In July of 2020, both the Department of Health of New Jersey and the Centers for Medicare and Medicaid Services (CMS) made updates to legislation and regulation that impact connectivity, Admission, Discharge, and Transfer Notifications (ADT), and information blocking requirements for Long-Term Care Organizations. In order to comply, long-term care organizations are being required to share ADTs and CCDA (or XDM) with the NJHIN before the deadline. This document describes the processes by which long-term care organizations and EHRs can become compliant.

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The NJHIN is owned by the New Jersey Department of Health and is operated by the New Jersey Innovation Institute (NJII), an institute of the New Jersey Institute of Technology that has been designated by the state as responsible for developing and managing the health information network. This group is responsible for providing the infrastructure for the electronic exchange of patient health information among Health Information Organizations and State health data sources. (New Jersey Health Information Network (NJHIN) | NJII); is owned by the New Jersey Department of Health (NJDOH).

In short, the NJHIN 2021 Requirement, also referred to as New Jersey Assembly Bill 4476, states that long-term care providers must:

1. Use an EHR that is certified by the Office of the National Coordinator for Healthcare IT (a department of the US Department of Health and Human Services)
2. Connect to the New Jersey Health Information Network (aka NJHIN)

What Kinds of Facilities Are Impacted By This Legislation?

This law sets a deadline for compliance of June 16, 2021, as it applies to the following facilities licensed in New Jersey:

• Skilled nursing facilities (nursing homes)
• Assisted living residences
• Comprehensive personal care homes
• Residential health care facilities
• Dementia care homes (memory care)

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If you are an Experience Care customer, to comply with the law, a long-term care facility will need to:

1. Select an HIE vendor:
   • NJII – preferred; Experience Care will work with clients to fully select and configure this option. NJII contacts listed below.
   • Other – If other, Experience Care may not be able to fully support by June 16, 2021, as it may require customer interface build-out, connectivity considerations, or other impacts to implementing.
2. Sign a DURSA with NJHIN/NJII.
3. Acquire OID number from NJHIN for document identification. (One per facility – this will be delivered after you sign the DURSA with the HIE)
4. Acquire an interface from Experience Care to specified HIE. If “Other” is selected, consult with Experience Care for schedule and pricing. Call Support or your Account Manager for assistance.
5. Upgrade to NetSolutions 7.4.0 (Patch number with New Jersey updates TBD) Add new required communication information including provider NPI, practice unit name, and facility information.

NJII Contacts:

• Jennifer D’Angelo, Senior VP and General Manager – Healthcare Division, NJII – Jennifer.Dangelo@njii.com
• Melissa Denino, Manager – Recruitment and Technical Onboarding, NJHIN – melissa.denino@njii.com (201) 450-8103

Important notes:

• NJHIN states no penalties to be incurred at this time.
• NJHIN is working aggressively towards the goal deadline.

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As a Long-Term Care Facility Not Using Experience Care to Comply With The NJHIN 2021 Requirement You Will Need To:

1. Implement a NJHIN 2021 Requirement compliant NJHIN-connected EHR
2. Select an HIE/ HISP vendor. NJII or other HIE.
3. Enter into a data-sharing agreement with the NJHIN (also known as a DURSA or Data Use and Reciprocal Support Agreement)
4. Acquire OID number from NJHIN for document identification. (One per facility.)
5. Acquire interface from EHR Vendor to specified HIE

If your EHR is not able to assist you in complying with the NJHIN 2021 Requirement, please reach out to Experience Care for help.

NJII Contacts:

• Jennifer D’Angelo, Senior VP and General Manager – Healthcare Division, NJII – Jennifer.Dangelo@njii.com
• Melissa Denino, Manager – Recruitment and Technical Onboarding, NJHIN – melissa.denino@njii.com (201) 450-8103

Important notes:

• NJHIN states no penalties to be incurred. This is not explicitly documented, but well understood.
• NJHIN is working aggressively towards the goal deadline, though is putting this together “as they go” much like many EHR vendors.

