HIE – HLN Consulting, LLC

ONC’s 3rd Interoperability Forum: Not Much to Report

by Noam Arzton August 26, 2019

On August 21 and 22, 2019 the Office of the National Coordinator for Health Information Technology (ONC) held its third Interoperability Forum in Washington, DC. More than 600 individuals participated in person with many others viewing the general sessions via webinar. The conference began and ended with half-day plenary sessions while providing five tracks with smaller sessions in between. I attended the Health Information Exchange (HIE)/Community-based Information Exchange (CIE) breakout session on both days.

The plenaries (aside from the usual welcome and farewell messages) focused on the current state and the future state of interoperability. Lots of talk about TEFCA, FHIR, and patient-centered control of health records, but I really did not hear anything new or terribly interesting. There was a fascinating presentation by Dr. Simon Eccles, head off Great Britain’s NHSX project, but this is their third attempt at an integrated health information system and it seemed more aspirational than actual.

In the track I attended on Tuesday there was a very good session on public health and health IT, very well attended with varying presentations from CDC, AIRA, APHL, and others. The second set of presentations was on improving coordination between acute and post-acute facilities using FHIR. On Wednesday, the same track had presentations on advancing social determinants of health using FHIR (including the HL7 Gravity Project), and a second set of presentations on health IT and behavioral health. It was nice, frankly, to finally hear some presentations on this topic that were not completely dominated by the opioid crisis.

To be honest, my expectations were fairly low for this conference. FHIR was all the rage. but its limited deployment still has it fairly early in the hype cycle. Until an RCE is named and begins its work, TEFCA is still a distant idea. The major market-driven HIE activities (Commonwell, Carequality, SHIEC) did not seem to have a terribly visible presence at this meeting. In fact, the more established HIEs seemed to spend the whole conference wondering out loud why no one was recognizing their role in interoperability. Likely we will have to wait until the publication of the final rule on Information Blocking before we really know what the HIE landscape will look like for the next few years.

ONC Gets It Mostly Right with TEFCA 2.0 [Updated]

by Noam Arzton April 24, 2019

See our final comments on the TEFCA v2 Draft

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^st 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):

HLN Participates in 2019 California Immunization Coalition Summit

by Noam Arzton April 10, 2019

HLN participated in the 2019 California Immunization Coalition Summit held on April 8-9. 2019 in Riverside, CA. For over twelve years, the CIC Summit has brought together partners and colleagues from throughout California and beyond to share ideas, highlight successes, and identify partnerships.

This year HLN’s president, Dr. Noam Arzt, delivered two talks during breakout sessions at the summit:

Several hundred stakeholders from around California attended this important event.

ONC Releases New NPRM on Interoperability: How Might it Affect Public Health? [Updated]

by Noam Arzton February 27, 2019

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.

AHRQ Releases Draft Guide for Registry Interoperability: Does Public Health Have a Role?

by Noam Arzton January 29, 2019

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.”