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NCHEX Pilot

Pilot Goal

The NCHEX pilot is designed to demonstrate the feasibility of quickly creating a low-cost statewide healthcare information exchange in North Carolina by leveraging the existing NCHESS technology in many hospitals. The pilot consists of the following two health systems and all their constituent facilities:

  • Moses Cone Health System
  • WakeMed Health and Hospitals

The two pilot health systems contain a representative cross-section of the healthcare delivery system in North Carolina and include:

Hospitals:

  • The Moses H. Cone Memorial Hospital
  • Annie Penn Hospital
  • Moses Cone Behavioral Health Center
  • Wesley Long Community Hospital
  • The Womens Hospital of Greensboro
  • WakeMed
  • WakeMed Cary Hospital

Freestanding Emergency Departments:

  • MedCenter High Point
  • WakeMed Apex Healthplex
  • WakeMed North Healthplex

57 physician practices or specialty clinics

Both Moses Cone and WakeMed have the interface engine installed as part of NCHESS-IMC, as do about 46 other hospitals in North Carolina, plus a few more hospitals that have similar technology installed by Truven Health Analytics. Together, these hospitals provide about 63% of the total hospital volume in the state. The pilot hospital comprise appoximately 9% of all statewide inpatient and ED utilization volume.

Pilot Work Streams & Deliverables

1. HIE Interoperability Between Hospitals

The first deliverable of the HIE will be interoperability between the pilot hospitals. Approximately 60 days from contract execution by all parties, we will bring up a basic HIE and demonstrate interoperability between the pilot hospitals in relation to inpatient data. The exchange of information between the pilot hospitals will "piggy-back" on top of the NCHESS installations and infrastructure; no additional hardware or software is required, and very little technical involvement will be required on the part of the hospital IT staff. The exchange will be initially populated with about a year of history (based on HL7 journal logs collected on the NCHESS servers) and will update data at least once a day. In the future, it is anticipated that updates from providers to the NCHEX system will be in near-real-time. The inpatient/hospital data will be mapped to the following hospital information systems (HIS):

  • ADT/Registration
  • Lab
  • Dictation
  • Pharmacy (if available)

The deliverables for this work stream include:

  • creation of a community Master Patient Index of all patients across the pilot hospitals
  • a record locator service for the participating entities
  • embedded terminology management to deliver data consistency across diverse data contributors
  • implementation of methods for medical episode grouping to create longitudinal linking of episodes of care
  • creation of a Virtual Single Patient Record (vSPR) that can be viewed on a web-based Continuity of Care Viewer (CCV)

2. HIE Interoperability Between Hospitals and Ambulatory Practices

The second deliverable will be to include physician practices in the NCHEX pilot. In around 120 days from contract execution by all parties, we will bring up HIE functionality between the pilot hospitals and their ambulatory care practices, with the following conditions:

  • Only hospital-owned practices running GE Centricity Logician and AllScripts Enterprise will be eligible for consideration in the pilot
  • Pilot hospitals will have to provide direct database access to their ambulatory EMR systems to support their inclusion in this work stream
  • Independent physician practices in the Wake and Guilford county medical trading areas will be recruited to join the pilot

Deliverables for this work stream include:

  • implementation of our existing direct connect drivers to GE Centricity EMR andAllscripts Enterprise
  • expansion of the unified Master Patient Index to include the ambulatory practice patient records
  • creation of a Virtual Single Patient Record (vSPR) that can be viewed on a web-based Continuity of Care Viewer (CCV)

The CCV will not only be able to show one patient/one record across a pilot hospitals' ambulatory and inpatient settings, but also data shared for that same patient across hospital-clinical system settings.

3. Production Activation

The pilot participants will work together to move the pilot into production within 60 days of work stream #2 going live, and two sub work-streams are required to accomplish this.

  • HIE Data and System Validation: The pilot hospitals will work with NCHA and Truven Health Analytics to validate the data in the HIE pilot and provide feedback on the system usability. NCHA and Truven Health Analytics will diligently work to validate the quality of the data before asking pilot hospitals to participate in the validation process.
  • HIE Legal and Management Structure Development: The pilot participants will work to create a NCHEX Production Activation working team to develop, execute and implement the legal and business structure necessary to move the pilot into production. We also anticipate working with the state HIE and other groups to harmonize our legal efforts allow for broad input and ease of connectivity to the state HIE and the Nationwide Health Information Network (NHIN).

4. Pilot Operation

NCHA and Truven Health Analytics will operate the pilot exchange through the end of 2010 at no cost to the pilot hospitals. We will explore opportunities to load historical data beyond the initial year, and we anticipate that future contracts will extend the duration of the pilot once it enters production mode.

Pilot Functionality and Applicability to Meaningful Use

The core function of NCHEX will be to provide exchange of core clinical data among participating hospitals and physician practices to enable providers to deliver the right care, to the right patient, at the right time. Based on the feedback from the pilot providers and the available data sets, there are additional features that will add value to the exchange regardless of any relationship to meaningful use provisions of ARRA HITECH. In this context, we recommend positioning the functions listed below for both their value in daily operations as well as the potential to assist with meaningful use.

  • Public health reporting
  • Immunization registry reporting
  • CCD generation for use by external providers
  • NHIN connectivity capability
  • Patient inquiry through the Continuity of Care Viewer
  • Medication reconciliation
  • Clinical alerts (surveillance)
  • Never Event management

Scope and Length of Pilot

The NCHEX pilot will be available until the end of 2010, and we anticipate the exchange could be operationalized before that time, or could be extended using contract addendums. All the functionality above will be available to a limited number of clinical staff of the participating providers while in the pilot phase.

Cost of Pilot

All costs of the NCHEX pilot implementation are covered by Truven Health Analytics. Hospitals requesting functionality beyond the features listed above will be considered on a paid basis.

Pilot Hospital Accountabilities

In order to bring the pilot online, we anticipate needing access to IT staff at each location for up to 20 hours of work.