The document outlines the implementation of North Carolina's Health Information Exchange (NC HealthConnex) aimed at connecting Medicaid providers securely to improve healthcare outcomes. It describes the legal mandates for providers to connect by specific deadlines, the technical onboarding process, and the resources available for providers, emphasizing the importance of data sharing for better patient care. Additionally, it highlights the role of various partners and the benefits of integrated health information, including improved medication reconciliation and clinical data access.

1. HIE IMPLEMENTATION FOR MEDICAID PROVIDERS
NC Providers Council
January 15, 2019
Kenya Servia, NC HIEA
Eric Myers, SAS Institute
Barry Pollack, Therap Services, LLC

2. 2
Health Information Exchange Overview
What is NC HealthConnex?
Work to Date
Connection Process
Value of Integrating Behavioral Health & Primary Care Data
Suite of Services
Connecting from an EHR Perspective
Questions?
North Carolina Health Information Exchange Authority
Overview of Topics

3. 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.
S T A T E D E S I G N A T E D
North Carolina’s state-designated
health information exchange
S E C U R E
Secure statewide network for
physicians and other health
care providers in North
Carolina to share important
patient health information to
improve patient care.
P A R T N E R S H I P
Housed within the Department
of Information Technology’s
Government Data Analytics
Center (GDAC). Our
technology partner is SAS
Institute.

4. 4
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
What are
the
clinical
benefits
of an
HIE?

5. 5
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 were required to connect by June 1, 2018.
All other providers of Medicaid and state-funded services shall connect by June 1, 2019 except;
• Dentists and ambulatory surgical centers are required to submit clinical and demographic data by June 1, 2021
• Pharmacies are required to submit claims data pertaining to State services once per day by June 1, 2021 using
pharmacy industry standardized formats
5

6. 6
Significant Progress
6
Number of Connected Facilities
Spring 2016 Spring 2017 Winter 2018
108 Facilities 877 Facilities 4,500+ Facilities
Number of Facilities in the Onboarding Process
2016 2017 2018
158 Facilities 578 Facilities 3,800+ Facilities

7. 7
Resources For You…

8. 8
EHR Funding Program for Behavioral Health/IDD Providers
8
243 BH/IDD Organizations
Applied
179 BH/IDD Organizations
Awarded
64 Not Awarded; either did not
meet Program Eligibility or
respond with add’l info

9. How to Connect

10. Migrating to New Platform
• Connections pass through Mirth and into HealthShare
• Extensible Data Model
• Cleaner mapping of CCDA data
• Vastly improved capabilities to feed analytics
• Updated Confidentiality & Consent Capabilities
• Upgraded Clinical Portal
• Updated UI and Functionality
• SSO to MU3 DSM Integration
• Centralized User Management
• NC*NOTIFY (Portal-Driven Notifications)
• Self-service Administration and Reporting for XDR DSM Participants
10

11. Connection Process
11
1. Sign Participation Agreement
Welcome Packet sent with Patient Education, FAQs, and Talking Points
2. Initial Communication
3. Technical Onboarding Call
4. Portal Credentials Issued (upon request until February 15)
Full Participation Agreements only
5. Connection Development and Testing
6. Live in Production
Participant receives “Live Connection Email”
Training and Patient Education information
7. Operations and Support
Ongoing from SAS Helpdesk Team
8. EHR Rollout
Cloud or Web-Based EHRs

12. 12
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
.
1 2
Elements Available Security in Place
Current data elements available in NC HealthConnex include:
Allergies, Encounters, Immunizations, Medications, Problems,
Procedures, Results
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
How Does Health Information Exchange Work?
All data is protected, stored and accessed only for
purposes permissible under federal and state law.

13. 13
Extension Process Update
• Participants who are in the queue to connect and are moving forward in the technical process,
will automatically receive an extension and remain in compliance.
• New participants who are mandated to connect by June 1, 2019, will automatically receive an
extension if they are still in the queue to connect on their deadline.
• Please note: Participants must remain responsive with the NC HealthConnex technical team and
continue to move forward in the connection process. The extension is not a waiver, but simply
an extended period of time to finish the connection build.

14. Attachment 1

15. Attachment 2

16. 16
How Do Providers Connect: The Participation Agreement

17. Attachment 3

18. Attachment 3

19. Attachment 3

20. Attachment 4 – Participating Entities

21. 21
Patient
Education &
Opt-Out
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.

22. NC HealthConnex Data flow &
Suite of Services

23. NC HealthConnex High Level Dataflow
Hospitals
DSM
Clinical Portal
Specialists
NC HealthConnex
DSM
Public Health
Dashboard
Document
Exchange
Primary Care
Cloud EMR

24. Suite of Services
CommunicateExchange Notify Connect Contribute
Flexible Delivery
Custom delivery methods
integrate into varied
provider workflows
NC*Notify
Notifies providers as their
patients receive services
across the care continuum
Public Health Reporting
Diabetes Public Health
Registry and NC
Immunization Registry (help
providers meet MU/MIPS)
Provider Directory
More than 21,000 secure
messaging addresses of
health care providers
Direct Secure Message
Connection with other
providers by sending and
receiving secure, encrypted
messages.

