South Carolina
Health Information Exchange

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Provider FAQs

The SCHIEx Interim Governance Committee has developed a list of provider-level FAQs. This list is also available as a PDF.

Contents

1. What is the South Carolina Health Information Exchange?
2. What is a health information exchange?
3. What is an electronic medical record?
4. What is an electronic health record?
5. What is the difference between a EMR and EHR?
6. How does SCHIEx work?
7. Who can participate in SCHIEx?
8. What information is available via SCHIEx?
9. What services are offered by SCHIEx?
10. What data would a health care provider make available via SCHIEx?
11. Does SCHIEx store the data of participating physicians?
12. Can SCHIEx access the patient information exchanged via SCHIEx?
13. What are the permissible uses of patient information exchanged via SCHIEx?
14. How does SCHIEx keep patient information safe and secure?
15. Why would a health care provider want to connect to SCHIEx?
16. How does a health care provider become a Participant in SCHIEx?
17. What does a health care provider need to start the on-boarding process?
18. What is the cost to health care providers to participate in SCHIEx?
19. When will SCHIEx become operational?
20. Who is responsible for hardware and software necessary to connect to SCHIEx?
21. Who administers SCHIEx?
22. Can a patient "opt out" of having his or her health information exchanged via SCHIEx? If so, how does a patient opt out?
23. Can a patient who opted out of having information exchanged via SCHIEx cancel the opt out? If so, how does a patient cancel the opt out?
24. Will SCHIEx connect to providers outside South Carolina?
25. Can patients access SCHIEx?
26. Is there training available for SCHIEx?
27. Who should I contact for additional information?

Provider FAQs

The South Carolina Health Information Exchange (SCHIEx), pronounced SKY-eks, is South Carolina's existing statewide health information exchange. SCHIEx provides a state-level information infrastructure that enables participating health care providers to exchange a patient's medical information, including medications, diagnoses, and procedures, with other participating providers in an encrypted format.

In 2007, the South Carolina Budget and Control Board, in connection with the South Carolina Department of Health and Human Services (SCDHHS), launched SCHIEx as an electronic health network for the state's 700,000 Medicaid beneficiaries. In 2009, South Carolina applied for a grant from the State Health Information Exchange Cooperative Grant Program for funding to develop SCHIEx into South Carolina's first statewide electronic information system enabling the confidential and secure exchange of patient information among participants. South Carolina received its grant in March 2010, and South Carolina will begin exchanging clinical data via SCHIEx in January 2011.

Health information exchange (HIE) means the electronic movement of health-related information according to nationally recognized standards. HIE may also refer to the electronic infrastructure that enables health care providers to access and share a patient's medical information electronically to enhance coordination of patient care among providers, improve the quality and efficacy of care that a patient receives, improve patient safety, reduce medical errors and duplicative services, and enhance public health and disease detection and monitoring.

An electronic medical record (EMR) is a computerized record of a patient's clinical, demographic, and administrative data. An EMR is an electronic version of a patient's medical record that allows for easy access to patient data and information within a health care organization.

An electronic health record (EHR) means an electronic record of health-related information on an individual that is created, gathered, managed, and consulted by authorized health care clinicians and staff. See Section 13400(5) of the HITECH Act.

While EMR and EHR are evolving concepts, SCHIEx refers to EMRs as a computerized legal medical record created in an organization that delivers care, such as a hospital and doctor's office. A patient's EHR, on the other hand, is a systematic collection of electronic health information about individual patients in an electronic format that can be shared across more than one health care organization. SCHIEx will enable participating providers to share and exchange patient information with other participating providers treating a patient no matter where the provider is located within the state and even when the providers are unaware of the other provider's existence.

SCHIEx integrates multiple programs, including a master patient index (MPI) and a Record Locator Service (RLS), which enable users to locate patient health information from participating providers across South Carolina quickly and securely. SCHIEx provides the mechanism for finding a patient's data from various providers who may maintain patient information in different electronic formats. SCHIEx provides both the means of locating and retrieving the patient information and coordinates the application of standard information formats that can be accessed by a participating provider's EMR.

