Noam H. Arzt

See the following -

ONC's Trusted Exchange—A Public Health Perspective

In January 2018 the Office of the National Coordinator for Health Information Technology (ONC) issued a draft Trusted Exchange Framework and Common Agreement (TEFCA), and related supporting documents, in response to a requirement imposed by Congress in the 21st Century Cures Act. The Act says that the TEF may include a common method for authenticating users, a common set of rules, enabling policies, and a process for managing non-compliance. Nowhere does the Act instruct ONC to determine an actual technical architecture in this process, though such a step is not precluded either. The primary document is in two parts: Part 1 is a set of principles that set the foundation for Part 2 which is a set if minimum terms and conditions for trusted exchange.

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Open Source Immunization Forecaster Updated to Support Pfizer COVID Vaccine

Press Release | HLN Consulting | December 16, 2020

On December 15, 2020, HLN released a new version (v1.26.2) of the Immunization Calculation Engine (ICE) in support of the Pfizer COVID vaccine. ICE is a state-of-the-art open source software system that provides clinical decision support for immunizations for use in Immunization Information Systems (IIS), Electronic Health Record (EHR), and Personal Health Record (PHR) Systems. Version 1.26.2 includes support for new COVID-19 Vaccine Group (with the Pfizer vaccine only). A subsequent release, coming soon, will likely add support for the Moderna vaccine. Read More »

Open Source in the Worldwide COVID-19 Response

February marks the celebration of creation of the Open Source Initiative (OSI) in 1998. OSI created the standard definition of the term Open Source that helped guide many of LPI's initiatives today. Through the past year, open source provided many opportunities to organizations to continue to work, implement their projects, and continue reaching out to communities. Here are just a few examples of how open source provides opportunities through the face of COVID-19. The COVID-19 crisis brought out all the creativity of the open source movement. In every area of innovation--open source software, open data, open collaboration, and even open equipment--companies and research institutes have addressed medical and public health needs quickly. This article highlights some of the initiatives in each area.

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Open Source Solutions For Public Health Case Reporting and COVID-19

The United States is continuing its slow emergence from a nation-wide shut down imposed to slow down the spread of COVID-19. Most states have started to reopen, with bars, restaurants, and many workplaces starting to fill. As people begin to spend more time together again, it is critically important that public health agencies do everything they can to help prevent further spread of the infection and continue to monitor the level of infection within the population. Data is an important tool that public health has to understand what is going on in the country. Years of limited government investment and neglect of current systems has limited public health's ability to meet the challenges of managing both localized outbreaks and pandemics.

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Preliminary Thoughts on CMS Proposed MIPS IP Rule Changes: 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)...The purpose of this NPRM is to address proposed changes for Year 3 of the Merit-based Incentive Payment System (MIPS), the provider (as opposed to hospital) side of the Quality Payment Program. The part that is most relevant to public health is the Medicaid Promoting Interoperability (IP) Program for Eligible Professionals (EP)” (the EHR Incentive Programs have been renamed). A major goal of this NPRM is to synchronize as much as possible the EP program with the hospital-based program that was addressed in a previous NPRM just a few months ago.

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Preparing for 2017: Four Important Reports

With so much transition ahead of us at the Federal, state, and local levels in 2017, it is important to begin to plan for what the Health IT landscapes will look like for the coming year (and beyond). Several key reports have come out – mostly from government sources – which are worth serious consideration for any Health IT planner...There are no easy answers here, and it’s easy to get overwhelmed by the information presented in these reports. But they cannot be ignored and can help form the basis of a solid organizational or governmental strategy.

Ready or Not: New Report on Protecting the Public's Health

The Trust for America's Health (TFAH) released its 2019 edition of what it hopes will be an annual report, Ready or Not: Protecting the Public's Health from Diseases, Disasters and Bioterrorism last February. The ground-breaking report warns about key global challenges ahead, like the risk of a flu pandemic; the impact of weather pattern changes due to climate change; the dangers of antimicrobial resistance, and others, and tries to offer advice on how to prepare for them.

