NC HIE Integration Workflow

North Carolina HIE Integration

Contents

Introduction/Important Considerations
Initial Setup/Staff Direct Addresses
Task: New Patient Setup
Task: Create an Inpatient Episode of Care
Task: Change inpatient to outpatient / create outpatient Episode of Care
Data Capture Requirements
Task: Capture Active Allergies
Task: Enter Active Medications / New Prescriptions
Task: Record Patient Vitals
Task: Enter Patient Diagnoses
Task: Enter Treatments / Procedures Performed
Task: Enter Immunizations
Task: Generate Discharge Orders / Instructions / Destination

INTRODUCTION / IMPORTANT CONSIDERATIONS

This guide is intended to serve as a reference and training manual for the North Carolina HIE Integration, detailing the workflows that must be used in order to generate messages for transmission for the HIE. Please be sure to share this document with your clinical staff so that they are following proper workflow.

As a general note, it is important to know that merely creating a patient’s chart will not send information to the HIE-- an episode of care will need to be created. This prevents test charts from erroneously sending data, for example.

Once the Episode of care is created as per the workflows below (page 10 for Inpatient, Page 12 for outpatient), then the HIE will receive messages.

Please be advised that if your practice provides alcohol or substance use disorder treatment, 42 C.F.R. Part 2 prohibits providers from transmitting data to NC HealthConnex that would identify a patient as a substance abuser (such as in the note contents, remarks in Discharge summaries, diagnosis data, etc.)

For more information, please see this FAQ from NC Health Connex:

(taken from https://hiea.nc.gov/frequently-asked-questions#are-there-restrictions-on- submitting-substance-abuse-data-to-nc-healthconnex )

Are there restrictions on submitting substance abuse data to NC HealthConnex?

Alcohol or substance use disorder programs that hold themselves out as or advertise as providers of substance use disorder treatment and who receive any type of federal assistance as outlined in 42 C.F.R. Part 2 cannot generally disclose data through to NC HealthConnex in the following conditions:

1. If the data would identify a patient as an alcohol or substance abuser, and
2. If that data was obtained by an alcohol or substance abuse program for treating,
diagnosing or making a referral for the patient’s alcohol or substance abuse problem.

Units within a larger health care organization that are covered by 42 C.F.R. Part 2 should also withhold patient data pertaining to substance use disorder patients. However, the remaining clinical data (i.e., general medical information, mental health data, procedures, laboratory tests, etc.) can be submitted to NC HealthConnex.

Part 2 providers may disclose part 2 information in the event of an emergency directly to a requesting physician if he or she needs the information to treat the emergency condition pursuant to 42 C.F.R. §2.51, or if the patient has authorized the specific disclosure in writing in compliance with 42 C.F.R. § 2.31. This can be done using NC HealthConnex Direct Secure Messaging. Please review 42 C.F.R. Part 2 before disclosing any alcohol or substance abuse information through NC HealthConnex.

For further information, please contact kenya.servia@nc.gov

INITIAL SETUP / STAFF DIRECT ADDRESSES

As ICANotes relies upon Kno2’s Direct Messaging System to send patient data over to the HIE, it is important that all providers who will be generating notes / charts for patients have a direct address associated with their ICANotes account, as that will be the “from” address the documentation is sent with. Without a direct message address set up, any work done for a patient’s chart by the provider without an address will not be sent over.

First, the Kno2 direct addresses for the providers must be set up for all your providers within Kno2. This can be done by logging into the Kno2 dashboard and:

1. Log into your Kno2 account.

2. Click the settings gear in the upper right-hand corner.

3. Under Document Sources, select Kno2 Addresses from the list displayed.

4. Select the “+” sign located in the upper right-hand corner.

5. The setup window will appear.

Fill out the window as follows:
1. Address Type - Choose Provider.
2. NPI – Enter the Provider’s NPI.
3. Enter the provider’s first and last names.
4. Kno2 Address - Enter the desired prefix for the Direct address. The remaining part of the address (after the @ symbol) is preconfigured in the Domain field. For example, Provider John Doe would be johndoe. Note that if you see records@organization.direct.kno2fy.com, this address is a default one set up for your organization by Kno2.
5. Send Permission - Add one or many users who have the privilege to send on behalf of this address. For the purposes of this integration it is best to leave this set uniquely per provider.
6. Select Save Changes and the Kno2 address will appear in the list below in alphabetical order.

7. Complete Steps 1-5 for all Kno2 addresses needed.

Once you have finished creating Kno2 addresses, these must be entered into ICANotes and associated with providers by following these steps:

1. As a security Administrator, from the Chart Room, click the drawer,

2. Click and enter your password.

3. Find the provider for whom you need to enter a direct address and click the button on their row.

4. Enter the user's Direct Address email up top:

5. Click the button to save the Direct Address.

TASK: NEW PATIENT SETUP

Create a new chart. In addition to the normal patient data be sure to populate the tabs of the chart with mandatory data as below:

In the demographics tab, Physicians must all make sure to fill in:

1. First Name, Last Name
2. Date of Birth
3. Press Continue
4. Gender
5. Address
6. Phone number (one must be present, even a cell phone)
7. Social Security Number
8. Marital Status
9. Ethnicity
10. Religion
11. Race
12. HIE Opt-In Status
13. Opt-in Start Date
14. Assign Clinician to chart
15. Assign location where patient is seen

In the insurance tab:

1. Click “New” to add a new insurance- Enter Member Policy #
2. Enter Policy #
3. Enter Group #
4. Enter relationship of patient to insured
5. Enter Insurance Type
6. Save and go to chart face

This initializes the chart and transmits an A08 message. Next an Episode of Care must now be added to generate the A01, A04, message. (See next section)

TASK: CREATE AN INPATIENT EPISODE OF CARE

Load patient demographics and click on the “Date of Current Admission From" box.

