NC HIE Hospital Onboarding Strategy

NC HIE Hospital Onboarding Strategy
April 2014
I.
Purpose of Document
This document presents a comprehensive plan for onboarding the North Carolina hospitals that
bill Medicaid for services to the North Carolina Health Information Exchange (NC HIE) to enable
compliance by NC HIE, the North Carolina Department of Health and Human Services (NC DHHS
or “The Department”) and hospitals with the North Carolina Health Care Cost Reduction and
Transparency Act of 2013 (N.C. Session Law 2013-382, s. 14.1). The following sections describe
the legal requirement and NC HIE’s proposed approach to compliance for all parties by October
31, 2015.
II.
Background
NC HIE was established to plan, implement, and operate the statewide health information
exchange infrastructure (the HIE Network) that allows the secure electronic sharing of a
patient’s personal health information with other healthcare entities that have a relationship with
that patient. Initial and ongoing funding for NC HIE has been made available to NC HIE through
a program managed by the Division of Medical Assistance with funding from the State and the
Centers for Medicare and Medicaid Services (CMS). By executing the DHHS-NC HIE Master
Services Agreement, the Department recognized NC HIE as a strategic partner to further the
Department’s goals and objectives related to improving the quality and coordination of care
provided to beneficiaries of DHHS programs and initiatives across health systems through
timely access to claims and clinical data.
With the enactment of the North Carolina Health Care Cost Reduction and Transparency Act of
2013 (N.C. Session Law 2013-382, s. 14.1), the strategic partnership between the Department
and NC HIE will increase significantly to enable the Department to have timely access to clinical
information from hospitals concerning Medicaid and HealthChoice beneficiaries. Such access
will enable the Department to use this information to enhance its ability to (i) implement and
evaluate Medicaid reform strategies designed to control health care costs and improve the fiscal
oversight of the Medicaid program; (ii) perform comparative and population-based research and
evaluation designed to increase quality, enable more effective population health management
and reduce duplication of Medicaid services; and (iii) identify fraud and abuse within the
Medicaid program.
The submission of patient demographic and clinical data from the hospitals across North
Carolina is critical to improving the timeliness and safety of health care services provided to
some of NC’s most vulnerable citizens. The submission of hospital data across the State will also
enhance interoperability between healthcare systems allowing for the treatment of the whole
patient and improvement in many services including public health surveillance and disease
management.
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III.
Scope of Work
According to Statement of Work Number 5 to the NC DHHS-NC HIE Master Service Agreement
and pursuant to House Bill 834, NC HIE shall connect all hospitals that bill Medicaid for services
to the HIE Network such that the following data elements for all patient encounters are made
available in the HIE Network on a real-time or near-real-time basis:
i. Demographic;
ii. Payer(s);
iii. Encounter Purpose/Diagnosis;
iv. Problems;
v. Procedures;
vi. Medications;
vii. Immunizations;
viii. Allergies;
ix. Laboratory Results;
x. Vital Signs;
xi. *Family History;
xii. *Social History;
xiii. *Advance Directives;
xiv. *Medical Equipment;
xv. *Functional Stats; and
xvi. *Plans of Care.
*Note that these data elements may not be available from all hospitals upon initial connectivity.
NC HIE shall accomplish the former through two main interfaces required for all hospitals:
Admission, Discharge, Transfer (ADT), and Continuity of Care Document (CCD), part of the
Consolidated Clinical Document Architecture (CCDA) standard promoted by the Office of the
National Coordinator of Health Information Technology (ONC), the Centers for Medicare and
Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC) and other
federal agencies promoting the standardized sharing of health data across health care providers
and enterprises.
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IV.
Implementation/Electronic Health Record Landscape
Implementing a statewide integration plan for our health care environment can be a tedious
process due to multiple variables in the electronic health record (EHR) environment. In the state
of North Carolina, there are more than 20 different EHR vendors scattered throughout our
hospitals. Within EHRs there is the potential to have multiple products and versions, creating
alternate paths to integration.
There will be opportunities to explore efficiencies in connectivity as more hospitals are onboarded. The State of North Carolina has larger integrated delivery networks (IDNs) that share
EHR systems, so the potential to integrate with a single source of data can encompass multiple
individual hospitals. There are also EHR vendors that are prevalent within the State where
integration methods may be reused according to the likeness of those systems.
V.
Standard Integration Process
The standard integration process for hospitals at NC HIE consists of the following eight phases.
