Noam H. Arzt

See the following -

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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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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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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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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HLN and Oregon Health Authority Present Optional Approaches to Oregon's School Immunization Reporting Process at Atlanta Conference

At the 2018 National Immunization Conference (NIC) held in Atlanta May 15-17, HLN co-presented Diverse Stakeholder Perspectives to Improve Oregon’s School Immunization Reporting Process in collaboration with the Oregon Immunization Program (OIP). Aaron Dunn, Oregon’s Immunization Program Manager, and Marcey Propp, HLN Project Manager, presented the project context, approach, and outcomes as part of the segment for Improving measurement and reporting to foster clear vaccine communication. The project context included antiquated technology, the growing complexity of vaccine requirements, and excessive, redundant and unnecessary workload that culminated in making the current school immunization reporting process unsustainable.

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HLN Releases New Version of Open Source Immunization Forecaster

Press Release | HLN Consulting | August 2, 2017

HLN Consulting has released a new version of the award winning Immunization Calculation Engine (ICE). ICE is a service-oriented, standards-based immunization forecasting software system that evaluates a patient's immunization history and generates the appropriate immunization recommendations. ICE can be used in Immunization Information Systems (IIS), Electronic Health Records (EHR), Health Information Exchanges (HIEs), and Personal Health Record (PHR) Systems. The release includes changes to the rules for several vaccine series, including Polio, Meningococcal ACWY, and Influenza.

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HLN Releases Roadmap for Open Source Immunization Forecaster

Press Release | HLN Consulting | September 18, 2017

On September 7, 2017 HLN Consulting released a product Roadmap for its award winning Immunization Calculation Engine (ICE). ICE is an open source service-oriented, standards-based immunization forecasting software system that evaluates a patient's immunization history and generates the appropriate immunization recommendations. The Roadmap describes modifications that have already been scheduled for inclusion in new releases of ICE in the near future, in addition to ongoing changes that may be required to maintain compliance with Advisory Committee on Immunization Practices (ACIP) recommendations...

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HLN Releases v 1.9.1.0 of its Open Source Immunization Forecaster

Press Release | HLN Consulting | October 11, 2017

HLN Consulting has released a new version of the award winning Immunization Calculation Engine (ICE). ICE is a service-oriented, standards-based immunization forecasting software system that evaluates a patient's immunization history and generates the appropriate immunization recommendations. ICE can be used in Immunization Information Systems (IIS), Electronic Health Records (EHR), Health Information Exchanges (HIEs), and Personal Health Record (PHR) Systems...

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HLN Submits Comments to the CMS Quality Payment Program

On June 14, 2018 HLN submitted the following comments on the Centers for Medicare and Medicaid Services (CMS) 2019 Inpatient Prospective Payment System Notice of Proposed Rulemaking (NPRM) to Quality Payment Program based on our earlier comments...We are quite concerned by both the overall direction and the specific recommendations regarding public health objectives and measures in the NRPM. Regarding the changes to the proposed measures, CMS has not provided any explanation for why Syndromic Surveillance reporting was selected as the required measure. Other public health measures (e.g., Immunization reporting, Electronic Laboratory Reporting, Electronic Case Reporting) continue to require incentives for implementation.

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HLN's Open Source Immunization Forecaster Receives 2017 Upshot Award

Press Release | HLN Consulting | June 12, 2017

On June 6, 2017, HLN was awarded the 2017 Upshot Award for Excellence in Vaccine Supply, Access, and Use by the US Department of Health and Human Services National Vaccine Program Office (NVPO) for its ICE Open Source Immunization Forecaster. In the letter of award, Dr. Jewel Mullen, Principal Deputy Assistant Secretary for Health commented that, "HLN Consulting's efforts on the Immunization Calculation Engine (ICE) are impressive. This powerful tool-including its open-source nature and seamless integration into clinical workflows-holds great promise for improving clinical decision-support and ultimately vaccination rates. Thank you for daring to innovate, collaborate, and lead in an area that is not only complex, but constantly evolving."

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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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Key exhibitor booths at HIMSS18 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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Multiple New Reports on Interoperability Released

Two new reports on interoperability, and a related Call to Action were released in fall 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. The Call to Action released by the Health Information Management and Systems Society (HIMSS) calls on the Department of Health and Human Services (HHS) to demonstrate leadership and promote progress in a number of key areas.

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New Modalities for Technical Assistance Consulting

Technical assistance (TA) is provided by expert consultants to public health systems projects in order to improve their performance against functional standards or to help solve recurring or one-time problems or issues. Unlike other forms of training or support, TA is usually focused or tailored to a specific circumstance or situation. Common examples of TA include assistance to a jurisdiction in migrating from one product to another, consultation related to a specific programmatic initiative such as school immunization health compliance, EHR interoperability implementation, or data quality review.

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