The individuals and entities eligible to participate in SCHIEx are those who provide health care treatment to individuals and who provide certain public health information to federal and State agencies. Eligible individuals are health care providers licensed in the State of South Carolina and providing health care services within their statutory scope of practice, including medical doctors, dentists, chiropractors, optometrists, podiatrists, pharmacists, physician assistants, and nurse practitioners. Eligible entities are health information exchanges and entities within which eligible individuals practice, including hospitals, ambulatory surgical facilities, home health agencies, case management providers, telemonitoring providers, and pharmacies. Eligible governmental agencies are the South Carolina Department of Health and Environmental Control, the South Carolina Department of Mental Health, the South Carolina Department of Social Services, the South Carolina Department of Disabilities and Special Needs, and the South Carolina Department of Alcohol and Other Drug Abuse Services.

The clinical information available via SCHIEx depends entirely upon what information participants make available. When SCHIEx goes online in January 2011, SCHIEx will be to exchange a broad range of health care information among participants, including lab results, immunization information, discharge summaries, medication lists, and operative and clinical notes that participating providers and agencies choose to make available via the health information exchange.

SCHIEx offers both the Core Network services required to engage in health information exchange and Optional Services that enable enhanced functionality. Core Services include the following: Record Locator Service (RLS), Master Patient Index (MPI), Terminology Services and Standards, Trusted Uniform Transport: Public Key Infrastructure (PKI) Certificate-based Encryption Scheme and Authentication of Exchange Participants, Audit Log of Document Transport between Exchange Participants, Public Health Reporting/ Immunization Registry, RX (Prescription) HUB, and the NHIN Connect Gateway. For more information on Core Services, please refer to the descriptions located at http://www.schiex.org/provider_services.php.

Optional Services include the following services that SCHIEx may provide participants who choose to contract and pay for such services in addition to the Core Services covered under the terms of the Participation Agreement: Clinical Viewer, EMR-Lite, E-prescribe, and Care Coordination Tools. Both Core Services and Optional Services are subject to modification in order to meet ONC and Centers for Medicare and Medicaid Services ("CMS") "meaningful use" requirements for health information exchange.

Each SCHIEx participant must determine what data or documents it will make available in its document repository and register in the SCHIEx Statewide Document Registry for other SCHIEx Participants to query and retrieve. This is part of the onboarding process as described in the SCHIEx Interoperability Services Guide, which is part of the SCHIEx Policy Manual and is available on the SCHIEx website at http://www.schiex.org.

SCHIEx is not a clinical data warehouse. Instead, SCHIEx is a secure network that participating providers can use to access clinical data from various sources. Each participating provider or agency maintains control over its own data and oversees the principles and protocols for the release of the data. All participants are required to adhere to SCHIEx's policies governing use, security, and privacy of health information.

Because SCHIEx utilizes a federated model architecture, SCHIEx staff will not have access to the PHI contained in documents transported via SCHIEx or any ability to decrypt these documents in transport. Nor will SCHIEx know the identity of the Participant's individual system users who access the PHI.

SCHIEx will audit log information regarding each patient document level (no PHI) query and retrieval performed between SCHIEx participants. For example, SCHIEx will know that a Continuity of Care Document regarding patient A was sent from provider B to provider C, but will not know the contents of the document or the individual system users who accessed PHI.

The permissible uses of patient information exchanged via SCHIEx are as follows:

• treatment of an Individual with whom the Participant User has a treatment relationship;
• HIPAA permitted uses and disclosures under 45 C.F.R. § 164.512(a) - (d), (h), and (j) - (l), related to (i) an Individual with whom a Participant User has an established Treatment Relationship, or (ii) a public health initiative;
• a Participant's submission of information required by law, including but not limited to immunization data, quality reporting data, and communicable disease data to a State or federal agency; and
• uses and disclosures premised on an Authorization provided by the Individual who is the subject of the message.

SCHIEx participants must follow all applicable federal and State laws and regulations that protect the privacy of an individual's health information. Only authorized users may access and view an individual's clinical data via SCHIEx.

