Noam H. Arzt

See the following -

A Public Health Perspective on ONC's Strategy to Reduce Burden on Physicians

On November 28, 2018, the Office of the National Coordinator for Health Information Technology (ONC) released a draft Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs for public comment. The strategy aims to reduce the time and effort and improve the functionality of electronic health records (EHRs) for clinicians, hospitals, and other healthcare organizations. This strategy was developed primarily through the efforts of ONC-convened workgroups in response to requirements laid out by Congress in the 21st Century Cures Act (Section 13103). The report itself does not identify who exactly served on these workgroups and what organizations were represented.

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A Public Health Perspective on the CMS Quality Payment Program

I have seen several pretty good summaries of the recently 0release Centers for Medicare and Medicaid Services (CMS) 2019 Inpatient Prospective Payment System Notice of Proposed Rulemaking (NPRM) to Quality Payment Program (one from AMIA, one from CDC). Here are just a few additional tidbits I picked out of the NPRM. Of course, this document is written like stereo instructions so I welcome any corrections or comments to my interpretation of what’s in the rule. I put page numbers (from final FBO version referenced above which has just been released) where relevant in parenthesis. And I apologize in advance as much of what’s here is cryptic to anyone who has not been exposed to this before and I don’t make much of an attempt to explain the context (or even the acronyms)...

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AHRQ Releases Draft Guide for Registry Interoperability: Does Public Health Have a Role?

On January 11, 2019, the Agency for Healthcare Research and Quality (AHRQ) released a draft Addendum to the Third Edition of Registries for Evaluating Patient Outcomes: A User's Guide called Tool and Technologies for Registry Interoperability. AHRQ has long written about registries - largely from a research standpoint - and I have been following this from afar for some time. This new guide is focused on helping those who both create and use registries understand the issue surrounding leveraging external data to improve registry completeness, accuracy, and usefulness. This report covers lots of ground and does a good job of summarizing important subtopics. Each chapter is overflowing with footnotes and sources.

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AIRA 2018: Is Open Source the Key to Immunization Software Sustainability?

On August 14-16, 2018 the American Immunization Registry Association (AIRA) held its 2018 National Meeting. This meeting brought together more than 350 informatics professionals, public health officials, EHR vendors, and other stakeholders who all care passionately about Immunization Information Systems (IIS) and their role in the healthcare community. IIS projects leverage interoperability with EHRs, PHRs, and other systems to promote clinical practice at the point of care; enable public health surveillance, and reduce cost by assisting in preventing both under and over immunization.

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Anatomy of a Public Health Open Source Project: HLN's Immunization Calculation Engine (ICE)

An immunization information system (IIS) aggregates immunization information for children (and some adults) living or receiving immunization services in a jurisdiction. One of the core components of an IIS is its immunization evaluation and forecasting system: the computerized algorithm that is used to determine if vaccine doses that were administered to the patient are clinically valid (evaluation) and to project what doses are due now and in the future (forecasting). These algorithms are used to support clinical decision support (CDS) at the point of care and also to help public health agencies understand and manage the immunization status of whole populations.

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Approaches for Immunization Information System (IIS) Project Collaboration with HIE Networks

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...

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Are Open Source Clinical Decision Support (CDS) Services Subject to HIPAA Regulations?

Clinical Decision Support (CDS) services such as HLN’s Immunization Calculation Engine (ICE) are modular, loosely-coupled components of larger systems accessed via web services in a service-oriented architecture (SOA). Under HIPAA, services provided to Covered Entities (CE) which involve protected health information (PHI) as defined in the statute are subject to the regulation. But are CDS services such as ICE subject to this regulation?

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CDC Issues RFI for Real-world Testing of Health Information Technology

In October the Centers for Disease Control and Prevention (CDC) issued a Request for Information (RFI) for a Natural Test Collaborative (NTC). Through a series of questions, the RFI seeks opinions and information about "The development of a national testbed (notionally called the National Test Collaborative (NTC)) for real-world testing of health information technology (IT)" and "Approaches for creating a sustainable infrastructure" to achieve it. The scope of the questions is somewhat confusing and quite broad, starting with Clinical Decision Support (CDS) and electronic Clinical Quality Measures (eCQMs) but quickly expanding to Electronic Health Records (EHR) and interoperability (not precisely defined).

