HLN Consulting

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2022 HL7 Working Group Meeting Continues to Advance a Public Health Agenda

The HLN Consulting team attended the HL7 36th Annual Plenary & Working Group Meeting (WGM) held in Baltimore, MD, September 17 – 23, 2022. More than 500 attendees, representing all aspects of the industry, were a part of the WGM in-person meeting after 2 years of virtual meetings. The seven day event started on Saturday with a weekend connectathon. This meeting offered an opportunity for attendees to come together and collaborate. It was a valuable meeting especially for people involved in standards development around healthcare. Read More »

A Consulting Firm Attempts a Transition to Open Source Health Software (Part 1 of 2)

Andy Oram | EMR & HIPAA | September 6, 2016

Open source is increasingly understood to be the future of software, because communities working together on shared needs can produce code that is at least as good as proprietary products, while representing user interests more effectively and interoperating without friction. But running an open source project is a complex task, and keeping a business going on it is absolutely perilous. In his 2001 book The Cathedral & the Bazaar, Eric S. Raymond listed half a dozen ways for businesses to profit on open source software, but today only one or two are visible in the field (and they differ from his list).

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A Consulting Firm Transition to Open Source Health Software (Part 2 of 2)

Andy Oram | EMR and HIPPA | September 7, 2016

The best hope for sustaining HLN as an open source vendor is the customization model: when an agency needs a new feature or a customized clinical decision support rule, it contracts with HLN to develop it. Naturally, the agency could contract with anyone it wants to upgrade open source software, but HLN would be the first place to look because they are familiar with software they built originally. Other popular models include offering support as a paid service, and building proprietary tools on top of the basic open source version (“open core”). The temptation to skim off the cream of the product and profit by it is so compelling that one of the most vocal stalwarts of the open source process, MariaDB (based on the popular MySQL database) recently broke radically from its tradition and announced a proprietary license for its primary distinguishing extension.

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A Public Health Perspective on the CMS Quality Payment Program

I have seen several pretty good summaries of the recently 0release Centers for Medicare and Medicaid Services (CMS) 2019 Inpatient Prospective Payment System Notice of Proposed Rulemaking (NPRM) to Quality Payment Program (one from AMIA, one from CDC). Here are just a few additional tidbits I picked out of the NPRM. Of course, this document is written like stereo instructions so I welcome any corrections or comments to my interpretation of what’s in the rule. I put page numbers (from final FBO version referenced above which has just been released) where relevant in parenthesis. And I apologize in advance as much of what’s here is cryptic to anyone who has not been exposed to this before and I don’t make much of an attempt to explain the context (or even the acronyms)...

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AIRA 2018: Is Open Source the Key to Immunization Software Sustainability?

On August 14-16, 2018 the American Immunization Registry Association (AIRA) held its 2018 National Meeting. This meeting brought together more than 350 informatics professionals, public health officials, EHR vendors, and other stakeholders who all care passionately about Immunization Information Systems (IIS) and their role in the healthcare community. IIS projects leverage interoperability with EHRs, PHRs, and other systems to promote clinical practice at the point of care; enable public health surveillance, and reduce cost by assisting in preventing both under and over immunization.

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Approaches for Immunization Information System (IIS) Project Collaboration with HIE Networks

We have written in a previous policy white paper about collaboration between Immunization Information System (IIS) projects and Health Information Exchange (HIE) networks, and a second more technical white paper about options for interoperability between IIS and electronic health record (EHR) systems. We described a range of interoperability options for EHR users and IIS and the strengths and challenges of each alternative...

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Are Open Source Clinical Decision Support (CDS) Services Subject to HIPAA Regulations?

Clinical Decision Support (CDS) services such as HLN’s Immunization Calculation Engine (ICE) are modular, loosely-coupled components of larger systems accessed via web services in a service-oriented architecture (SOA). Under HIPAA, services provided to Covered Entities (CE) which involve protected health information (PHI) as defined in the statute are subject to the regulation. But are CDS services such as ICE subject to this regulation?

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ASTHO Releases Two New Reports On IIS

In March 2023 the Association of State and Territorial Health Officers (ASTHO) released two environmental scans related to public health data and systems funded by a grant from ONC. The first report, Immunization Information Systems, and Health Information Exchanges: An Environmental Scan of Factors Influencing Data Sharing and Opportunities to Advance Population Health, provides a review of the state of both IIS and HIEs – as well as their points of intersection and support – especially as they were affected by the COVID-19 pandemic. ASTHO used a mixture of secondary source review (including our white paper on this topic from nearly ten years ago) and current interviews and focus groups to inform us about this complex and fluid topic.

