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:
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.
Noam Arzt, president of HLN, has published a new article, “Why Cloud-Based Public Health Solutions are a Good Option for Clinical Decision Support” in OpenHealthNews. Cloud computing is one of the most powerful technology deployment strategies in use today. In this article Dr. Arzt examines some of the key reasons to host public health clinical decision support (CDS) solutions in the cloud. The article goes on to explain the difference between cloud computing and traditional computing. It then goes on to define Clinical Decision Support for Immunizations, or CDSi, and HLN’s Open Source Immunization Calculation Engine (ICE) and related tools and utilities. Finally, the article concludes with a discussion of how externally hosted services may provide some distinct advantages for organizations that deploy CDS tools such as these.
On October 3, 2017 Noam Arzt and Daryl Chertcoff from HLN attended the Patient Centered Clinical Decision Support Learning Network (PCCDS-LN) 2017 Annual Conference in Crystal City, VA. HLN was also a Bronze-level Sponsor of this event, which brought together clinicians, informaticists, and health policy advocates to discuss current trends in clinical decision support leveraging information from Patient Centered Outcomes Research (PCOR) findings and patient-specific information. The conference featured national experts in CDS and patient-centered research in the morning, and a participative set of breakout sessions in the afternoon developing an idealized design of the patient-centered CDS process through four different perspectives.
Must of this conference focused on patient-centered CDS. But it seems that this term absorbs a number of somewhat different concepts and is used by different people to mean different things. “Patient centered” to some people means “patient-facing” – that is, it refers to an application (in this case a CDS-enabled application) that is used or accessed by a patient directly. To others, patient-centered is synonymous with “patient-empowered” which implies support for more patient control of his or her care and records. Many uses of CDS support do not directly involve patients in real time while still impacting patients and their care.
For HLN’s work in clinical decision support, this conference presented a number of useful themes and raised a number of important issues. While there was a lot of focus at this conference on user interface, it is important for HLN to maintain its focus on the back-end services we are developing (like our ICE Open Source Immunization Forecaster). But it is equally important that we continue to develop a rich set of application programming interfaces (APIs) to our services, including our traditional SOAP-based Web Services, supplemented by various RESTful services (including FHIR, SMART, and CDS Hooks). And all of this work should support and use accepted standards embraced by the healthcare industry.
See article in OpenHealthNews