25. Background:
• Representation across:
• BH and IDD
• EMR types
• Regular meetings
• Quarterly large group
• Weekly connections (EMR specific)
• “Clear the path”
Accomplishments:
• Stage 1 connections completed
• Stage 2 target established
• Stage 2 connections completed
• Stage 3 priorities (in process)
• HIE domain knowledge
25
BH/IDD Technical Workgroup - Update
THANK YOU!!

26. BH/IDD Workgroup Outcomes
26
Demographics
Core HIE
Data
Expanded
Data Target
Required for Patient registration/MPI
Minimum for registering documents
Encounter level data
Problem History
Medications
Allergies
Bi-Directional Exchange
Enhanced Encounter Models
Care Plan Highlights (CCA content)
Risk Assessments
Social Determinants
Goal Target Elements HIE Portal User Experience
• View Patient Summary
with demographics
• View incoming CCDs
• View Patient Summary with
clinical data
• Create Patient snapshot
• View timeline of interactions
• View Patient Summary with
clinical + BH data
• Create Patient snapshot
with clinical + BH data
Stage 2
Stage 3
Stage 1

27. 27
NC Notify Rollout
Pilot Phase
• Weekly Admit/Discharge Report
• 50k active subscriptions
Phase 1.0
• Limited release (10-15 sites)
• Published user documentation
• Custom frequencies
Phase 1.5
• Expanded Participation
• Alternative delivery mechanism
Phase 2.0
• Portal subscriptions
• Additional triggers and notification content
January
2018
Q3 2018
Q4 2018
2019

28. Full participation agreement
Complete NC*Notify enrollment form
Send patient list (sent via Secure FTP)
Mechanism for receiving alerts (Secure FTP)
NC*Notify – How to Enroll

29. Connecting from an EHR Perspective

30. © Therap Services 2003 - 2017. All Rights Reserved. U.S. Patents #8281370, #8528056, #8613054, #8615790, #8739253, #8819785.
Barry Pollack
Therap Services
Southeast Regional Director
Barry.Pollack@TherapServices.net
HIE Implementation for Medicaid Providers
________________________________
An EHR’s Perspective

31. What is Therap?
• Therap Services is a Secure, SaaS/Web-Based, COTS,
Nationally Certified, HIPAA compliant, Case
Management, Documentation, Billing, Communication,
and Reporting solution for Human Service Providers,
States, Counties, MCOs and other entities.
SaaS (Software as a Service)
● A software distribution model in which a third-party
provider(Therap) hosts applications and makes them
available to customers over the Internet.
Overview
© Copyright Therap Services, LLC. 2003 - 2015, All Rights Reserved. U.S. Patents #8281370, #8528056, #8613054, #8615790, #8739253, #8819785

32. ONC-HIT
Meaningful Use Certified

33. ● Over 5,000 Providers
● Over 340,000 Users
● Over 590,000 Individuals
● Extensive experience with HL7 interfaces and HIEs
● Serving organizations in 50 states
● 10 State Contracts include Statewide Incident Management
● State contracts currently with 17 states across the US
● 103 Therap North Carolina Providers
National Leader in the Industry
© Therap Services 2003 - 2018. All Rights Reserved. U.S. Patents #8819785, #8739253, #8281370, #8528056, #8613054, #8615790, #9794257. 33

34. Therap - NC Health Connex - Status
 6 Providers – Live Connection
 16 Providers in the Cue
 Average time to get connected 2-3 months
 Average EHR Set-up/Implementation 1-2 Months
for HIE Elements
 2-12 months for comprehensive functionality

35. Interoperability
© Therap Services 2003 - 2018. All Rights Reserved. U.S. Patents #8819785, #8739253, #8281370, #8528056, #8613054, #8615790, #9794257. 35

36. Interoperability

37. Interoperability
© Therap Services 2003 - 2018. All Rights Reserved. U.S. Patents #8819785, #8739253, #8281370, #8528056, #8613054, #8615790, #9794257. 37

38. Health Information Exchange (HIE)
Unidirectional / Bidirectional
© Therap Services 2003 - 2018. All Rights Reserved. U.S. Patents #8819785, #8739253, #8281370, #8528056, #8613054, #8615790, #9794257. 38

39. What Happens After I Complete The Participation Agreement

40. HIE Interface
© Copyright Therap Services, LLC. 2003 - 2016, All Rights Reserved. U.S. Patents #8281370, #8528056, #8613054, #8615790, #8739253, #8819785,

41. © Therap Services, LLC. 2003 – 2016
• ADT: Admission, Discharge, Transfer
• Ability to exchange individual’s health
information data within an HIE connection
• Users can receive and acknowledge messages
• Next Phase: Encounter will be a Program
Enrollment-Allowing for multiple programs
ADT Message Interface

