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 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.
HLN has released a product Roadmap for its award winning Immunization Calculation Engine (ICE). ICE is an open source service-oriented, standards-based immunization forecasting software system that evaluates a patient’s immunization history and generates the appropriate immunization recommendations. The Roadmap describes modifications that have already been scheduled for inclusion in new releases of ICE in the near future, in addition to ongoing changes that may be required to maintain compliance with Advisory Committee on Immunization Practices (ACIP) recommendations. Addition of new vaccine schedules, changes to core business logic, and additional functionality are all included on the Roadmap. As additional modifications are scheduled they will be published on the Roadmap as well. HLN hopes this information will help clinical organizations seeking to use ICE in their practices and software vendors seeking to incorporate ICE into their products to plan for new feature availability.
ICE provides state-of-the-art clinical decision support for immunizations (CDSi). ICE can be used in Immunization Information Systems (IIS), Electronic Health Records (EHR), Health Information Exchanges (HIEs), and Personal Health Record (PHR) Systems.
See Press Release
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. Noam Arzt, President of HLN, attended the second annual Netsmart Public Health Summit. This meeting brought together representatives from local public health agencies who primarily use NetSmart’s public health electronic health records software. Dr. Arzt was invited to attend and he delivered a presentation on Clinical Decision Support Tools for Public Health.