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ONC Gets It Mostly Right with TEFCA 2.0

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ONC Gets It Mostly Right with TEFCA 2.0

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 (T ...

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):

HLN Participates in 2019 California Immunization Coalition Summit

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HLN Participates in 2019 California Immunization Coalition Summit

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 ...

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.

HLN Presenting at Upcoming Healthcare Meetings

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HLN Presenting at Upcoming Healthcare Meetings

Over the next several months HLN will be attending a number of important healthcare and public health meetings and events and presenting our work and perspectives. Events and prese ...

Over the next several months HLN will be attending a number of important healthcare and public health meetings and events and presenting our work and perspectives. Events and presentations include:

2018 OSEHRA Open Source Summit (July 18-20): HLN will be joining colleagues on the Immunization Working Group for an update of the groups activities, including an update about HLN’s ICE Open Source Immunization Evaluation and Forecasting System (7/18, Afternoon Session II, 2:30pm ET).


American Immunization Registry Association (AIRA) 2018 National Meeting (August 14-16): As a gold sponsor of the meeting, HLN shows its strong commitment to the Immunization Information System (IIS) community. We will deliver several presentations during this conference, including:

  • Strategies for Evaluating and Integrating SmartyStreets (Session 1B, 8/14, 1pm MT)
  • IIS Platform or Module Migration – Is Your Program Prepared? [with CDC, AIRA & PHII] (Session 2B, 8/14, 2:30pm MT)
  • CAIR2 Patient Matching: Solving the 25 Million Piece Puzzle [with CA and DXC] Session 3A, 8/15, 9:15am MT)
  • IIS Past, Present, and Future: A Conversation and a Discussion [with PHII] (Session 4E, 8/15, 11am MT)
  • Comparative Analysis of AFIX-IIS Tools [with CA] (Session 5D, 8/15, 1pm MT)
  • Cloud-Based Solutions: A Good Option for Hosting CDS for Immunizations (Session 5D, 8/15, 1pm MT)
  • Vaccines For Children (VFC)-IIS Integration Strategy [with CA] (Session 6E, 8/15, 2pm MT)
  • ICE: An Open Source Option for Immunization Forecasting (Session 7D, 8/16, 11am MT)
  • Hearing from Everyone: Diverse Perspectives to Improve Oregon School Immunization Reporting [with OR] (Session 8C, 8/16, 9:45am MT)

HLN will also have an exhibitor booth at the meeting.


2018 Public Health Informatics (PHI) Conference (August 19-23): HLN will have an even greater presence at this bi-annual CDC-sponsored conference including delivery of the following presentations:

  • Case Study for Cloud Computing Solutions in Public Health: Clinical Decision Support (Session E03, 8/21, 4:15pm ET)
  • Reportable Conditions Knowledge Management System (RCKMS): Developing Quality Decision Support in the Data Supply Chain for Public Health Surveillance [with CSTE] Session B01, 8/21, 10:30am ET)
  • A Collaborative Approach to Supporting Information System Migration Projects [with CDC, AIRA, & PHII] (Session G01, 8/22, 1:30pm ET)
  • Clinical Decision Support for Immunizations as a Community-drive, Standards-based Activity [with CDC & NYC] (Session H04, 8/22, 3pm ET)
  • Developing a Data Integration and Management System: Improving New York City’s Population Health Research and Surveillance [with NYC] (Session H07, 8/22, 3pm ET)
  • The Changing Face of Interoperability and its Impact on Public Health (Session K11, 8/23, 9:15am ET)

In addition to being an exhibitor at the conference, HLN will demonstrate some of its Open Source software as part of a HIMSS Interoperability Showcase that accompanies this event:

  • Immunization Use Case – ICE Immunization Evaluation and Forecasting System
  • Electronic Case Reporting Use Case – Reportable Conditions Knowledge Management System (RCKMS)


Health Level 7 (HL7) 32nd Annual Plenary and Working Group Meeting (9/29-10/5): HLN will attend this important gathering, including demonstrating our Open Source products at the FHIR Connectathon that takes place in conjunction with the meeting.

Epic and Cerner Connect to HLN’s ICE at FHIR Connectathon

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Epic and Cerner Connect to HLN’s ICE at FHIR Connectathon

At the 18th FHIR Connectathon in Cologne, Germany on May 12-13, 2018, HLN successfully integrated its open source Immunization Calculation Engine (ICE) service with test instances ...

At the 18th FHIR Connectathon in Cologne, Germany on May 12-13, 2018, HLN successfully integrated its open source Immunization Calculation Engine (ICE) service with test instances of two Electronic Health Record (EHR) products, Epic and Cerner, using the CDS Hooks standard.

CDS Hooks is an emerging specification for invoking third-party Clinical Decision Support (CDS) web services from various points within an EHR workflow, such as whenever a patient is viewed. Registering a CDS service in an EHR is as easy as supplying a service discovery URL.
When invoked, the ICE CDS Hooks service accepts patient demographics and immunization history supplied by the EHR in FHIR format; calls the ICE decision support service; and sends back immunization forecasting alerts to the EHR for display.

The Connectathon was held prior to the May HL7 Working Group Meeting in Cologne. Version 1.0 of the CDS Hooks standard (cds-hooks.org) is being voted on during the May 2018 HL7 ballot cycle.

More information on ICE is available at cdsframework.org.

TEFCA: A Public Health Perspective (final)

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TEFCA: A Public Health Perspective (final)

In January 2018 the Office of the National Coordinator for Health Information Technology (ONC) issued a draft Trusted Exchange Framework and Common Agreement (TEFCA), and related s ...

In January 2018 the Office of the National Coordinator for Health Information Technology (ONC) issued a draft Trusted Exchange Framework and Common Agreement (TEFCA), and related supporting documents, in response to a requirement imposed by Congress in the 21st Century Cures Act. The Act says that the TEF may include a common method for authenticating users, a common set of rules, enabling policies, and a process for managing non-compliance. Nowhere does the Act instruct ONC to determine an actual technical architecture in this process, though such a step is not precluded either.

The primary document is in two parts: Part 1 is a set of principles that set the foundation for Part 2 which is a set if minimum terms and conditions for trusted exchange. While the principles seem overall quite reasonable, the terms and conditions have many, many technical specifications and standards embedded within them and lay the groundwork for a very specific nationwide implementation. Though the phrase “network of networks” appears nowhere in these documents, Part 2 seems to describe a technical implementation not too unlike the original NwHIN/eHealth Exchange model that was implemented with limited success a number of years ago. It does not appear that this model fits all that well with any of the major market-based strategies that have emerged in the past several years, notably the Commonwell Health Alliance, Carequality, or the Strategic Health Information Exchange Collaborative (SHIEC).