Please note that the timeframe provided here—estimated at an average of 12 weeks per
hospital—is an approximation based on recent experience with integrations and can vary
depending upon multiple factors including EMR vendors and hospital resource levels.
1. Initiation: Involves hospital receipt and completion of the NC HIE Business Requirements
Form, Implementation Planning Questionnaire and VPN Connectivity Form, and provision
of the hospital’s EHR specifications to NC HIE. Forms are received and reviewed by NC HIE
for accuracy, followed by a technical discovery call with all parties to clarify details necessary
for the planning and preliminary groundwork for development and testing. The timeframe
for this phase is 1-2 weeks.
2. Planning: Involves identification and documentation of the complete scope of integration;
creating an integration project schedule for NC HIE, hospital and its EHR vendor; creation of
Test Plan; agreement on high-level milestones; and finally the project kick-off call. The
timeframe for this phase is 1-2 weeks.
3. Design: Involves facility list build, design, and data mapping analysis of all the interfaces in
scope. The timeframe for this phase is 2-3 weeks.
4. Build and Execution: Involves establishing connection, mostly through VPN, and in certain
cases through web services. Once the connectivity is established, the hospital will send test
messages for validation, after which development and unit testing for each interface occur.
This is the most time consuming phase and should typically last 5-6 weeks.
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5. User Acceptance Testing: Involves NC HIE’s creation and hospital review of user acceptance
test scripts, code promotion to the Test Environment, and testing. Once complete, the
hospital reviews the results, orders more testing is necessary or provides final sign-off. This
phase can last 1-2 weeks.
6. Production Implementation: Involves review of the go-live schedule and migration plan
developed by NC HIE and the hospital and promotion of the code to the Production
Environment. Final production implementation testing then occurs. This phase lasts for 1
week.
7. Training: Provided in recorded or live webinar format for participants through the NC HIE
website, or when required onsite, due to the extent of integration and the number of
facilities involved.
8. Closeout: Involves sign-off via the customer acceptance form, which establishes mutual
agreement on a successful roll-out of code into production and completion of
implementation testing.
The flowchart on the following page depicts the above eight-step standard integration process
for onboarding one hospital.
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NC HIE Hospital Onboarding Strategy
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VI.
Hospitals in Scope and Roll-Out Schedule
The following schedule represents an estimated roll-out of hospital onboarding for all hospitals
covered under the legislative requirement over 18 months from the anticipated April 2014
agreement between NC DHHS and NC HIE, or from May 1, 2014 – October 31, 2015.
Hospitals Currently Under Contract with NC HIE
Twenty-seven (27) hospitals are currently under contract with NC HIE. These hospitals,
contracted on or before April 1, 2014, are listed in the table below with estimated go-live dates
based on current implementation projects. “Go-live” is defined in the below table to mean the
date when ADT and CCD information for that hospital is available in the HIE Network.
Current Hospital Participants of NC HIE
(Contracted prior to April 1, 2014)
EHR System
Estimated Go-Live
1.
Morehead Memorial Hospital
Meditech
15-May-14
2.
Carteret General Hospital
Meditech
15-May-14
3.
Granville Health System
Meditech
15-May-14
4.
Lenoir Memorial Hospital
Meditech
15-May-14
5.
Halifax Regional Medical Center
Meditech
15-May-14
6.
UNC Chatham Hospital
Epic
31-May-14
7.
Rex Healthcare
Epic
31-May-14
8.
University of North Carolina Hospitals
Epic
31-May-14
9.
Wilson Medical Center
Meditech
15-Jun-14
10.
Maria Parham Medical Center
Paragon
15-Jun-14
11.
Person Memorial Hospital
Meditech
15-Jun-14
12.
Hugh Chatham Memorial Hospital
CPSI
30-Jun-14
13.
Our Community Hospital
HMS
30-Jun-14
14.
High Point Regional Hospital (UNC Health Care)
McKesson
30-Jun-14
15.
UNC Caldwell Memorial Hospital
Siemans
30-Jun-14
16.
UNC Pardee Hospital
Meditech
30-Jun-14
17.
UNC Wakebrook
Epic (?)
30-Jun-14
18.
Johnston Medical Center (UNC Health Care)
Meditech
30-Jun-14
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19.
Nash Hospitals
Cerner
30-Jun-14
20.
Wake Forest Baptist Hospital
Epic
30-Jun-14
21.
Davie Medical Center (Wake Forest Baptist Health)
Epic
30-Jun-14
22.
