I have written several times about patient matching in the US, both in a blog entry and a published article. On December 11, 2017 the Office of the National Coordinator for Health Information Technology (ONC) sponsored a half-day “Interoperability in Action” webinar focused on Patient Matching Milestones at ONC (see agenda and slides). The webinar focused on four ONC projects from the past year. Here’s a quick run-down on what they covered.
Two new reports have been released on interoperability in September 2017 with potential impact on public health. The reports focus on the perceived successes and barriers to health information exchange and interoperability. We draw out the relevance of these reports to public health as well as some of our own observations on these issues from a past working paper.
Firth, the Office of the National Coordinator for Health Information Technology (ONC) released a commissioned study, Connecting Public Health Information Systems and Health Information Exchange Organizations: Lessons from the Field. This study of former ONC Health Information Exchange (HIE) grantees focuses on their experience, best practices, and lessons learned promoting the use of HIEs for public health reporting. The report covered a number of areas, including leadership issues, technical considerations, financial issues, privacy and security, and legal and policy issues. Generally the report provides useful information and insight, though it is not clear how many actual public health agencies were interviewed (as opposed to the HIEs alone). There is also an over-emphasis on clinical documents when much of public health reporting is still leveraging HL7 v2 messages. And the discussion of CMS 90/10 funding requires a more nuanced understanding to be used effectively.
HIEs can certainly be effective partners for public health reporting and data exchange. We have studied this in the past – see the HLN White Paper, IIS and HIE: Is there a Future Together? (November 2013). This report stresses the collaborative nature of public health-HIE collaboration, which we also emphasized in our White Paper.
Second, The National Quality Forum (NQF) recently issued A Measurement Framework to Assess Nationwide Progress Related to Interoperable Health Information Exchange to Support the National Quality Strategy: Final Report. This report is the culmination of an NQF project to understand the barriers to interoperability and develop a measurement framework to monitor its effectiveness. While there is only passing reference to public health in this final report, there is some useful insights and strategies toward measuring interoperability.
Last week I attended with my colleague Mike Berry the ONC 2017 Technical Interoperability Forum. This meeting was convened under the 21st Century Cures Act passed by Congress in late 2016. Several hundred attended a series of panel presentations and discussions over one and a half days covering a variety of topics related to interoperability, including discussion of the business case for interoperability, semantics, national networks, and application programming interfaces (APIs). In many ways the speakers were “the usual suspects” involved in national networks, standards development, and HIE planning and implementation.
Nearly two years ago I wrote an essay, The Interoperability of Things, based on the collection of comments received by ONC on the draft Nationwide Interoperability Roadmap. Though I asked the new National Coordinator for Health Information Technology, Dr. Don Rucker, in a previous meeting if the Roadmap was still relevant and he said it was, there was absolutely no mention of this document at the Forum and it did not seem like the Roadmap was the operative guide for ONC activities or thinking. My own essay drew out a number of themes in interoperability I perceived at the time, including: lack of consensus on definition and scope; ambiguity over the role of HIEs, especially at the state level; disagreement over whether the pace of change was too fast or too slow, too general or too specific; and the complex state of consent and privacy laws across the country that really put a crimp in cross-state data sharing.
On June 19-20, 2017, Dr. Noam Arzt, President of HLN, participated by invitation in the 12th Annual Stewards of Change Institute National Symposium on behalf of the Healthcare Information and Management Systems Society (HIMSS). This symposium provided a unique opportunity to discuss key issues in data management and interoperability with a small, but diverse set of stakeholders across the health and human services. The symposium included a particular focus on issues surrounding the current opioid epidemic. In addition, a new National Interoperability Collaborative (NIC) was launched (with funding from the Kresge Foundation) to spearhead information sharing regarding interoperability strategies and activities. Though there was no CDC participation at this symposium, there was a very nice briefing from several representatives of the Department of Health and Human Services including the new National Coordinator for Health Information Technology, Dr. Don Rucker.
This symposium represents a welcomed expansion of the Stewards of Change focus from human services into the health domain. This expanded conversation will allow public health to participate more fully as the shift to our collective concern about wellness requires a more holistic view of people, their requirements, and their circumstances. We look forward to continuing engagement with this community and an opportunity to bring what we have learned in public health about interoperability into this new forum.
A public health perspective on interoperability
We have written previously about interoperability and its increasing important to public health. Yet public health has some specific challenges to making interoperability effective:
- There are more than 2,500 public health agencies in the U.S. at the federal, state, local, territorial and tribal levels. This not only leads to great diversity, but as a result public health cannot and does not speak with one voice about interoperability issues (or anything else for that matter). This makes it difficult for some stakeholders to engage public health consistently or to implement solutions that can be used more uniformly and therefore more effectively across public health.
See full blog entry