Noam ArztA recent article in HealthAffairs describes a significant decline in the number of both operational HIEs and HIEs in the planning stage from several years earlier. The authors note continuing barriers to broad-based HIE and a shift to vendor-driven exchange which diminishes the effectiveness of community-based networks. In effect, this translates to a shift away from geographic-based/dominated HIEs to product-dominated HIEs. We have already noted (see The Interoperability of Things) the lack of a national strategy on HIE, and ONC’s Nationwide Interoperability Roadmap barely mentions the concept.
Immunization Information System (IIS)
See the following -
Anatomy of a Public Health Open Source Project: HLN's Immunization Calculation Engine (ICE)
By Michael J. Suralik, and Noam H. Arzt, Ph.D. | January 29, 2019
An immunization information system (IIS) aggregates immunization information for children (and some adults) living or receiving immunization services in a jurisdiction. One of the core components of an IIS is its immunization evaluation and forecasting system: the computerized algorithm that is used to determine if vaccine doses that were administered to the patient are clinically valid (evaluation) and to project what doses are due now and in the future (forecasting). These algorithms are used to support clinical decision support (CDS) at the point of care and also to help public health agencies understand and manage the immunization status of whole populations.
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Approaches for Immunization Information System (IIS) Project Collaboration with HIE Networks
By Noam H. Arzt, Ph.D. | February 11, 2018
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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CMS Promoting Interoperability Program: A Public Health Perspective
By Noam H. Arzt, Ph.D. | September 6, 2018
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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GAO Report on Patient Matching: Nothing New Under the Sun
By Noam H. Arzt, Ph.D. | March 4, 2019
On January 15, 2019 the US Government Accountability Office (GAO) released a new report to Congress, Health Information Technology: Approaches and Challenges to Electronically Matching Patients' Records across Providers. This report is in response to the mandate in the 21st Century Cures Act for the GAO to study patient matching. To develop this report, GAO reviewed available literature and interviewed more than thirty-five stakeholders (who are not identified) over the course of a year. I have written several blogs and a feature article on patient matching developments in the US. Similarly, this new GAO report is an excellent retrospective on industry efforts over the past several years.
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HLN and Oregon Health Authority Present Optional Approaches to Oregon's School Immunization Reporting Process at Atlanta Conference
By Noam H. Arzt, Ph.D. | May 23, 2018
At the 2018 National Immunization Conference (NIC) held in Atlanta May 15-17, HLN co-presented Diverse Stakeholder Perspectives to Improve Oregon’s School Immunization Reporting Process in collaboration with the Oregon Immunization Program (OIP). Aaron Dunn, Oregon’s Immunization Program Manager, and Marcey Propp, HLN Project Manager, presented the project context, approach, and outcomes as part of the segment for Improving measurement and reporting to foster clear vaccine communication. The project context included antiquated technology, the growing complexity of vaccine requirements, and excessive, redundant and unnecessary workload that culminated in making the current school immunization reporting process unsustainable.
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How are Clinical Decision Support Artifacts Tested Today?
By Noam H. Arzt, Ph.D. | December 4, 2018
In October 2018 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 this RFI is daunting. It might be useful, rather than to try to tackle this whole topic broadly but superficially, to take just one Clinical Decision Support (CDS) domain and show as completely as possible how testing is currently done.
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New Modalities for Technical Assistance Consulting
By Noam H. Arzt, Ph.D. | March 20, 2018
Technical assistance (TA) is provided by expert consultants to public health systems projects in order to improve their performance against functional standards or to help solve recurring or one-time problems or issues. Unlike other forms of training or support, TA is usually focused or tailored to a specific circumstance or situation. Common examples of TA include assistance to a jurisdiction in migrating from one product to another, consultation related to a specific programmatic initiative such as school immunization health compliance, EHR interoperability implementation, or data quality review.
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ONC EHR Reporting Program RFI: A Public Health Perspective
By Noam H. Arzt, Ph.D. | September 12, 2018
On August 24, 2018, the Office of the National Coordinator for Health Information Technology (ONC) released a Request for Information (RFI) related to the EHR Reporting Program. This RFI is required by the 21st Century Cures Act and its primary purpose is to gather ideas and suggestions related to how ONC might provide better information about Certified EHR Technology (CEHRT). Apparently, the initial intention was to create a "star rating" like the type used in Consumer Reports to use to rate EHRs, but that seems to have been abandoned in favor of some kind of measurement system. But it is far from clear exactly how this would be done.
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ONC Gets It Mostly Right with TEFCA 2.0
By Noam H. Arzt, Ph.D. | April 25, 2019
On April 17, 2019 the Office of the National Coordinator for Health Information Technology (ONC) released the second draft of its Trusted Exchange Framework and Common Agreement (TEFCA) for comment. The initial version was released more than a year ago in January 2018 (see my original blog). As before, this is in response to a requirement imposed by Congress in the 21 Century Cures Act. After a somewhat lengthy (but well written) introduction, the document contains three parts (compared to just two parts the first time around)...
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The Reduction of State-coordinated HIE: How Should Public Health React?
By Noam H. Arzt, Ph.D. | August 2, 2016
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