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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).

HLN Participates in PCORS CDS Learning Network National Webinar

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HLN Participates in PCORS CDS Learning Network National Webinar

HLN organized and participated in a national webinar titled CDS for Immunizations (CDSi): A Community and Standards-based Approach on January 18, 2018. Speakers included: Dr. ...

HLN organized and participated in a national webinar titled CDS for Immunizations (CDSi): A Community and Standards-based Approach on January 18, 2018. Speakers included:

  • Dr. Noam Arzt, President of HLN, who spoke about the business case for clinical decision support for immunizations, and about HLN’s Open Source ICE vaccine evaluation and forecasting product
  • Stuart Myerburg from CDC who spoke about the CDC CDSi project
  • Angel Aponte from the NYC Department of Health and Mental Hygiene who spoke about real-work implementations in the Citywide Immunization Registry (CIR)

Over 50 individuals participated in the webinar which was sponsored by the Patient-Centered Clinical Decision Support (CDS) Learning Network (PCORCDS).

Approaches for IIS-HIE Collaboration

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Approaches for IIS-HIE Collaboration

We have written in a previous policy white paper about collaboration between Immunization Information System (IIS) projects and Health Information Exchange (HIE) networks, and a se ...

We have written in a previous policy white paper about collaboration between Immunization Information System (IIS) projects and Health Information Exchange (HIE) networks, and a second more technical white paper about options for interoperability between IIS and electronic health record (EHR) systems. We described a range of interoperability options for EHR users and IIS and the strengths and challenges of each alternative:

HIE: The New Landscape

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HIE: The New Landscape

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 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.

HLN Presents at AMIA 2017 on RCKMS

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HLN Presents at AMIA 2017 on RCKMS

On November 8, 2017 Dr. Noam Arzt, President of HLN, participated in a panel discussion titled, "Advancing Electronic Case Reporting (eCR) to Enable Public Health Disease Control a ...

On November 8, 2017 Dr. Noam Arzt, President of HLN, participated in a panel discussion titled, “Advancing Electronic Case Reporting (eCR) to Enable Public Health Disease Control and Emergency Response: Getting Into the Technical Weeds.” Along with his colleagues from the University of Utah, the Association of Public Health Laboratories (APHL), and CGI Federal, this session discussed details of the current national implementation of electronic case reporting (eCR) including its sponsorship by the Digital Bridge project. Specifically, Dr. Arzt presented on various models of deployment for the clinical decision support (CDS) component of eCR, referred to as the Reportable Condition Knowledge Management System (RCKMS).

Dr. Arzt suggested in this talk that while there are strong reasons why a centralized decision support service is recommended at this time (and is in fact being deployed), other more decentralized CDS options are possible, including replication of the centrally-deployed software at a local site or incorporation of the national CDS rules themselves into a local CDS product (for instance, by using CQL). Given the diversity of systems in the US and the varying timetables for implementation, likely all these strategies will be enabled over time. The most important thing is for all these deployment strategies to rely on a single, consistent set of rules developed by public health and compliant with state and local jurisdiction law and policy.