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 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.
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.
Dr. Noam Arzt, president and founder of HLN, has been appointed to the Office of the National Coordinator for Health Information Technology Health Information Technology (ONC) Policy Committee (HITPC)/Health Information Technology Standards Committee (HITSC) Public Health Task Force. It’s overall charge is to, “make recommendations to help inform public health issues and challenges related to health IT.” More specifically, the Task Force will initially, “Make specific recommendations to better assist in the standardization of pregnancy status data, clinical decision support in health IT systems, and case management in public health settings—which are important components to addressing many public health challenges.”
Task for recommendations to the HITPS/HITSC are expected in April 2017.