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 21st 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):
On March 7, 2019, HLN released a new version (v1.16.1) of the Immunization Calculation Engine (ICE). ICE is a state-of-the-art open-source software system that provides clinical decision support for immunizations for use in Immunization Information Systems (IIS), Electronic Health Record (EHR) and Personal Health Record (PHR) Systems.
This version includes:
- DTP Vaccine Group: Added an update to the “Six by Seven” rule to explicitly state that duplicate shots on the same day do not count towards this rule. The intention of this change is to prevent potentially “bad data” that may be passed into the ICE service from affecting the forecast result.
- Hib Vaccine Group: Improved handling of duplicate shots administered on the same day. For details, please refer to the Two Shots, Same Vaccine Group, Same Day Exception Rules page.
- Minor logic changes to the Meningococcal B, Polio, Rotavirus and Pneumococcal vaccine groups.
HLN recently demonstrated ICE integrated into two EHRs at the HIMSS19 Interoperability Showcase starting in February in Orlando, FL.
The full software release is available for download at https://cdsframework.atlassian.net/wiki/display/ICE/Downloads. A revised ICE Implementation Guide is also available.
See the feature article about ICE in Open Health News.
|See our final comments on the ONC NPRM and the CMS NPRM Patient Matching RFI|
On February 11, 2019 the Office of the National Coordinator for Health Information Technology (ONC) released its latest Notice of Proposed Rulemaking (NPRM) to Improve the Interoperability of Health Information. Referred to by some people as the “Information Blocking NPRM,” since this was the primary topic anticipated, the document actually covers a host of other topics related to interoperability driven primarily by requirements of the 21st Century Cures Act. Besides the initial text of the NPRM, ONC also released a set of summary slides and fact sheets to help explain the document.
Given the relatively minimal mention of core public health reporting certification criteria in this NPRM, there is still a fairly large potential impact on public health. Topics, descriptions, issues, impacts, and potential opportunities discussed in this article and associated documents are based on our careful read of the NPRM and related material. But please note that this information is voluminous and at times confusing. Ongoing discussion and review will attempt to clarify (and if necessary correct) initial ideas presented here.
In order to help focus the reader, I have prepared a detailed table of Public Health Issues, Impacts, and Opportunities (currently at Version 15) which will be updated periodically, as well as a separate detailed response to the ONC Patient Matching RFI and CMS Patient Matching RFI.
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 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. It includes a clear statement of the problem, good discussion on both barriers and progress to date, insights from the stakeholders interviewed on their practical issues, and a review of various initiatives by the Office of the National Coordinator for Health Information Technology (ONC) over the past several years. The footnotes alone are worth the read as they contain excellent sources and side comments.
On January 11, 2019 the Agency for Healthcare Research and Quality (AHRQ) released a draft Addendum to the Third Edition of Registries for Evaluating Patient Outcomes: A User’s Guide called Tool and Technologies for Registry Interoperability. AHRQ has long written about registries – largely from a research standpoint – and I have been following this from afar for some time. This new guide is focused on helping those who both create and use registries understand the issue surrounding leveraging external data to improve registry completeness, accuracy, and usefulness.
This report covers lots of ground and does a good job of summarizing important subtopics. Each chapter is overflowing with footnotes and sources. In Chapter 1, AHRQ reviews the context for registries today within the notion of a learning health system, and then quickly jumps into a useful discussion of interoperability barriers and problems. Many research-oriented registries are narrowly focused on a specific issue or problem; AHRQ envisions a more interoperable set of registries that can create a more integrated “national research infrastructure.”