The South Carolina Health Information Exchange (SCHIEx), pronounced SKY-eks, is South Carolina’s existing statewide health information exchange. SCHIEx provides a state-level nformation 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.

SCHIEx gives providers access to key information such as such as medical histories, medications, allergies, diagnoses, and procedures  that may be used to make more informed clinical decisions at the point of care, and reduce duplication and potential errors by providing information about services previously rendered.  Making this information available to providers when and where it is needed for medical treatment supports care that is more coordinated, timely, and efficient for patients and caregivers and can improve their overall health care experience.  SCHIEx offers participating providers a single solution for both electronic health information exchange and public health reporting, including bi-directional exchange with the DHEC Immunization Registry.

SCHIEx has an annual subscription fee which is currently waived for providers who enroll in the SCHIEx Early Adopter Program.  SCHIEx is governed by an eleven-member Governance Committee comprised of key stakeholders, including five health care provider association groups. The Governance Committee approves all SCHIEx policies including the fee schedule. More information about SCHIEx governance is located at  http://www.schiex.org/governance.php

Providers as well as staff members who perform referral, care coordination and follow up activities benefit from easier access to needed information, reduced paper flow,  and less time spent faxing, mailing, or calling other providers.  It also assists providers participating in the Medicare and Medicaid EHR Incentive Programs with addressing exchange-related requirements for Meaningful Use.  More complete patient data may have value to providers involved in some quality-related initiatives or incentives.

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 and EHN depends entirely upon what information participants make available. SCHIEx and EHN 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.

The end user experience in terms of how the community record information is displayed and integrated into current work flow largely rests with the provider and their specific EHR product functionality. SCHIEx acts more as the highway that allows providers to exchange information about shared patients for permitted purposes. However, SCHIEx does offer a Clinical Viewer for providers who prefer this option to what is available through their native EHR system.

Yes, each SCHIEx Participant organization or practice is responsible for identifying its staff members who need access to information available through SCHIEx in accordance with established policies.  SCHIEx policies require each Participant to have these staff members sign a user agreement as part of the chain-of-trust.

SCHIEx itself has no additional implementation cost and complies with Nationwide Health Information Network (NwHIN) specifications for secure data exchange and nationally recognized interoperability standards.  However, practices will need to discuss costs their EHR vendor and/or technology partner such as Electronic Health Network may impose related to their specific EHR system and SCHIEx connectivity/on-boarding requirements. Providers will share the ongoing costs associated with operating SCHIEx through annual subscription fees.  These fees are currently waived for at least a year to promote widespread adoption, which in turn will support optimal clinical benefit and keep fees as low as possible.

Providers will typically involve their EHR vendor and/or Electronic Health Network in the on-boarding process. SCHIEx has interoperability experts available to work with the provider and these representatives throughout the technical testing components of on-boarding to SCHIEx.

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.

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: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.

The SCHIEx core technology is built on a federated, network-of-networks model for electronic health information exchange.  The SCHIEx federated architecture means each participating provider continues to maintain their clinical data, eliminating the need for a centralized clinical data repository. The SCHIEx core services and policies function such that Participants query and retrieve clinical information directly from other Participants involved in a patient’s care. The network-of-networks model gives providers flexibility in how they participate. A provider or organization may choose to participate independently, as part of an integrated delivery network, or as a member of Electronic Health Network.

The SCHIEx policy framework allows participating health care providers using electronic health record (EHR) systems to exchange clinical information for treatment and public health and quality reporting purposes.

SCHIEx itself does not have access to clinical patient data. SCHIEx maintains a “registry” of document metadata necessary for one Participant to discover other locations where information is available about a given patient and then send a query to that Participant location. Each provider maintains and controls its document repository, and decides what information it will make available in the repository for query by other Participants. SCHIEx functions much like a card catalog in a library, or a pointer to where information is available.

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.

SCHIEx is the designated statewide Exchange in the Office of the National Coordinator (ONC) State Health Information Exchange Cooperative Agreement Program.  As such, SCHIEx is required to implement a sustainable, statewide HIE for South Carolina health care providers that complies with national standards and helps address the HIE related requirements for each phase of Meaningful Use in the Medicare and Medicaid EHR Incentive Programs. For example, providers that participate in SCHIEx can share patient care summaries across unaffiliated organizations and exchange data with the Public Health Immunization Registry.

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.

SCHIEx is a statewide, federated, standards-based health information exchange that became available for on-boarding in 2011. Some of the SCHIEx core technology was developed in 2006 and used in several key production pilots across the state and the SC DHHS Medicaid physician portal. In 2009, following a series of state HIT Summits SCHIEx became the designated Exchange in the Office of the National Coordinator (ONC) State Health Information Exchange Cooperative Agreement Program.  Funding from this Program was used to address emerging national interoperability standards and expand the core technology platform statewide.

The Center for Information Technology Implementation Assistance (CITIA) is South Carolina’s regional extension center for health information technology (HIT). It can provide basic information and direct assistance for some provider groups.  https://www.citiasc.org    Providers should communicate expectations related to SCHIEx connectivity requirements and on-boarding technical assistance with EHR vendors in conjunction with the contract discussions and implementation process.

SCHIEx provides the core network services that enable providers with systems that comply with SCHIEx national interoperability standards to electronically share key clinical information such as medical histories, medications, allergies, diagnoses, and procedures once on-boarded to SCHIEx.  Information is shared “EHR to EHR,” such that the user interface itself is specific to the Participant EHR system.