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ONC Selects Noam Arzt to serve on the Trusted Exchange Framework Task Force

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ONC Selects Noam Arzt to serve on the Trusted Exchange Framework Task Force

The Office of the National Coordinator for Health Information Technology (ONC) has selected Dr. Noam H. Arzt, President of HLN Consulting (HLN), as a member of the Trusted Exchange ...

The Office of the National Coordinator for Health Information Technology (ONC) has selected Dr. Noam H. Arzt, President of HLN Consulting (HLN), as a member of the Trusted Exchange Framework Task Force. This group of healthcare and health information technology specialists will advise ONC on various aspects of the Draft Trusted Exchange Framework. This framework outlines a common set of principles for trusted exchange of health information records and minimum terms and conditions for trusted exchange as directed by Congress in the 21st Century Cures Act.

The task force is expected to consider a number of important implementation issues for the framework, including the nature of the coordinating body that ONC envisions for this activity (the Recognized Coordinating Entity, or RCE); the definition, attributes, and functioning of the organizations that will operate within this framework to exchange data (the Qualified Health Information Networks, or QHINs); issues related to privacy and security that must be understood and settled before interoperability can take place; and determination of exactly what activities and uses will be supported by the network.

Dr. Arzt has been a vocal proponent of health data interoperability and health information exchange for many years, with particular emphasis on public health’s needs and activities. Dr. Arzt has written extensively on the challenges and potential solutions to interoperability, including The Interoperability of Things which describes why interoperability in the US seems so hard to achieve. In a recent blog post (HIE: The New Landscape), Dr. Arzt described the state of health information exchange today and the changes that have taken place since Federal funding under the HITECH Act ended. He has also written key articles on important issues in health information technology such as information blocking, the state of patient matching strategy in the US, and cloud computing.

Dr. Arzt recently submitted public comments related to TEFCA on behalf of HLN, and participated in the responses developed and submitted by key organizations including the American Immunization Registry Association (AIRA), American Medical Informatics Associations (AMIA), Healthcare Information and Management Systems Society (HIMSS), and the Joint Public Health Informatics Task Force (JPHIT).

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).

Update on Patient Matching Activities

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Update on Patient Matching Activities

I have written several times about patient matching in the US, both in a blog entry and a published article. On December 11, 2017 the Office of the National Coordinator for Health ...

I have written several times about patient matching in the US, both in a blog entry and a published article. On December 11, 2017 the Office of the National Coordinator for Health Information Technology (ONC) sponsored a half-day “Interoperability in Action” webinar focused on Patient Matching Milestones at ONC (see agenda and slides). The webinar focused on four ONC projects from the past year. Here’s a quick run-down on what they covered.

Two New Reports on Interoperability

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Two New Reports on Interoperability

Two new reports have been released on interoperability in September 2017 with potential impact on public health. The Office of the National Coordinator for Health Information Techn ...

Two new reports have been released on interoperability in September 2017 with potential impact on public health. 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.

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.

HLN Attends August ONC 2017 Technical Interoperability Forum

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HLN Attends August ONC 2017 Technical Interoperability Forum

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 la ...

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.