Feature Articles

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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The Story of How our Health Informatics Textbook Came into Being

I have been asked many times how and why I became interested in Health Informatics and how that led to the writing and self-publication of our textbook, Health Informatics: Practical Guide. The textbook is now in its 7th edition and has been adopted by a large number of universities for their health informatics courses. More co-authors have come on board, and we are now looking at publishing other textbooks. Thus we thought this would be a good point to tell the story.

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Using the Open Source LibreHealth EHR for Education in Academic Settings

Traditionally, access to EHRs has been viewed as important only for software training, particularly order entry. What seems to be overlooked is the potential for education, analytics and research. Additionally, one could argue that there should be an open-source “EHR Sandbox” so multiple external EHR integrations could be studied and reported. Furthermore, many EHR users view the software as a means to enter or extract data on one patient at a time and fail to see the benefit in analyzing their entire clinic population (population health). The following diagram displays how an EHR could be used for education, training, analytics and research.

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How Cyber Hardening Can Protect Patient Privacy And Treatment

The abundance of internet-connected devices that collect and share patient data has greatly increased the “attack surface” (where an attacker inserts or extracts data) and number of possible vulnerabilities within a system. Now that medical devices can connect to home-based routers, public Wi-Fi or cellular networks to relay data to hospitals, specialists, and care providers. In addition, the software in those devices lacks cybersecurity and can be updated and reprogrammed remotely. Thus, sensitive patient information is even more prone to data breaches, and the safety of the devices can be compromised. Recent supply chain compromises, and the migration of health applications and platforms to the cloud, also add to the threat equation. This article looks at why the medical community is so vulnerable and suggests how it can better protect life-saving equipment and sensitive data from unprecedented cyberattacks.

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Medicaid as a Service Part II: The State’s Perspective

This article is the second in a series of four proposing a revolutionary new direction in Medicaid Management Information Systems (MMIS) structure and pricing...Our first article, outlining the general scheme, may be read here. To summarize, we propose that states treat MMIS as a service, as opposed to treating it as a procurement. Put another way - MMIS is a verb (Something you do) vice a noun (something you possess). In the current paradigm, individual States (to include the District of Columbia) create independent, stand-alone MMIS platforms with long contract lead- and execution- times.

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HIMSS 18 and the Disruption of the Traditional Office Visit

Healthcare is evolving quickly and HIMSS 18 offers a broad range of healthcare issues to explore, but will it recognize the disruption of the traditional office visit? New requirements for implementing HIT systems are changing as new health IT priorities and procedures emerge. Convergence in the health care sector is accelerating the need for interoperability, not just for EHRs, but also across clinical, financial, and operational systems. This need is also challenging and changing one of the biggest traditions in healthcare—the doctor-patient medical visit. 

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DHIS2 - Transforming Health IT Standards in the Developing World (Part 2)

Rwanda's 2012 implementation of DHIS2 is one of at least 16 completed national rollouts of this free and open source health data management. A total of 54 countries are deploying DHIS2 on a national scale, 30 of which are in the pilot stage or early phase in their rollouts. Since DHIS2's release in 2006, NGOs and national governments in 60 countries have deployed DHIS2 for health-related projects, including patient health monitoring, improving disease surveillance and pinpointing outbreaks, and speeding up health data access.

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Drones and the Future of Disaster Response

Four continental states and one U.S. territory took a beating this fall as one natural disaster after another rocked communities in Northern California and along the Gulf Coast, spreading disaster relief resources and personnel thin as federal, state, and local governments scrabbled to address the crises. Wildfires in California's wine country claimed at least 42 lives, 8,400 structures, and 245,000 acres of land in October. Hurricanes Harvey and Irma pummeled Louisiana, Texas, and Florida only to be followed by Hurricane Maria, which slammed Puerto Rico on September 20 and left much of the U.S. territory without communications systems, electricity, clean water, or functioning hospitals....

