HLN Consulting, LLC – Innovators in Public Health Informatics

CDC Issues National Test Collaborative RFI

by Noam Arzton December 5, 2018

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).

The context for this RFI is equally confusing. It appears that on the one hand this is an extension of a CDC project called Adapting Clinical Guidelines for the Digital Age which started with an RFI in 2016 (see HLN’s response) and culminated in a five-day meeting whose purpose was to share ideas about how clinical guidelines could be better applied to patient care (see meeting summary). This would explain the initial scope as being related to CDS/eCQMs. On the other hand, there is some indication that CDC issued this RFI on behalf of itself and other sister agencies within Health and Human Services (HHS) because it had the administrative infrastructure and experience to issue it via FedBizOps more nimbly than other parts of the Department.

I find it odd that CDC did not even mention NIST in its background information in this RFI, especially given that NIST is its major partner not only with respect to CDS testing but also interoperability testing to support Meaningful Use. These are the closest thing to a national test bed in HIT that we have. I also find it odd that CDC did not mention the SMART project or its application sandbox as a prime example of an open source test bed. But the prospect of a national test bed for all health IT seems complicated, costly, and probably ill-advised. It is more realistic and feasible for CDC and HHS to better understand what is already in play and build on the experience of others. Health IT development and support is so distributed in the United States that standards for testing may be ambitious enough.

Responses to the RFI are due by 10am ET on December 20, 2018.

See my related case study on immunization evaluation and forecasting systems in OpenHealthNews: How are Clinical Decision Support Artifacts Tested Today?

Is the US Finally Ready to Get Serious About Biodefense?

by Noam Arzton November 19, 2018

Biological and other disaster threats – whether accidental, driven by forces of nature, or intentional – pose fairly grave risks to the United States and the world. Situational awareness has been a conspicuous topic ever since the 9/11 attacks and the anthrax scare that followed shortly thereafter. Since then we have experienced numerous disasters: health impacts of major weather events such as hurricanes and earthquakes, new virus outbreaks like Ebola in Africa, raging wildfires on the West Coast (I live in California), and the ever-present threat of pandemic flu which a hundred ago infected some 500 million people across the globe and killed an estimated 50 million people worldwide, according to the Center for Disease Control and Preparedness (CDC).

But since the initial flurry of public health preparedness funds in the ensuing several years after the 9/11 attacks, this topic has not had a high priority at CDC nor the funding necessary to implement it successfully.

HLN Presents ICE at Fall 2018 Centricity Users Group (CHUG) Meeting

by Noam Arzton November 12, 2018

On November 10, 2018 at the Centricity Healthcare User Group (CHUG) Fall meeting HLN partnered with Health One Technologies (Health1) and Allied Physicians Group (Mellville, NY) to discuss and demonstrate an implementation of GE Centricity that provides real-time decision support at the point of care using ICE, HLN’s Open Source immunization evaluation and forecasting system.

Health1 has over fifteen years experience implementing and optimizing EHRs in physician offices, hospitals, and specialty clinics. With HLN’s assistance, Health1 recently completed an integration between GE Centricity and ICE using a “helper service” that accepts a text file input from Centricity, and translates the evaluations back out in a text file output from ICE. A forecast section was then added to the existing immunization form in Centricity to display the additional data.

Allied Physicians Group is a single specialty pediatric group with 35 practices, 150 providers, 150,000 patients, and 600 users. Evaluation and forecasts from ICE are improving their ability to manage immunization administration and planning more effectively.

See presentation slides.

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

by Noam Arzton November 1, 2018

Dr. Noam H. Arzt, president of HLN 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 fellowshiip 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. “I feel honored to be recognized by my peers. AMIA is the premier medical informatics organization, and I look forward to continuing engagement with my colleagues to promote excellence in our field,” said Dr. Arzt.

“The establishment of FAMIA marks a watershed moment for the profession of health informatics,” said Douglas B. Fridsma, MD, PhD, FACP, FACMI, AMIA President and CEO. “This credential is the new hallmark of applied informatics professionals. Professionals who brandish FAMIA signal to patients, employers, and colleagues that they are steeped in evidence-based practice and engaged with a community of life-long learners who apply the latest advances in informatics to improve health and health care.”

New Fellows will be inducted into FAMIA at the AMIA 2019 Clinical Informatics Conference, in Atlanta, April 30 – May 2, 2019.

For more information on the AMIA Fellowship program, see the official AMIA press release.

ONC EHR Reporting Program RFI: A Public Health Perspective

by Noam Arzton 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. There may be something to learn from the Immunization Information System (IIS) community: with guidance from the CDC, the American Immunization Registry Association (AIRA) initiated a process to help assess compliance of IIS with national functional standards through a formal measurement and improvement initiative. “Validation,” rather than “certification” or “compliance,” is the carefully-chosen term to signify a system meeting the designated measures through formal testing. The process is interactive, and the results are only made public with the agreement of the IIS program. Perhaps some of the concepts and processes in this initiative can be useful for the EHR Reporting Program.

Frankly, there is not much of interest in here for public health, which is not in the business of worrying about CEHRT. Of course, the quality and functionality of EHR products does impact their effectiveness in supporting interoperability with public health registries. To that end, the RFI does as some questions towards the end (p. 42918) about additional information that might be useful for prospective purchasers of CEHRT, including “Submitting, editing, and retrieving data from registries, such as clinician-led clinical data registries.”

ONC asks for how they might prioritize including information related to this in EHR Reporting as well as data sources for reporting about this. It may be useful for public health to weigh in on these questions; comments are due no later than 5 p.m. on October 17, 2018 at the Federal eRulemaking Portal.