42. © Therap Services, LLC. 2003 – 2016
ADT Message Interface

43. © Therap Services, LLC. 2003 – 2016
ADT Message Interface

44. © Therap Services, LLC. 2003 – 2016
ADT Message Interface

45. © Therap Services, LLC. 2003 – 2016
ADT Message Interface

48. HIEs
• HIE is important, regardless of mandates and dates
• Gives you important information to coordinate your clients’ care
• Your investing in a Central Information System for your Organization
• BH/IDD WORKGROUP
• Benefits to realize: real time communication, outcome data analysis, critical information gets to the right people, efficiencies
allowing you to do more direct service, an over tool to better manage your business
• Get Participation Agreement now and start the legal review
The Selection Process
• We see many EHR selection processes. Many of them are flawed.
• Selection is sometimes seen as an IT process.
• Organizations don’t know what they want/need. RFPs reflect that.
• Consultants can help, but must have experience in your region, industry.
• Budget, timelines and process are not clearly defined.
• Over-emphasis on “ease of use”.
• Buying for today, not investing for the future.
• Direct correlation between how organized the selection process is and success of Implementation.
• Does the Vendor & EHR speak your language?
• How many Organizations do they support in NC & What Services?
• Does the vendor own equipment and host data or contract out. Rapid Response and control are critical.
• Is the product scalable to meet the needs of small/large organizations, Modular or all inclusive? Customizable so as to meet the
needs of different types of service providers or is it more of a “one size fits all” approach?
• Can they provide a cost effective, scaled down option that meets the minimum state requirements?
• How do you support your product both in terms of training/implementation and ongoing support for users (and are there costs
associated with utilization of support).
Experiences/References
• Ask them hard questions
• How long did implementation really take?
• Did you get what you expected at go-live?
• Can you get the information out of the system?
• Can you modify the system easily? Reports and screens? Are there libraries
• How responsive is Support?
• What cost extra?
• How long do customizations take to deliver?
• Do they have a local user group? Is it useful?
• Do they understand North Carolina? Do they understand your business?
• Experience?
• Do they come on-site
Choosing an EHR Vendor

49. Preparing For a Demo
 Have them come to your site.
 How many people do they bring? What are their roles? Will they be part of your implementation?
 One hour demos are useless. Don’t cut the time short.
 Is the vendor on time, organized, and have an agenda for you?
 Does the vendor give you honest answers? (i.e., we don’t do that and here is why, not “we can address that in implementation)
o Make sure the vendor wants to know your goals, plans, challenges and timeline before you start setting up demos.
 Will the vendor visit your site before the demo?
 How extensive are the pre-demo interviews?
 Does the vendor ask the right questions?
 Did the vendor request the right people in the pre-demo interviews?
 Did the vendor listen, or did they use that as a sales opportunity?
 Do you have to explain IRIS, PCP, etc?
 Expect to see-Depending on BH or IDD
 Intake process and demographics
 Scheduling
 Mobile and disconnected solutions, if applicable
 Assessments -> Treatment Plans – Progress Notes
 Medical (medications, MAR, vital signs)
 Signature routing, alerts, case load management
 Billing process – how many steps can it save me? Will I need more or less staff?
 End of month – how easy/difficult is it?
 Reporting – do I see what I need to run my organization?
 Analytics
 Implementation Process
 Infrastructure requirements
Pricing and Contracting
i. Get preliminary pricing early
1. What does agreements cover?
2. Get Multi-year cost estimates
ii. Make sure vendor clearly defines what is included and what is optional
iii. Negotiation
1. Vendors know it is easier to reduce price than add on, be sure you are getting any discounts, best pricing
2. Term of contract – are you sure you want to be with vendor for 3, 5 or 7 years?
a. Communicate and Give feedback
i. Helps the vendor understand how to do better
o Is the product/costing scalable to meet the needs of small/large organizations?
o Will you have to pay for functionality that we don’t need or have any intention to use?
o Is your product packaging customizable so as to meet the needs of different types of service providers or is it more of a “one size fits all” approach? Will we
have to pay for functionality that we don’t need or have any intention to use?
o Support Included, limited or unlimited, on-site, webinars, what does it include?
o Fixed or adjustable, based on Users, Individuals Served, Claims, etc.

50. What is it?
The CURES Act is designed to improve the quality of care provided
to individuals through further research, enhance quality control, and
strengthen mental health parity.
How does the CURES Act apply to HCBS programs?
Section 12006 of the CURES Act requires states to implement an
EVV system for Personal Care Services (PCS) by 1/1/20 and for
Home Health Care Services (HHCS) by 1/1/23.
Future Possible Linkages to HIE:
EVV-Electronic Visit Verification
EVV Required Elements
● Point-of-Service data collection
● GPS Location
● Time, Date, Location stamped
● Check In-Check Out
● Service Provided
● Electronic Signature

51. © Therap Services 2003 - 2017. All Rights Reserved. U.S. Patents #8281370, #8528056, #8613054, #8615790, #8739253, #8819785.
Q & A?

52. Thank You!
52
For more information visit,
www.nchealthconnex.gov
E-mail:
hiea@nc.gov
Eric.Myers@sas.com
Barry.Pollack@therapservices.net