Kristin A. Hellquist, M.S.

Licensure Portability for Health Information Technology (HIT)

Kristin Hellquist, National Council of State Boards of Nursing (NCSBN), November 2007

Barriers/Challenges to Interstate Nurse Licensure

• Nurse licensure is required for practice both physically and electronically in the state or territory where the patient is located (with few exceptions)

• Nurse licensure is more alike than different, but differences in uniform core licensure requirements perpetuate barriers to interstate licensing {notably CBCs}

• Challenges to Nurse Licensure Compact (NLC) from

stakeholders

Nurse Licensure Compact (NLC)

• Modeled after the Drivers License Compact• 22 states currently participating (see list of states)• 1 state awaiting implementation (RI)• NLC administered by the Nurse Licensure Compact

Administrators (NLCA)—NCSBN is secretariat for the NLCA

• New terminology/mindset: “multi and single state licensing” {All states still have ‘single’ state licensing operations}

Outlook for NLC in 2008

• Legislation pending in ??? • Legislation died in 2007 sessions in PA, MA, NV,

IN, WY & MT• 2 Attorney Generals Opinions do not allow NLC

in LA & KS (issue is delegation of authority, which can be very particular to state laws, although both states fully participate in many other compacts)

Supporters for NLC

• Emergency Nurses Association• American Organization of Nurse Executives• American Association of Occupational Health Nurses• Citizen’s Advocacy Center• Several state nurse and hospital associations• American Nephrology Nurses Association• NLC Supporters• American Telemedicine Association• Case Management Leadership Coalition• Case Management Society of America• Center for Telemedicine• Telehealth Leadership Coalition• U.S. Department of Commerce [1]

[1] The U.S. Department of Commerce supported the NLC in speech to the American Telemedicine Association in 2003 and formally recognized NLC

2006 Gallup Research on NLC

Key positive findings• NLCA found tremendous value in belonging to the

NLC, citing increased collaboration among regulators, and as a benefit to their publics.

• Nurses overwhelmingly supported the idea of all states belonging to the NLC.

• Increasing mobility by nurses, which gives better access to nurses in times of disaster or other need.

• Many BoNs believed that the NLC sped up hiring processes and allowed for rapid licensure verification.

2006 Gallup Research on NLC

Opportunities for improvement• Improve communication regarding operations, administration and

the costs associated with joining and maintaining the NLC. • More information regarding discipline, investigations and data

sharing in the NLC. • Increase education to Board of Nursing staff, licensed nurses and

other stakeholders regarding. (A survey finding correlated to this request was that 50% of surveyed nurses erroneously thought they were part of the NLC, even though they did not reside in a NLC state).

• Information regarding Nursys (NLC coordinated nurse licensure database). Specific to duplicative records, frequency of data submissions and the number of boards participating.

Criminal Background Checks (CBCs) for Nurses

• States that conduct FBI-fingerprint based CBCs: AK, AR, AZ, CA, FL, ID, IL , LA, MO, MD, NV, NH, NJ, NM, NC, OH, SD, UT & WY (19)

• State in process of implementing: ND, DE, DC• States pursuing the statutory authority: Guam,

KS• States that do other types of CBCs: IA, KY, MA,

MI, MS, WA

Licensure Portability Grant (LPG)Received by NCSBN

• OAT established this grant to provide support for nurse licensing boards to carry out programs for boards of nursing to cooperate, develop and implement state policies that will reduce statutory and regulatory barriers to telemedicine.

• Currently funded through Year II of grant

Specifics to NCSBN’s LPG

• Adopt Nurse Licensure Compact (NLC)• Promote Adoption of Criminal Background

Checks (CBCs) especially FBI fingerprint checks

• Increase knowledge of NLC & CBCs for boards of nursing

• Address barriers to nurse licensure portability (In Year 1 we explored feasibility of sharing FBI-CBCs by boards of nursing & meeting with nurse unions to educate on the NLC)

Specifics to NCSBN’s LPG

• Develop standardized tool to evaluate the costs of implementing NLC

• Award contract funds to eligible state boards of nursing to defray implementation costs of NLC and CBCs and to educate and convene ‘umbrella boards’ interested in pursuing CBCs