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Report on ONC’s Working Session on Patient Identity and Matching

On Monday, August 31, I attended the final Working Session on Patient Identity and Matching. This virtual event was hosted by the Office of the National Coordinator for Health IT (ONC). This Working Session was a followup to an earlier session back in June 2020. The event last week had over 300 attendees and covered a wide range of topics and technologies related to patient identity and matching. These ONC Working Sessions are being driven by requirements that are part of the 21st Century Cures Act as well as a Congressional request from December 2019 to continue to "...evaluate the effectiveness of current [patient identity and matching] methods and recommend actions that increase the likelihood of an accurate match of patients to their health care data." Much of the focus of this study has been on whether a national patient identifier should be implemented in the US.

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Report on the ONC 2017 Technical Interoperability Forum

Last week I attended with my colleague Mike Berry the ONC 2017 Technical Interoperability Forum. This meeting was convened under the 21st Century Cures Act passed by Congress in late 2016. Several hundred participants attended a series of panel presentations and discussions. The forum took place over one-and-a-half-days. The forum covered a variety of topics related to interoperability, including discussion of the business case for interoperability, semantics, national networks, and application programming interfaces (APIs). In many ways the speakers were “the usual suspects” involved in national networks, standards development, and HIE planning and implementation.

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So I Survived HIMSS19…

This was perhaps more of a fete than it initially seems. The conference was massive, with over 40,000 attendees. It centered around a trade show exhibit hall that spanned multiple football fields in length. In some ways, it was so big that I felt somewhat discouraged from attending some educational sessions because they were located so far from where I was hanging out that I could get back and forth in time. So I spent most of my time at the Interoperability Showcase since HLN was participating in two of the use cases: Immunization Integration & CDS, featuring our ICE open source immunization evaluation and forecasting system...

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Successful Public Health IT Project Collaboration

Most public health information technology projects rely on strong collaboration to be successful, especially across vendor-client boundaries. Here are some successful strategies: Clear vision. A concise and clear vision focused on public health outcomes is embraced and articulated by all participants in the project; Strong support and leadership from senior management. Without strong support from senior management, projects are rarely given the priority to enable success. This prioritization includes both agency and vendor commitment.

The Changing Face of Public Health System Procurement

The development and acquisition of public health systems is poised to change. Historically, public health agencies had the classic choice when it came to acquiring a new data system. Either they developed the system themselves – usually based on a belief that their requirements were “unique” – or they licensed a COTS/GOTS product from the limited choices available in a small market. Typically, agencies that chose to develop solutions were forced to use a waterfall approach as government procurement is not well suited to the flexibility of Agile systems development. Some agencies have been able to leverage open source offerings. While most do not have the wherewithal to support open source products themselves, many have formed strong partnerships with other organizations, both for-profit and nonprofit, to take advantage of these systems.

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The Evolving Landscape of Health Information Exchange

The original vision for nationwide health information exchange was a “network of networks” model where local HIEs would interact HIE-to-HIE to form a virtual national network. But notice that many of the new initiatives are essentially solving a different problem: they are enabling point-to-point connections across a wider geography and set of clinical sites. This seems more like a large, single national network rather than leverage of more distributed organizations or implementations. Only time will tell if these private sector initiatives will collaborate, converge or compete. And only time will tell of the limitations of ONC’s ability to influence and provide leadership will creates gaps or provide new opportunities for innovation.

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The Reduction of State-coordinated HIE: How Should Public Health React?

Noam ArztA recent article in HealthAffairs describes a significant decline in the number of both operational HIEs and HIEs in the planning stage from several years earlier. The authors note continuing barriers to broad-based HIE and a shift to vendor-driven exchange which diminishes the effectiveness of community-based networks. In effect, this translates to a shift away from geographic-based/dominated HIEs to product-dominated HIEs. We have already noted (see The Interoperability of Things) the lack of a national strategy on HIE, and ONC’s Nationwide Interoperability Roadmap barely mentions the concept.

The Sequoia Project Releases a Useful Workgroup Report on Information and Pandemic Response

In February 2022 the Sequoia Project released its Emergency Preparedness Information Workgroup’s Pandemic Response Insights and Recommendations. This workgroup was convened in the fall of 2020 at the height of the pandemic with a diverse set of stakeholders from all areas of the healthcare system. The resulting short report is worth a read as it offers concise analysis and recommendations. The first task the workgroup undertook was to conduct a SWOT (strengths, weaknesses, opportunities, threats) analysis focused on pandemic response. There was a strong public health focus that resulted from this activity: “During a declared emergency, and during non-emergency times as well, public health should be viewed as a collaborator and partner with equal access to shared data” (p. 6).