Lexington Medical Center (Wake Forest Baptist Health)
Epic
30-Jun-14
23.
CaroMont Regional Medical Center
McKesson
30-Jun-14
24.
Ashe Memorial Hospital
Meditech/Iatric
30-Jun-14
25.
Watauga Medical Center
Allscripts Sunrise
30-Jun-14
26.
Blowing Rock Hospital
Allscripts Sunrise
30-Jun-14
27.
Charles A. Cannon Memorial Hospital
Allscripts Sunrise
30-Jun-14
Hospitals Not Currently Under Contract with NC HIE
One-hundred and nine (109) hospitals under the legislation (estimated based on general/acute
care hospitals, long-term care, behavioral health hospitals, other specialty hospitals and stateoperated hospitals that bill Medicaid per 2014 GAP/MRI Plan; B1-B2 Inpatient Test Tab data
provided by the Division of Medical Assistance and available data on the North Carolina Hospital
Association website) are not under contract with NC HIE as of April 1, 2014. These hospitals are
listed in the table below along with EHR vendor, if known. If all hospitals execute an agreement
with NC HIE by July 31, 2014 (project assumption), per an expected agreement and
announcement by NC HIE and NC DHHS in late April 2014, the current integration project
timeline will allow for an average of 20-25 hospitals to complete implementation efforts and go
live on the HIE Network quarterly, completing all work by the target date of October 31, 2015.
The queuing of these systems will be based on when hospitals enter into contract as well as
readiness.
Future Hospital Participants of NC HIE
(Contracted after April 1, 2014)
EHR System
Alamance Regional Medical Center
Albemarle Hospital
Meditech
Alleghany Memorial Hospital
CPSI
Angel Medical Center
Cerner
Annie Penn Hospital
Anson Community Hospital
Asheville Specialty Hospital
Betsy Johnson Hospital
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Blue Ridge Regional Hospital
Cerner
Bladen County Hospital
Broughton Hospital
Brynn Marr Behavioral Healthcare
Cape Fear Valley Medical Center
Care Partners Rehabilitation Hospital
CarolinaEast Medical Center
Cerner
Carolinas Medical Center-Northeast
Carolinas Medical Center
Cerner
Carolinas Medical Center-University
Carolinas Medical Center-Mercy
Carolinas Medical Center-Pineville
Carolinas Medical Center-Lincoln
Carolinas Specialty Hospital
Catawba Valley Medical Center
Central Carolina Hospital
Central Harnett Hospital
Central Regional Hospital
Charlotte Institute of Rehabilitation
Cherokee Indian Hospital
Resource & Pt. Mgmt. System
Cherry Hospital
Cleveland Regional Medical Center
Columbus Regional Healthcare System
Crawley Memorial Hospital
Davis Regional Medical Center
Dosher Memorial Hospital
CPSI
Duke Raleigh Hospital
Epic
Duke Regional Hospital
Epic
Duke University Hospital
Epic
FirstHealth- Montgomery Memorial Hospital
FirstHealth- Moore Regional Hospital
FirstHealth- Richmond Memorial Hospital
Frye Regional Medical Center
Cerner
Grace Hospital Inc.
Highlands-Cashiers Hospital
CPSI
Highsmith-Rainey Memorial Hospital
Holly Hill Hospital
Iredell Memorial Hospital
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Julian F Keith ADATC
Kindred Hospital- Greensboro
Kings Mountain Hospital
Lake Norman Regional Medical Center
Lifecare Hospital of North Carolina
Martin General Hospital
MedWest Harris Regional Hospital
MedWest Haywood Regional Medical Center
MedWest Swain County Hospital
Missions Hospitals, Inc
Cerner
Moses Cone Memorial Hospital
Murphy Medical Center
CPSI
New Hanover Regional Medical Center
Northern Hospital of Surry County
Novant Health Brunswick Medical Center
Epic
Novant Health Charlotte Orthopedic Hospital
Epic
Novant Health Clemmons Medical Center
Epic
Novant Health Forsyth Medical Center
Epic
Novant Health Franklin Medical Center
Epic
Novant Health Huntersville Medical Center
Epic
Novant Health Kernersville Medical Center
Epic
Novant Health Matthews Medical Center
Epic
Novant Health Medical Park Hospital
Epic
Novant Health Presbyterian Medical Center
Epic
Novant Health Rowan Medical Center
Epic
Novant Health Thomasville Medical Center
Epic
Old Vineyard Hospital- Keystone
Onslow Memorial Hospital
Meditech
Park Ridge (Fletcher) Hospital
Cerner
Pender Memorial Hospital
Pioneer Community Hospital of Stokes
Randolph Hospital Inc.