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CMS Promoting Interoperability Program: A Public Health Perspective

Well, here we go again. The Centers for Medicare and Medicaid Services (CMS) has now released a new Notice of Proposed Rulemaking (NPRM), titled Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program...As this NPRM was released, the CMS Administrator, Seema Verma, published an open letter to doctors which is focused on reducing the burden on doctors so they can spend more time with physicians. HL7 has begun a similar initiative on reducing clinical burden. So the key question is: Does this NPRM go far enough to reduce provider burden in the spirit of Dr. Verma's letter?

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Consumer Access to Health Care Data: Still a Challenge

Consumers continue to be frustrated with lack of access to their healthcare data, even as wearables and other consumer-targeted devices and services continue to sprout. Recently, ONC launched a Consumer Health Data Aggregator Challenge to spur the development of new applications and partnerships to provide aggregated health data to patients. While the financial “prize” for this effort is meager, recognition by ONC might be the real brass ring. This challenge focuses on the use of FHIR exclusively to support interoperability between systems and present data to consumers. I suspect that applicants will have some trouble meeting the requirements of the challenge effectively, and this is indicative of the broader challenge in supporting this type of data access.

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DSS and HLN Consulting Partner to Offer Enhanced Immunization Forecasting Solution

Press Release | Document Storage Systems, Inc., HLN Consulting | July 17, 2018

Document Storage Systems, Inc. (DSS), a leading provider of health information technology (HIT) solutions for federal, private and public healthcare organizations, announced that it has partnered with HLN Consulting to offer an enhanced forecasting solution that provides clinical decision support (CDS) for immunizations. HLN Consulting’s open source Immunization Calculation Engine (ICE) is now interfaced with the DSS Immunization Dashboard (iDB), to bring patient-specific immunization forecasting to the provider without an interface to a registry. iDB provides a visualization of the patient’s historical record from the treating facility, as well as information from the Immunization Registry.

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Electronic Case Reporting (eCR) Takes Front Stage at PHI2018 Conference

But the real buzz at the conference seemed to be about electronic case reporting (eCR). This refers to the national effort to replace the current paper and FAX process of submitting reportable conditions from clinical care sites to state and local public health agencies with a more automated electronic process fed from electronic health records (EHRs)...HLN demonstrated the workflow for eCR at the HIMSS18 Interoperability Showcase. However, we did not see a lot of interest on eCR at the HIMSS conference. At PHI2018 we had significant interest, both among public health officials who were anxious to see how they could initiate eCR in their jurisdictions, and other vendor and stakeholder groups who seemed to feel eCR was becoming viable and more “real.”

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Feature Overlaps Between Immunization Information Systems and EHRs

Immunization Information Systems (IIS) have been around for nearly twenty years. Their functionality, completeness, and usefulness have all increased over this time. IIS and electronic health record (EHR) systems have always had unique features, as well as some overlapping features, and the deployment of EHRs has enhanced the local immunization capabilities of clinician practices. Several critical clinical features that are considered to be core functions of IIS are beginning to be supported by EHRs. This article will review and discuss five such critical features: online data entry, clinical decision support for immunization, reminder-recall, practice-level assessment of up-to-date status, and patient access to their immunization data.

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HIMSS18: Key Exhibitor Booths for Open Solutions, Collaboration, and Interoperability

The annual gargantuan HIMSS conference is back at Las Vegas with over 40,000 participants, over a thousand exhibitors, and more than 600 presentations. As we saw last year in Orlando, more than half of the conference presentations are focused on applications based on open source such as FHIR and Blockchain, and a great emphasis on open solutions for interoperability. With so many presentations and exhibits, it is impossible to provide a full overview. Below are a few of some of the most interesting exhibits of open solutions this year.

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HIMSS19: What to Look Out For

The 2019 HIMSS Annual Conference and Exhibition is in many ways a daunting event. Upwards of 40,000 people will likely attend this combination of educational experience, trade show, and overall shmooz-fest. But many people who go to this conference have a tough time: its sheer size can be quite overwhelming. There are pre-conference symposia, popular and important keynote speakers, educational sessions along with a myriad of topical tracks, and a massive exhibition hall that runs the full length of the Convention Center. Here are some of the things I'll be looking for this year to try to focus my activities...

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