherlands
• Government actively supporting HIEs • Government in doubt how to support
• Patiënt consent: opt-in needed (for regional and national HIE
sharing, not collecting) • Patiënt consent: opt-in needed (for both
• Healthcare data also used for analysis collecting and sharing)
on population level • Healthcare data only used on patiënt
• Based on international standards (CCD level
/ HL7) • Based on international standards (CCD
• Almost 10 million inhabitants, 3,5 times / HL7)
the area of NL.

12. Prerequisites for successful implementation
• Changing the way of working of a multitude of organizations and
persons, is a tough job.
• Drivers for change are both quantitative and qualitative
– Higher quality of care and lower cost (or more income)
• Even if both are the projected outcome of a network-project, a couple
of objectives must be met to become successful:
– The will to exchange the patients data – and be serious about it
– A compelling business case for the total value chain
– A fair business model promoting the use for each of the participant in the network
– An HIE system that is integrated with the current IS of the caregivers
• Individual healthcare providers have little influence on development roadmap
of ISVs

13. Questions - Discussion

14. Thank you, Jeff Miller !
• Thanks for sharing your thoughts and experiences with us today.
• "I'm Sure it's No Coincidence that
We're Sitting at this table Together.
Some things cannot be Mere Chance;
everybody has got an example of this.
On the other hand I think it's
Nonsense to Say Chance doesn't Exist.
I mean What's the Chance that
Nothing ever happens by chance"
Text and design by Nicole van Schouwenburg
for Royal Delft – Koninklijke Porceleyne Fles

15. Thank you, and have a great time at HIMSS 2012
Jeff Miller Toon van der Werf
• CEO NC HIE - Health Information • Consultant Vakgroep Zorg Capgemini
Exchange Netherlands
• jeff.miller@nchie.org • toon.vander.werf@capgemini.com
• +31(0)629 056 330
• Booth #13642-12