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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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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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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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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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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