Meditech
Rutherford Hospital
Sampson Regional Medical Center
Sandhills Regional Medical Center
Select Specialty Hospital- Durham
Select Specialty Hospital- Greensboro
Select Specialty Hospital- Winston-Salem
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Scotland Memorial Hospital
Southeastern Regional Medical Center
McKesson
St. Luke's Hospital
Stanly Regional Medical Center
The McDowell Hospital, Inc
Cerner
The Outer Banks Hospital, Inc (Vidant)
Epic
Transylvania Regional Hospital
Cerner
Union Memorial Regional Medical Center
Valdese Hospital
Vidant Beaufort Hospital
Epic
Vidant Bertie Hospital
Epic
Vidant Chowan Hospital
Epic
Vidant Duplin Hospital
Epic
Vidant Edgecombe Hospital
Epic
Vidant Medical Center
Epic
Vidant Roanoke-Chowan Hospital
Epic
WakeMed Cary Hospital
Epic
WakeMed Hospital
Epic
Walter B Jones ADATC
Washington County Hospital
Wayne Memorial Hospital
Meditech
Wesley Long Community Hospital
Wilkes Regional Medical Center
Wilmington Treatment Center
Yadkin Valley Community Hospital
VII.
NextGen
Cost to Hospitals
NC HIE’s pricing structure was configured to spread the operating costs of the HIE Network
evenly among North Carolina Hospitals. The current costs to hospitals for initial connectivity
and ongoing subscription fees are represented in the below table.
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Participant
Category
CORE Services Subscription Fee
(Annual Fee)
Estimated Integration Fees
(One-time Charge)
Hospitals/IDNs
(includes
access for all
hospital-based
providers)
$250 per licensed bed
Core interfaces to be included:
- ADT (Admission, Discharge, Transfer)
- CCD (Continuity of Care Document; bi-directional)
Core interfaces: $7,000
$50 per licensed bed for skilled
nursing or long-term care beds
Public Health interfaces to be included:
1. NC Immunization Registry interfaces:
- VXU (Vaccination Update Message)
- QBP (Query By Parameter)
- RSP (Response Message)
2. NC Electronic Lab Reporting interface:
- ORU (Observation Result Message)
Public Health interfaces: $11,000
DSM Direct EMR Integration (optional): $10,000
VIII.
Project Assumptions
The following assumptions have been made to ensure adherence to the project schedule:
1. All hospitals will be under contract with NC HIE by July 31, 2014.
2. No discounted annual pricing will be available to hospitals for contracts signed after
May 1, 2014.
3. The following are completed no later than 2 weeks from contract execution between
the hospital and NC HIE:
a. Pre-technical documentation by the hospital, including completion of NC HIE’s
Business Requirements Form, Implementation Planning Questionnaire, VPN
Connectivity Form and other requested documentation; and
b. Resource allocation is done at all three ends: NC HIE, Hospital and EHR Vendor.
4. Hospital system readiness is confirmed during the initiation phase.
IX.
Conclusion
In conclusion, the Onboarding Strategy herein is an aggressive but feasible approach to connect
all hospitals in the State to NC HIE pursuant to the North Carolina Health Care Cost Reduction
and Transparency Act of 2013 (N.C. Session Law 2013-382, s. 14.1). The connectivity established
will allow for data sharing between the hospitals, other healthcare providers and trading
partners and the Department of Health and Human Services (DHHS) to (i) implement and
evaluate Medicaid reform strategies designed to control health care costs and improve the fiscal
oversight of the Medicaid program; and (ii) perform comparative and population-based research
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and evaluation designed to increase quality, enable more effective population health
management and reduce duplication of Medicaid services. The availability of statewide clinical
data will allow healthcare providers to be more efficient in the treatment of patients and to
streamline care coordination efforts amongst multiple providers, improving the quality of care
administered and reducing rising healthcare costs.
X.
Appendices
The following documents are appended to this Onboarding Strategy document to provide
further context for its contents:
A. North Carolina Health Care Cost Reduction and Transparency Act of 2013 (N.C. Session
Law 2013-382, s. 14.1)
B. DHHS-NC HIE Master Services Agreement
C. DHHS-NC HIE Master Services Agreement, Scope of Work #5
D. NC HIE Technical Specifications
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