In the past several years we have seen a real shift in leadership over Health Information Exchange (HIE) in the US. The phase out of the ONC State HIE Cooperative Agreement Program in 2014 marked a real turning point in HIE planning and implementation as ONCs leadership has waned and other more market-driven forces have ascended. Some activities have continued with funding from CMS under the Medicaid Electronic Health Record Incentive Program Health Information Technology (HIT) 90 percent Federal Financial Participation (FFP) program, and to a lesser degree under the Medicaid Management Information System FFP program. State-level HIEs have continued to flourish in some states (including Delaware, New York, Michigan, and others) while they have floundered in others.
On October 3, 2017 Noam Arzt and Daryl Chertcoff from HLN attended the Patient Centered Clinical Decision Support Learning Network (PCCDS-LN) 2017 Annual Conference in Crystal City, VA. HLN was also a Bronze-level Sponsor of this event, which brought together clinicians, informaticists, and health policy advocates to discuss current trends in clinical decision support leveraging information from Patient Centered Outcomes Research (PCOR) findings and patient-specific information. The conference featured national experts in CDS and patient-centered research in the morning, and a participative set of breakout sessions in the afternoon developing an idealized design of the patient-centered CDS process through four different perspectives.
Must of this conference focused on patient-centered CDS. But it seems that this term absorbs a number of somewhat different concepts and is used by different people to mean different things. “Patient centered” to some people means “patient-facing” – that is, it refers to an application (in this case a CDS-enabled application) that is used or accessed by a patient directly. To others, patient-centered is synonymous with “patient-empowered” which implies support for more patient control of his or her care and records. Many uses of CDS support do not directly involve patients in real time while still impacting patients and their care.
For HLN’s work in clinical decision support, this conference presented a number of useful themes and raised a number of important issues. While there was a lot of focus at this conference on user interface, it is important for HLN to maintain its focus on the back-end services we are developing (like our ICE Open Source Immunization Forecaster). But it is equally important that we continue to develop a rich set of application programming interfaces (APIs) to our services, including our traditional SOAP-based Web Services, supplemented by various RESTful services (including FHIR, SMART, and CDS Hooks). And all of this work should support and use accepted standards embraced by the healthcare industry.
See article in OpenHealthNews
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.
Dr. Arzt, President of HLN, gave a presentation about an Open Source HL7 quality assurance tool for syndromic surveillance ADT messages at the 2015 CSTE annual meeting in Denver on December 9.