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Preparing for 2017: Four Important Reports

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Preparing for 2017: Four Important Reports

With so much transition ahead of us at the Federal, state, and local levels in 2017, it is important to begin to plan for what the Health IT landscapes will look like for the comin ...

With so much transition ahead of us at the Federal, state, and local levels in 2017, it is important to begin to plan for what the Health IT landscapes will look like for the coming year (and beyond). Several key reports have come out – mostly from government sources – which are worth serious consideration for any Health IT planner:

HHS Public Health 3.0 White Paper: This seminal paper sets the stage for ongoing maturation of the public health infrastructure and capability at all levels of government to continue to assure the public’s health.

ONC 2017 Interoperability Standards Advisory: Now in its third year, this material gets longer and longer, and more and more complex each time. The current incarnation is a navigable website chock full of standards, though you can still download a PDF by clicking on the “2017 ISA Reference Edition” or “ISA 2017” links.

ONC 2016 Report to Congress on Health IT Progress: This HITECH-required report updates Congress about progress during the past year. While it is a really good summary of recent and current activities and initiatives, it only deals with what is really going on (or not going on) on the ground in a cursory way.

National Governors Association Road Map for States to Improve Health Information Flow Between Providers: A very detailed report aimed at State policy makers with clear guidance – and lots of examples – to try to move interoperability forward at the State level.

There are no easy answers here, and it’s easy to get overwhelmed by the information presented in these reports. But they cannot be ignored and can help form the basis of a solid organizational or governmental strategy.

The Reduction of State-coordinated HIE: How Should Public Health React?

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The Reduction of State-coordinated HIE: How Should Public Health React?

A recent article in HealthAffairs describes a significant decline in the number of both operational HIEs and HIEs in the planning stage from several years earlier. The authors note ...

A recent article in HealthAffairs describes a significant decline in the number of both operational HIEs and HIEs in the planning stage from several years earlier. The authors note continuing barriers to broad-based HIE and a shift to vendor-driven exchange which diminishes the effectiveness of community-based networks. In effect, this translates to a shift away from geographic-based/dominated HIEs to product-dominated HIEs. We have already noted (see The Interoperability of Things) the lack of a national strategy on HIE, and ONC’s Nationwide Interoperability Roadmap barely mentions the concept.

Consumer Access to Health Care Data: Still a Challenge

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Consumer Access to Health Care Data: Still a Challenge

Consumers continue to be frustrated with lack of access to their healthcare data, even as wearables and other consumer-targeted devices and services continue to sprout. Recently, O ...

Consumers continue to be frustrated with lack of access to their healthcare data, even as wearables and other consumer-targeted devices and services continue to sprout. Recently, ONC launched a Consumer Health Data Aggregator Challenge to spur the development of new applications and partnerships to provide aggregated health data to patients. While the financial “prize” for this effort is meager, recognition by ONC might be the real brass ring. This challenge focuses on the use of FHIR exclusively to support interoperability between systems and present data to consumers. I suspect that applicants will have some trouble meeting the requirements of the challenge effectively, and this is indicative of the broader challenge in supporting this type of data access.

Or Maybe It’s Siloed Workflow?

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Or Maybe It’s Siloed Workflow?

In an earlier post I wondered whether public health’s siloed systems might not be more appropriately thought of as siloed data. But after attend a meeting of the Joint Public Healt ...

In an earlier post I wondered whether public health’s siloed systems might not be more appropriately thought of as siloed data. But after attend a meeting of the Joint Public Health Informatics Taskforce (JPHIT) I am wondering whether the issue is really siloed workflow.

In public health, data is used to support specific programs, and systems develop to provide a means to collect, analyze, and disseminate this data. Individuals in the programs define the data sets and create systems that support specific protocols and activities that are considered unique to the program area. This is often the result of increased specialization in both the clinical and epidemiological practice and can result in processes that are at their core quite similar being described in diverse ways. Data definitions, codes and terminology sets often also evolve in a divergent way when often they are describing the same qualities or attributes, often about the same patients, conditions, or environment.

Public health agencies need to focus on the commonalities across their programs rather than on the differences. Existing and emerging standards activities should help promote a convergence of systems, data, and workflow to increase interoperability, reduce redundancy, and promote sharable, reusable, cheaper system components. As collaboration among programs and agencies moves some implementations to shared solutions or cloud-based implementations, public health needs to be careful not to create a set of siloed platforms that provide parallel, non-interoperating services to the same agencies.

Siloed Systems or Siloed Data?

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Siloed Systems or Siloed Data?

Categorical funding, insufficient resources, and lack of agency vision keep public health systems isolated and unintegrated – a phenomenon often referred to as “siloed” systems. In ...

Categorical funding, insufficient resources, and lack of agency vision keep public health systems isolated and unintegrated – a phenomenon often referred to as “siloed” systems. In a 2007 white paper on the Evolution of Public Health Information Systems I argued that public health agencies needed to think about enterprise-wide systems integration, and several models from distributed, to cooperative, to more centralized were offered for consideration. More recently the action has shifted to interoperable systems (see both the ONC Nationwide Interoperability Roadmap, and my reaction to it in The Interoperability of Things). Interoperability focuses more on the implementation of standards that permit data to flow between systems rather than on combining disparate systems into larger objects to facilitate data sharing.

While this distinction between system integration and system interoperability does have implications for system architects, at the end of the day users are concerned about data. It is more important to focus on siloed data rather than siloed systems as a way to break the impasse that often arises when an agency tries to improve its operational or analytical capabilities. Agencies should consider many different strategies – system redesign, Commercial and Government off-the-shelf (COTS/GOTS) solutions, Master Data Management (MDM) strategies, service-oriented architecture (SOA), Open Source components – but always focus on the impact on the user and ultimately on the user’s experience. And of course as time goes on agencies will want to exchange data with systems outside of public health more and more which requires even more flexibility.