Connie Registration Form

Welcome to Connie!
Fill out the Connie Registration Form to start connecting with Connie!
Welcome to Connie!

This form is the first step towards meeting your requirement to connect to, and participate in, the statewide Health Information Exchange, Connie. This form is used by organizations interested in and/or mandated to connect to Connecticut’s statewide Health Information Exchange (HIE) and those organizations or providers who may be exempt from connecting to the statewide HIE.
Connie, Connecticut’s Statewide HIE

A health information exchange, or HIE, is a safe electronic way for health care providers and organizations to share clinical information about their patients. By state statute, Connie was authorized to be an independent, not-for-profit, neutral, and trusted organization to develop and operate the statewide HIE in Connecticut (Conn. Gen. Stat. 17b-59d and 17b-59g).

Connie enables providers and physicians to:

• Better share clinical information across all healthcare settings.
• Support care coordination.
• Reduce preventable costs associated with readmissions and duplicative testing.
• Support public health reporting, academic research, and population health analytics.
• Adhere to and promote standards and interoperability.
• Provide patients with access to their own health information.

Connie is a growing network comprised of hundreds of healthcare providers. As Connecticut’s official HIE, Connie is working to connect all of Connecticut’s providers, including hospitals, pharmacies, payors, health departments, state agencies, and health centers.

Mandate Requirements

The Office of Health Strategy (OHS) deemed Connie operational on May 3, 2021.

The State statute required hospitals and labs to apply to begin the process of connecting to and participating with Connie within one year and all other healthcare providers within two years of Connie’s operational date. For more information about the requirement, see Conn. Gen. Stat. 17b-59e.

What does it mean to “connect” and “participate”?

For provider organizations with an EHR/EMR capable of connecting with the statewide HIE (Connie):

Connecting to the statewide HIE (Connie): Your organization is required to complete the Connie Registration form below and connect with the statewide HIE (Connie) in a manner that provides for the electronic exchange of health information for allowed uses within federal and state privacy laws.

This has two stages:

1. Legal Onboarding: This step is complete when the appropriate Data Sharing Agreement and Use Case Exhibits are executed.

2. Technical onboarding: The second stage of the Connect step is complete when technical integration necessary to facilitate data exchange is complete.

Participating in the statewide HIE (Connie) - An organization is participating when its clinical and demographic information is being sent to Connie on an agreed to frequency and quality, on an ongoing basis as outlined in the legal onboarding documents. All data should meet federal and state privacy laws including all required privacy disclosures or patient consent as may be required by law. Within this step, Participating Organizations also determine their data viewing preference(s) and complete the associated implementation and training activities to access the data.

For provider organizations who do not have an EHR/EMR capable of Connecting with the statewide HIE (Connie):

Your organization is required to complete the Connie Registration Form below and either provide or obtain a secure Direct email address.

Connie will assist you with determining if your EHR/EMR can connect with the statewide HIE, and with obtaining a secure Direct address, for no charge, if needed.

What is the deadline for meeting this mandate?

The deadline for applying to begin the process of connecting to, and participating in Connie was May 3, 2023. Providers and organizations who did not complete their Connie Registration form by the deadline may still apply to begin the process by completing this form below. Once an organization has applied, an Account Manager will reach out to complete the next steps of the onboarding process.

Where can I find more information about the mandate and Connie?

The Office of Health Strategy website has information about the statewide HIE and what it means to connect and participate with it – link here.

Connie has a website with lots of information including FAQs – link here.
Connie Registration Form
Instructions: If you are a licensed healthcare provider organization or a solo licensed healthcare provider, fill out the form below and submit. A Connie Account Manager will be in touch to complete the onboarding process.

If your organization is not licensed but employs licensed healthcare providers, you can fill the form out indicating that you are not licensed but employ licensed providers. Your providers may need secure Direct email addresses to be compliant with the mandate. A Connie Account Manager will be in touch to complete the onboarding process.

If you are an individual licensed healthcare provider employed with another organization (for example, a physician employed by a health system or a nurse employed by a local health department), your organization may already be working to connect to Connie and your statutory requirement will be fulfilled through them. This can be true for both licensed health care organizations (such as hospitals) as well as non-licensed health care organizations (such as a physician group practice). Talk to your organization’s leadership to determine if they are already working to connect with Connie.

If you are licensed, but not seeing patients, or generating medical records, please indicate that on the form below. 

Completing this form and returning it to Connie serves as documentation of your organization’s application to connect to, and participate in, the statewide HIE as required by Conn. Gen. Stat. 17b-59e. Even if you believe you are exempt from complying with the mandate, you must complete this registration form and register your exemption criteria.
Mandated providers are only required to send patient health data that is not otherwise restricted from disclosure by law. Additionally, if the data specifically requires patient affirmative consent to share, providers are required to obtain consent before disclosing to Connie. Organizations are expected to proceed in good faith with next steps, as applicable, to complete their requirement under the mandate.*

I understand and have read the terms and conditions above
Are you a licensed healthcare provider or does your organization employ/contract with licensed healthcare providers to provide healthcare services in the State of Connecticut?*

NoYes
Legal business name of the organization responsible for signing the Connie Data Sharing Agreement (N/A if not a licensed provider/not providing licensed services in the State of Connecticut)*
If "no" - Please describe the services your organization provides to the community*
Does your organization actively provide healthcare services that create an individual health record for a patient in Connecticut?

Yes, actively treating individual patients in Connecticut.No, not actively treating individual patients in Connecticut
No, not actively treating individual patients in Connecticut because (you may select more than one):

My organization is conducting researchThis is a teaching organization.I am a retired provider with an active license.I only provide patient assessments for third-party clients.I only provide group treatment.It Depends/Other (please explain)
If your organization provides home and community based (HCBS) services on the Medicaid waiver for DSS, would your organization like to participate in the DSS HCBS value-based payments program?*

NoYes
Click here for more information on HCBS program requirements.
What is your Federal Tax ID number?*
Please select your organization's type below*

Accountable Care OrganizationAmbulatory Medical PracticeBehavioral HealthCare Coordinator/ManagementCare Transformation OrganizationClinically Integrated NetworkCommunity-Based Organization not providing health care servicesDentistFirst ResponderGovernment or Government AffiliationHealth SystemHospitalLaboratoryLong Term/Post-AcutePayerPharmacyRadiology CenterUrgent CareOther
Affiliations (Please list all that apply)
e.g., hospital, accountable care organization (ACO), clinically integrated network (CIN), independent physician association (IPA)
Business Website*
Business Phone*
Main Office Address*
Organization NPI Number*
Please fill "N/A" if not applicable
Full name of person responsible for signing agreements*

First NameLast Name
Contact E-mail Address*
Contact Title*
Does your practice use electronic health record (EHR) software? If so, please fill in the EHR vendor name and/or software product name, or enter N/A if you do not use an EHR. *
Examples of common EHR's include Athena, Practice Fusion, Eyefinity, Dentrx, Chirotouch, Simple Practice, etc.
Do you use the following lab(s):

LabCorpQuestNoneOther – please fill in the box.
How do you currently receive important state/federal health and insurance information updates? (i.e. Forum, subscribed Info site, association newsletter, etc.)
Why is your organization interested in connecting with Connie?*
Do you have any questions/comments about Connie or connecting to the HIE? Please let us know so an Account Manager can reach out to you with the relevant information.
Please verify that you are human*
By filling this form, I am granting Connie permission to send information to my email address.
Should be Empty:

Welcome to Connie!

Fill out the Connie Registration Form to start connecting with Connie!

Connie Registration Form