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Bipartisan Commission on Biodefense Issues Call For a National Public Health Data System

In April 2022 the Bipartisan Commission on Biodefense released a new report titled The Athena Agenda: Advancing the Apollo Program for Biodefense. Established in 2014, the privately-funded commission convenes periodically and conducts research to assess the state of US biodefense efforts and to make recommendations for change and improvement. Spurred by the events surrounding the COVID-19 pandemic, this report challenges the country to prepare itself for future pandemics by establishing aggressive goals, gathering our “best and brightest” talent, developing action-oriented plans, and funding their accomplishment as the “next Apollo Program.”

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CDC Issues RFI for Real-world Testing of Health Information Technology

In October the Centers for Disease Control and Prevention (CDC) issued a Request for Information (RFI) for a Natural Test Collaborative (NTC). Through a series of questions, the RFI seeks opinions and information about "The development of a national testbed (notionally called the National Test Collaborative (NTC)) for real-world testing of health information technology (IT)" and "Approaches for creating a sustainable infrastructure" to achieve it. The scope of the questions is somewhat confusing and quite broad, starting with Clinical Decision Support (CDS) and electronic Clinical Quality Measures (eCQMs) but quickly expanding to Electronic Health Records (EHR) and interoperability (not precisely defined).

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Clinical Decision Support Strategies for Electronic Case Reporting and its Open Source Connection

A key element of public health surveillance is the reporting of infectious and certain non-infectious conditions to state, local, and tribal public health agencies (PHA) around the United States. Historically, there have been a number of key challenges with the process of case reporting that is pervasive in the United States today. To help overcome some of these barriers, an effort has been underway to move the process of case reporting to electronic. A key component of the emerging electronic care reporting (eCR) strategy is the use of clinical decision support (CDS) to help clinical care organizations determine if a reportable condition is present in a patient's record. Multiple approaches have been identified for this CDS service, including a centralized model being implemented today, and several distributed options which will likely become equally viable. Given the size, diversity, and decentralized nature of healthcare enterprises, it is likely that all three approaches for CDS discussed in this article will be deployed simultaneously.

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CMS Promoting Interoperability Program: A Public Health Perspective

Well, here we go again. The Centers for Medicare and Medicaid Services (CMS) has now released a new Notice of Proposed Rulemaking (NPRM), titled Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program...As this NPRM was released, the CMS Administrator, Seema Verma, published an open letter to doctors which is focused on reducing the burden on doctors so they can spend more time with physicians. HL7 has begun a similar initiative on reducing clinical burden. So the key question is: Does this NPRM go far enough to reduce provider burden in the spirit of Dr. Verma's letter?

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Cures Act EHR Reporting Program Draft Measures—What this Means for Public Health

As part of the ONC Health IT Certification Program, Congress mandated the establishment of an Electronic Health Record (EHR) Reporting Program to help determine the effectiveness of the program. The first step toward implementation was the development of an initial set of CEHRT developer metrics which were released in draft form in December 2021. When finalized, these metrics will represent data that EHR vendors will have to report to ONC as a Condition and Maintenance of Certification. The initial focus of the metrics developed was interoperability, and public health was one of four categories considered.

Daryl Chertcoff

Daryl Chertcoff provides project and technical leadership on complex, multi-vendor application design and development efforts, and has architected major public health systems. As a senior project manager for HLN Consulting since 2000, he uses a diverse set of skills and approaches to tackle complex problems in creative and unique ways. Daryl has worked with a wide range of technologies and he has managed, designed and implemented systems and applications that utilize various integration and database technologies.

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Dr. Noam Arzt named Fellow of the American Medical Informatics Association

Press Release | HLN Consulting | November 1, 2018

Dr. Noam H. Arzt, president ofHLN Consulting, LLC, has been named a Fellow of the American Medical Informatics Association (AMIA). Dr. Arzt joins 129 of his colleagues in the inaugural class of fellows. The fellowship was created to recognize AMIA members who apply informatics skills and knowledge within their professional setting, who have demonstrated professional achievement and leadership, and who have contributed to the betterment of the organization. A member of AMIA since 1998, Dr. Arzt has been a leader in public health informatics for many years. He has been active in various AMIA task forces and workgroups, and has been a speaker at AMIA conferences, events, and webinars.

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