Each participating provider must sign a Participation Agreement and Business Associate Agreement and agree to abide by SCHIEx's conditions for participation and polices governing use. The Participation Agreement allocates responsibilities and states the terms of use that will enable all participants to access and send confidential clinical data securely and safely. The Participation Agreement also incorporates the SCHIEx Policy Manual (available at http://www.schiex.org) which more specifically defines and outlines the rights and responsibilities of participants and SCHIEx and also states the technical requirements and interoperability standards necessary to participate in SCHIEx. Secure sign-on information, including individual specific network IDs and passwords, ensure that only participants and their designated agents can access clinical data via SCHIEx and enable SCHIEx to audit access for proper and legal use.

All data being exchanged is encrypted via x.509 (128 bit encryption and certificate verification). SCHIEx's RLS also protects an individual's privacy and security concerns by using "blindfolded" record linking. Under this blindfolded approach, the likeness or similarity of patient demographics are used to match a patient's medical records from different providers, not the patient's actual demographic information.

Connecting to an electronic health information exchange is a key component to being able to demonstrate that a provider is a "Meaningful EHR User" under the provisions of the Health Information Technology for Economic and Clinical Health Act ("HITECH") of 2009. Being a Meaningful EHR User allows eligible providers to qualify under HITECH for certain incentive payments and to avoid Medicare payment reductions beginning in 2015.

Additionally, but even more importantly, SCHIEx gives providers access to clinical information that may be used to make more informed clinical decisions at the point of care, and reduce duplication and potential errors by providing providers with information on services previously rendered. SCHIEx helps consumers receive more coordinated health care, saving time and expenses associated with duplicate or unnecessary tests and medical visits, paperwork or treatment delays.

Becoming a participant in SCHIEx involves both a technical component and a legal component. An applicant must technically connect to SCHIEx through a multi-step process which is set out in the SCHIEx Interoperability Services Guide, which is a part of the SCHIEx Policy Manual and is available on the SCHIEx website at www.schiex.org. At the appropriate point in the technical process, the provider will be asked to execute the SCHIEx Participation Agreement and Business Associate Agreement which set out the legal obligations of both the provider and SCHIEx. Upon execution of these Agreements, the applicant will be required to pay the applicable SCHIEx subscription fee. A complete overview of the on-boarding process is available at http://www.schiex.org/connecting.php.

Prior to becoming a participant in SCHIEx, an applicant needs to have an operational EMR system capable of sufficient EHR functions to meet the national interoperability standards discussed in the SCHIEx interoperability guide. If an applicant is using a "certified EMR" tested and certified under the Temporary Certification Program maintained by the ONC, the applicant should be able to meet the requirements in the SCHIEx Interoperability Services Guide and begin the on-boarding process. The ONC's list of certified EMRs is available at http://onc-chpl.force.com/ehrcert .

SCHIEx participants will share the ongoing cost of operating SCHIEx core services through annual subscription fees approved by the SCHIEx Governing Authority. Fees are to be set as necessary to ensure the ongoing sustainability of SCHIEx and fair cost allocation among participants. The Interim Governance Committee has adopted a fee schedule for the period of time from January 1, 2011, to December 3, 2012. A special discount is also approved for this same time period. Fees are set by Participant type. For example, under the current fee schedule, the fees for physicians include a $230 base fee per facility ($150 discount rate) and a $230 per physician fee ($150 discount rate). Hospital fees are determined by a base amount and a per bed charge. For example, under the current fee schedule, a hospital with 50 to 99 beds would pay $7,500 plus $137 per bed over 50 beds (discount rate is $4,900 plus $89 per bed over 50). The current SCHIEx Subscription Fee Schedule is available on the SCHIEx website at http://www.schiex.org/fees.php.

SCHIEx will become operational as South Carolina's first statewide health information exchange in January 2011.

Each participant will be responsible for procuring all hardware, software, and equipment necessary for it to access SCHIEx, use its services, and provide information to SCHIEx. The participant's hardware and software must conform to SCHIEx's specifications as set out in the SCHIEx Interoperability Services Guide in the SCHIEx Policy Manual and available on the SCHIEx website at http://www.schiex.org.

SCHIEx is governed by an Interim Governance Committee (the "IGC"). The IGC was established by Governor Mark Sanford in Executive Order 2009-15 on October 16, 2009 to recommend strategies and policies to successfully implement and sustain a statewide HIE in South Carolina.