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As an EHR, To Comply With The NJHIN 2021 Requirement You Will Need To:

At the time of writing, many long-term care EHR software companies are NOT compliant with the NJHIN 2021 requirements. This includes some of the larger providers in the industry and we recommend that all long-term care facilities ensure your providers are compliant. To assist in industry-wide compliance, Experience Care has provided a breakdown of the data flow for other EHR providers. Below is the methodology for ensuring compliance:

Data Flow

Inbound/ Receive

1. CCDA or XDM Send: Referring Facility needs to send CCDA or XDM using DSM email address automatically upon discharge or manual send.
2. Secure Transfer to HISP: Message is transferred using industry-standard encryption methods.
3. EHR Receive: Query the HISP regularly for available messages from referring facility.
4. Readable Document Availability: Validation to be based upon first and last name, date of birth, and social security number.
   1. If resident information is currently stored within the long-term care EHR

CCDA/XDM Automated Outbound (Send)

1. Transferring Facility: Patient transfers to a facility. EHR to send CCDA or XDM to NJHIN
2. Patient is admitted: EHR to send ADT for patient to NJHIN
3. NJHIN to processes data: Discharge/Transfer is matched with Admin ADT
4. NJHIN sends patient record to admitting facility EHR: via CCDA or XDM
5. Admitting facility EHR receives patient record: via CCDA or XDM in human readable format.

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Terminology

Technology Terms

• ACRS – Active Care Relationship Service; A file format that defines an active patient roster at a facility. Users of NJII (the Experience Care preferred solution) will have this automatically managed for them by NJII. The ACRS will be used to match patients to providers will be provided by the facility. This is managed by the HIN and requires no action from Experience Care or a facility.
• ADT – Admit/Discharge/Transfer HL7 Message;
• CCDA – Consolidated Clinical Document Architecture; This set of rules for the Consolidated CDA was implemented to ease sharing of patient documentation. It became most prominent during the Meaningful Use Stages 1, 2, and 3 where C-CDA v1.1 was required for use. The CDA is basically an electronic machine-readable version of the Clinical Care Document (CCD) traditionally used as a paper document within facilities. FHIR is the assumed future format C-CDA will transition into, but this has not yet become reality as of 2021.
• DSM – Direct Secure Message;
• HL7 – Health Level 7; Is a set of clinical standards and messaging formats that create a framework for the integration, exchange, management, and retrieval of electronic information across different healthcare systems.
• OID – Object IDentifier; A dot-separated series of numbers. Each dot-separated number has a specific meaning. For the purposes of this project, OIDs can be issued by NJII at no cost per facility for use with NJHIN. (For detailed background on OID used in a larger context, refer to Introduction to OIDs .)
• XDM – Cross-Enterprise Document Media Interchange; This permits the patient to use physical media to carry medical documents. This is essentially an XML file that passes healthcare information.
• XDR – Cross-Enterprise Document Reliable Interchange; This enables document interchange between EHRs and other healthcare IT systems in the absence of a document sharing infrastructure.
• VPN – Virtual Private Network;

Entities:

• NJDOH – New Jersey Department of Health
• NJII – New Jersey Innovation Institute (New Jersey Innovation Insitute (NJII) | An NJIT Corporation); combines the vast resources of NJIT, strong industry and government relationships, and proven methods to drive innovation and deliver transformative products and services. Of the many divisions of NJII, we work with their Healthcare Delivery division. NJII is a corporate of NJIT.
• NJIT – New Jersey Institute of Technology (New Jersey Institute of Technology |); the state’s public polytechnic university.
• NJHIN – New Jersey Health Information Network; provides the infrastructure for electronic exchange of patient health information among Health Information Organizations and State health data sources. (New Jersey Health Information Network (NJHIN) | NJII); is owned by the New Jersey Department of Health (NJDOH).