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The 'Year of Living Dangerously'

February 24, 2012
by Jennifer Prestigiacomo
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Federal agencies struggle to create HIE pathways to public health departments

At the Health Information Exchange (HIE) Symposium during the “Inter Agency Collaboration: A Federal Update” session on Monday, Feb. 20 at HIMSS12, federal leaders shared the pathways their agencies were creating to bridge local exchanges with public health despite limited funding from ARRA.

Seth Foldy, CDC, noted that this was the “year of living dangerously,” with meaningful use as the disruptive change forcing struggling public health departments to update legacy systems, as well as established HIEs having to translate their idiosyncratic exchange protocols to national standards. “There’s no national public health entity that does all this,” he emphasized.

Foldy noted that the three public health objectives, reporting laboratory results to state, creating immunizations registries, and maintaining syndromic surveillance, of meaningful use continues to be a challenge for states that lost revenues from recession.

Despite not receiving much money from the HITECH Act, CDC has been able to progress on several fronts, said Foldy. Among them was linking state HIT coordinators with RECs and national public health coordinators to assess community needs and learn best practices. He also mentioned the Laboratory Interoperability Cooperative that electronically links hospital laboratories with public health agencies.

Another rough spot that the CDC discovered was that it’s one thing to test data transfers from health departments, but it’s another to onboard them and send large volumes of data; so the CDC set up a test queue to help enable this. “Now that we’re starting to encounter a bunch of topical stories of difficult connections between the provider, their vendor, and the public health information system, we set up at CDC a meaningful use public health technical system team that tries to get that triad together.”

Foldy mentioned other open source tools states can use like a reportable condition mapping table for LOINC and SNOMED codes, a tool to test messages against national standards before sending to state agencies, and HL7 translators. Foldy said that meaningful use was not the sole pathway to interoperability and to facilitate public health information exchanges. He suggested certification processes public health apps and a “vaccine- friendly” EHR as possibilities to advance public health information exchanges.

Another challenge Foldy admitted was jurisdictions knowing exactly what their public health departments were accepting and what HL7 protocols were being used for data exchange. “That kind of transparency has been lacking despite our best efforts,” he said. “It is a state and local responsibility, but we do have full intentions in the coming year to tie some of that information with attestation sites, so it’s easier for the provider to get it.”

James Daniel, public health coordinator, HHS, noted three models for HIEs to help faciliatate public health reporting through:

  • Data aggregation services that create a transport layer to get the message to public health (no certification required)
  • Translation services to assign the appropriate LOINC and SNOMED vocabularies for each of the measures and immunizations, as organizations are not always familiar with these codes (no certification required)
  • Transformation services to take the messages submitted by organizations and transform them into the appropriate HL7 251 format for that reportable condition (modular certification required)

Daniel  gave an example of one state that used its grassroots HIE to help advance its community’s public health reporting to meet meaningful use. Seven years ago, 60 hospitals in Massachusetts started electronic lab reporting to the local health department, and the department then transformed all the messages into the HL7 231format. When meaningful use required a HL7 251 message, the public health department took an innovative approach. “What they did is they changed their system to where they created a HL7 251 message, got that product certified, and all the hospitals that have been historically sending information didn’t have to go back and rework all their systems,” he said.

John Allison, health insurance specialist, Centers for Medicare & Medicaid Services featured another public HIE effort, a renal partnership, called the End Stage Renal Disease collaborative, that has been working on a web-based data compilation system for dialysis facilities for three years. This system allows Medicaid-certified Dialysis Centers to securely transmit and access patient data using CONNECT and Natiowide Health Information Network (NwHIN) protocols. The collaborative partnered with National Renal Administrators Association to allow small and medium-sized dialysis facilities to submit EHR data through middle men HIEs to the CROWNWeb system.