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HLN's Report on Patient Centered CDS Learning Network Conference

The Learning Network is an initiative funded by the Agency for Healthcare Research and Quality (AHRQ) whose goal is to encourage collaboration and development of tools and resources to support clinical decision support (CDS) as it relates to individual patients and their caregivers. This work is an offshoot of the Patient-Centered Outcomes Research (PCOR) initiative which focuses on the relationship between healthcare providers in patients in making better, more informed, healthcare decisions. A sister project to the Learning Network is the AHRQ-funded CDS Connect Repository which has begun to house shareable CDS artifacts which represent evidence-based standards of care.

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Developing Nations Improving Health Communication Through the Use of DHIS2 (Part 1)

DHIS2 implementations are spreading steadily among national health services in developing countries as well as among international non-governmental organizations (NGOs) working to improving health in the developing world through the use of health information technology. As an open source solution, DHIS2 offers developing countries the advantage of adopting a cost-effective and flexible solution for aggregate statistical data collection, validation, analysis, management, and presentation as well as for data sharing between healthcare professionals and facilities. Organizations and individuals who work with humanitarian software solutions will need to know what DHIS2 is, how it works, and how it might be implemented by national health services and other health-related projects across the globe...

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Why Cloud-Based Public Health Solutions are a Good Option for Clinical Decision Support

Cloud computing is one of the most powerful technology deployment strategies in use today. In fact, the notion of cloud resources has become prominent in consumer computing with only a limited understanding of what it means or does (e.g., Apple iCloud and Google Cloud). In this article we will examine some of the key reasons to host public health clinical decision support (CDS) solutions in the cloud. In a recent national survey, 95% of respondents indicated that they were using some form of cloud computing in their environment...The first step is to to understand the difference between cloud computing and traditional computing.

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A New Pricing Model for Medicaid Management Information Systems (MMIS)

The Centers for Medicare & Medicaid Services’ (CMS) recent $5 billion-per-year commitment to modular Medicaid Management Information System (MMIS) technologies has signaled a long-overdue paradigm shift in the way we think about Medicaid information systems. This shift is already beginning to revolutionize and improve a health care system that over 73 million people depend on every day. Currently, MMIS services is at least a $7 billion-per-year industry. As the influence of modular, cloud-based, and SaaS (Software as a Service) technologies continue to exert themselves on MMIS, this industry will mature and move into the 21st century. One exciting aspect of this maturation will be a new pricing model for MMIS services.

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Moving Counter-Clockwise: Lessons from Hurricanes, Floods and Earthquakes

The plethora of natural disasters raises all sorts of complicated but expected issues – from discussions of the legitimacy of global warming to the adequacy (or lack thereof) of on the ground relief efforts. One would have thought that post-Katrina, we would be ready, willing and able to provide immediate relief to those in need of disaster relief...despite capacities, we have been stunningly slow in moving these new services into disaster areas. Instead of technology advancing the ball, it is as if we are moving our clocks backwards. Sure, in the absence of cell towers, creative workarounds have been enabled like ATT&T facilitating communications to/from the mainland for its customers.

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Reflecting on Data as a Service Provider in Education

One would think that all educators have been keen for decades on collecting, analyzing, thinking about, using data creatively and making data available across the disciplines and within their own institutions.  Sadly, this has not happened.  Education is way behind healthcare in this regard. Within the past several decades, though, have data have become the “new kid on the education block” and have garnered real interest.  Indeed, institutions now talk about data informed decision-making although to be sure, it often stops -- not enables – innovation because the absence of data is rolled out as the excuse for making forward progress.

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Improving Healthcare Delivery: Data as Service Provider

We have all experienced, or know someone who has experienced, problems with our healthcare delivery systems. To be sure, there are commonalities among the issues that arise but each patient’s situation has unique, personal features.  These differences can lead to vastly different outcomes, including those affecting family caregivers. Consider a couple general examples. There can be a range of medical errors, whether caused by physicians or other medical personnel, some largely inconsequential and others leading to devastating outcomes; there can be discontinuity of care with siloed or non-integrative providers and procedures where each sector of the medical profession is working to solve the body part problem in their limited sphere and coordination is hard to achieve...

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