SCHIEx was developed by the South Carolina Budget and Control Board, Office of Research and Statistics ("ORS") and CareEvolution. While SCHIEx has a proven track record of success in its pilot projects, ORS developed the SCHIEx platform without the separate governance structure necessary to direct SCHIEx as the State's HIE.

The IGC serves as the governance authority for SCHIEx. The IGC is a joint public and private entity made up of eleven members from various stakeholder groups, including executive officers and directors, or designees, from provider organizations, non-profit research institutions, and state agencies as well as a consumer representative. While the Director of ORS is a member of the IGC, the IGC and ORS have separate and distinct roles in the implementation and operation of South Carolina's statewide HIE. Under the terms of the Agreement between ORS and South Carolina's Department of Health and Human Services ("DHHS") which applied for and received the State Cooperative Grant from the ONC, ORS will continue to operate, house and staff SCHIEx. However, ORS staff will perform these tasks under the direction of the SCHIEx Executive Director, who serves at the pleasure of the IGC, and under the governance of the IGC, or SCHIEx's future permanent governing body once enabling legislation is passed by the South Carolina Legislature.

Yes, a patient may "Opt Out" of having his or her individual health information exchanged via SCHIEx. Parents or legal guardians may also make the decision about inclusion in SCHIEx on behalf of their children or the individuals they represent. A SCHIEx participant must implement a process to allow its patients to Opt Out. The form and manner by which the patient notifies the participant of the desire to Opt Out is determined by the participant but must contain the notice and information required in the SCHIEx Policy Manual. A sample Opt Out form, as well as sample language regarding a participating provider's participation in SCHIEx is available on the SCHIEx webpage.

If a patient opts out, the participant must then implement appropriate mechanisms to ensure that the patient's information is not made available through SCHIEx. It is important to note that a patient's Opt Out is global. At this time, if a patient Opts Out with one participating, that patient's information will no longer be exchanged by or available from any SCHIEx participant, except when required by law.

Yes, a patient who initially opted out may decide at a later time to cancel the opt out and have his or her individual health information exchanged via SCHIEx. The individual or individual's personal representative must make that request in writing in a form and manner to be determined by the SCHIEx Participant. The Participant must document and maintain documentation of all patients' decisions to opt out or cancel the opt out to have information exchanged via SCHIEx.

There are plans underway for SCHIEx to join the National Health Information Network ("NHIN") in January 2011. Once SCHIEx becomes an NHIN Participant, it will be able to serve as an NHIN Gateway exchanging health information with other NHIN Participants who have executed the NHIN Data Use and Reciprocal Support Agreement ("DURSA"), including federal agencies and large nationwide entities using NHIN standards, services and policies.

At this time, there are no plans for patients to be able to access their own health information via SCHIEx.

Yes, SCHIEx staff will offer training for applicants and participants. Initially, this training will primarily consist of "Train the Trainer" seminars designed to assist applicants who have begun the application process to become SCHIEx participants. Training will cover the rights and responsibilities of participants, services provided by SCHIEx, and obligations of individual users accessing SCHIEx. Training will also address patient concerns regarding access and privacy and security. While SCHIEx imposes some new obligations on providers, including limiting the purposes for which patient information may be exchanged, most of SCHIEx's privacy requirements mirror those already required by the HIPAA privacy rules as modified by the HITECH Act.

Training dates will be posted on the SCHIEx website: http://www.schiex.org.

• General Information
  
  • SCHIEx
  • SC Office of Research and Statistics
  • Email: schiexinfo@ors.sc.gov
  • Phone: 803.898.9962
  •  
• If you are a prospective Participant, or a Participant in the process of connecting to SCHIEx, and have questions, please contact:
  
  • SCHIEx
  • SC Office of Research and Statistics
  • Email: support@ors.sc.gov
  •  
• If you are a SCHIEx Participant, in production, and need Technical Support, please contact:
  
  • SCHIEx
  • Department of State Information Technology (DSIT) Help Desk
  • Email: ciohelpdesk@cio.sc.gov
  • Phone: 803-896-0001
  • Toll-free: 800-922-1367
  •