KY BON Implementation of the NLC

Communication • Mailing to Kentucky RN/LPN licensees to declare a primary state of

residence• Mailing to 1,200 Kentucky Health Care Providers information on NLC

implementation• Mailing to 1,969 Kentucky licensees claiming another compact state as

primary residence to endorse into their home compact state. This notice included a paper certificate acknowledging the dates they were licensed in Kentucky

• Mailing to 6,948 Kentucky licensees that claimed non-compact states as their primary residence that they would have a license “valid only in Kentucky”

• Presentation to Kentucky stakeholders on NLC, included presentation to State Meeting of Nurse Recruiters in Bowling Green KY and Video Conference from Kentucky Public State Health Facility in Frankfort KY

Information Technology Program Changes for NLC:• Programming the KBN Oracle Database to support implementation of the

NLC

RI Working to Implement NLC

• July 1, 2008 is expected implementation date

• Assistance with communication to key stakeholders

• Monies to purchase of needed equipment (computers)

• Hiring temporary staff to deal with increased volume of licensing activities

NE BON Led Education Session to Promote CBCs for Portability Across

Healthcare Professions• Held funded July 2007 educational

session for all health-related licensing boards on CBC importance for increased public protection

• Work within ‘umbrella/central agency’ structure to build support for all boards to pursue CBC authority.

ND Working to Implement CBCs

• Implement by July 1, 2008• Develop policies & procedures• Update and enhancement to online

system for applications• Communicate with stakeholders• Equipment purchase (shredder for security

and filing cabinet for hard copy storage)

Vision for Grant

• That all non-NLC boards of nursing explore the Nurse Licensure Compact, and the benefits it could bring to their state and nurses regarding licensure portability.

• That all states not conducting federal FBI fingerprint based CBCs on their licensure applicants consider this as a means of better protecting their publics and moving toward uniform core licensure standards in the U.S.

Work at NGA Center for Best Practices

• Health Care Practice Task Force (part of their Committee on e-health) has been looking at licensure models.

• The group has invited NCSBN, FSMB and NABP to speak about models of licensure (i.e., the NLC and single state model) and discuss initiatives to streamline licensure processes.

Work with ATA’s SIG for Nursing

• Participate with the Nursing SIG on development of a telenursing position statement.

• The practice of nursing over distance using telecommunications technology (NCSBN, 1997 Delegate Assembly).

• Nursing SIG formally supports the NLC

Promoting Portability in Times of Disaster

• States in the NLC are not dependent on Governor declared state of emergencies like the EMAC or Uniform Emergency Volunteer Health Practitioners Act (UEVHPA)

• Continuity of care issues are seamless across participating states

• One license for each nurse would translate into unduplicated count of nurses

Health Information Projects at NCSBN Outside of LPG

• Nursys 2.0 (phase 1) to be released in January 2008 New features also include clear identification of multi-state/single state

licenses for NLC states with history of each license type, integration of newly proposed privilege to practice discipline codes by HRSA for multi-state licenses that will provide for better reporting of discipline HIPDB database, and newly improved reporting mechanism which will further help NLC members eliminate multiple multi-state licenses.

• Nursys 2.0 (Phase 2) expected to be released December 2008 More requested features from Boards of Nursing including a complete

electronic process of reporting discipline actions to HRSA’s HIPDB database.

• Study to outline details of policy/process and procedures to use Nursys database by various external emergency responders.

• Study to outline details of Data Management System for Member Boards• Develop a comprehensive tool for Member Boards to allow them to

efficiently collaborate in matters of disseminating known fraudulent activities by nurses; organizations; schools etc. This tool/database will have the ability to store pictures, finger prints, signatures, and various type of images of transcripts, board discipline orders, etc.

Contact information

• Kristin Hellquist, NCSBN at [email protected]

• www.ncsbn.org

List of Current NLC Participants• Arizona • Arkansas • Colorado• Delaware• Idaho• Iowa• Kentucky• Maine• Maryland • Mississippi• Nebraska• New Hampshire• New Mexico• North Carolina• North Dakota • South Carolina• South Dakota• Tennessee• Texas• Utah• Virginia• Wisconsin

As of November 2007 (* Rhode Island planning to implement July 2008)