1. Click Add to create a new episode of care.
2. Enter the From date of the episode.
3. Enter the Time the episode began.
4. Select “Inpatient”.
5. Click “Save”.

6. Click "Back" and then "Continue" on the main Demographics page.

TASK: CHANGE INPATIENT TO OUTPATIENT / CREATE OUTPATIENT EPISODE OF CARE

Load patient demographics and click on the “Date of Current Admission” From box.

1. Click Add to create a new episode of care.
2. Enter the From date of the episode.
3. Enter the Time the episode began.
4. Select “outpatient”.
5. Click “Save”.

6. Click "Back" and then "Continue" on the main Demographics page.

DATA CAPTURE REQUIREMENTS

In order to comply with data-sharing requirements for patient services, providers must capture several pieces of key information, namely:

• Active Allergies,
• Active Medications / New Prescriptions;
• Patient Vitals;
• Diagnoses;
• Treatments / Procedures Performed;
• Immunizations, and
• Discharge Orders / Instructions / Destination

This guide will show you what areas in ICANotes must be populated in order to fill out all of these sections so that the CCD data file sent to North Carolina contains all the information needed.

Sections will be presented in order to simulate how a provider may work through the workflow.

Please note this is not an in-depth guide in how to use all these sections – for more detailed assistance please call our support line at 443-569-8778.

TASK: CAPTURE ACTIVE ALLERGIES

Location:

Note > PN, Part 1 Tab > Drug Reactions button

Click the button and the Adverse Drug Reaction (ADR) List window will populate. The directions to input are numbered. The first step is to click the button.

The window will open up for actions. Under step 2, use the dropdown menu to choose an allergy. For Step 3, select the date of the first reaction or 'Unknown Date'. Indicate the reactions associated with the allergy and their severity.

Click the Save button and repeat as needed for any other allergies.

TASK: ENTER ACTIVE MEDICATIONS / NEW PRESCRIPTIONS

Location:

STANDARD PRESCRIBING: Prescriber Note > PN, Part 2 Tab > Medications Button

E-PRESCRIBING: Prescriber Note > PN, Part 2 Tab > “Go to E-Prescribe” Button

If you are prescribing medications electronically (for example, with DrFirst), then please follow the workflow set forth in our knowledge base article 1247, “Using DrFirst e-Prescribing.”(https://icanotes-ehr.na1.teamsupport.com/knowledgeBase/2600693)

Follow the directions there and disregard the rest of this section. (If you are using Rcopia4 with DrFirst, you may also find the reference material at https://icanotes-ehr.na1.teamsupport.com/knowledgeBase/22454728 helpful as well.)

Please note it is important you do not free-text medications in DrFirst- only use the medications in the formulary entered into DrFirst otherwise the correct coding will not be sent to the HIE.

If you are prescribing manually, please continue with the rest of the steps in this section.

Step one: Click the “Enter” button next to medications.

You will then proceed to enter medication information as per the workflow on adding medications in our knowledge base, which can be found at: https://icanotes-ehr.na1.teamsupport.com/knowledgeBase/3554083

If you cannot find the medications you need in the dropdown list in our medication entry area, PLEASE DO NOT “free-text” medications as they will not be captured properly by the HIE. Perform the following steps to add new medications to our list (again, only if our dropdowns do not contain the information:

Step one: From the medication entry area, select the standard medication list tab.

Step two: Click the "edit drug list" button. You will be presented with a screen:

From here you can either add a new medication by clicking add medication and then adding the details of the new medication including the Rx norm code that goes with it, or you can click on the box in the “Rx Norm column” for the line item corresponding to the medication you are prescribing, and input the Rx norm code there.

Then hit “Back” and add the medication to the note.

TASK: RECORD PATIENT VITALS

Locations:

Note > PN, Part 1 Tab > Mental Status Exam Button (for the Mental Status Exam portion of the Discharge Summary)

When in the MSE section vital signs can be captured by clicking the “Constitutional / Vital Signs”
button at the bottom of the screen as seen in the screenshots above.

Enter the height and weight and then press done at the upper right of the screen.

TASK: ENTER PATIENT DIAGNOSES

Location:

Note > PN, Part 2 Tab > Box 3 – Diagnosis (for inputting ICD-10 Diagnoses)

TASK: ENTER TREATMENTS / PROCEDURES PERFORMED

Location:

Chart Face > Treatment Plan Button > Interventions Section

You will need to create a treatment plan for the patient – be aware that the interventions specified in the plan are what will populate the CCD file that goes to the Health Information exchange. A detailed guide on filling out treatment plans is here: https://icanotes-ehr.na1.teamsupport.com/knowledgeBase/9937732

When you are making the final note that will become your discharge summary, you will also want to link the treatment plan to the note before saving it. A guide to linking can be found here: https://icanotes-ehr.na1.teamsupport.com/knowledgeBase/12232393

TASK: ENTER IMMUNIZATIONS

Location:

Progress Note, Part 1 – Immunizations & Screening button