LAS VEGAS -- Think you're having trouble keeping up with HIT implementations? Try meeting federal meaningful use mandates with no budget, no incentive funding and little-to-no IT infrastructure or expertise to accomplish it.
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That describes the typical public health department in this country. Most struggle to just verify their required health information exchange (HIE) connectivity, which includes immunization registries, syndromic surveillance and other population reporting.
That's the bad news. The good news? There isn't any, really, according to federal HIT leaders presenting at an HIE symposium here at the Healthcare Information and Management Systems Society HIMSS 2012 annual conference and exhibition.
Public health agencies are "beleaguered" already, overwhelmed with more work than their funding can cover, said Seth Foldy, M.D., director of the Public Health Informatics and Technology Program Office at the Centers for Disease Control and Prevention (CDC).
Local agencies -- left out of the HITECH Act grants, which nonetheless spread funding to state governments, doctors, hospitals and many other groups of health professionals -- have had to work out ways to help physicians meet meaningful use stage 1 requirements so docs can reap incentives. At the same time, these agencies have little infrastructure to receive data. So 2012 will be a year of playing catch-up for public health officials -- starting with building connectivity to large hospitals, followed by smaller providers.
Interestingly, after sharing what seemed like bleak prospects for health agencies to get to the promised land of robust HIE connectivity to harvest and run analytics on whole-population health data, Foldy did predict that it would happen one day, perhaps even in the next few years.
Foldy envisions health departments using software -- certified modules, which would help standardize implementations -- that in turn would promote specialized HIE that isn't in the meaningful use criteria because it only applies to a subset of doctors and isn't universally applicable to all.
"Not all of the immunization functions -- such as ordering vaccines for children, which is part of immunization data exchange -- is going to be relevant for every provider in America," Foldy said.
HIE connectivity offers hospitals, public health a helping hand
The Office of the National Coordinator for Health IT (ONC) is stepping in to pair public health agencies with their local HIE entities to help remediate their lack of IT infrastructure and expertise, reported James Daniel, ONC public health coordinator, who followed Foldy at the symposium.
These entities are doing three things with the data.
- First they aggregate it -- that is, take in reports from physicians and hospitals.
- Then they translate it into standardized data with proper Logical Observation Identifiers Names and Codes (LOINC) and Systematized Nomenclature of Medicine -- Clinical Terms (SNOMED CT) codes. This is important, since some electronic health record systems don't do this.
- Finally, they transform the data into mandated versions of Health Level Seven International (HL7) standards when local HIT infrastructure might be standardized on earlier versions.
In this way, HIEs provide services to enable meaningful use when parties on either side of the transaction might not be able to quite do it on their own.
We don't have to build multiple point-to-point interactions between public health departments and providers. We can take advantage of the infrastructure that's already in place.
James Daniel, public health coordinator, Office of the National Coordinator for Health IT
To achieve HIE connectivity, "we don't have to build multiple point-to-point interactions between public health departments and providers," Daniel said. "We can take advantage of the infrastructure that's already in place."
He went on to offer several examples of collaborations between HIEs and public health departments.
- One Massachusetts HIE collects reports from 60 hospitals, which had already been filing public health reports for years on a previous HL7 message standard. This way, the public health departments and hospitals do not need to change an implementation that's already working.
- A San Diego HIE is searching incoming data for immunization reports and forwarding relevant data to public health officials. Montana has a similar project about to go live statewide.
- Louisiana and Colorado state HIEs are aggregating immunization data for public health.
To improve HIE connectivity for all, share what works
Interactions among the CDC, ONC and Centers for Medicare and Medicaid Services to assist meaningful use-mandated health data exchange came from an inter-agency committee's meetings, said panel moderator Claudia Williams, state HIE program director for the Department of Health and Human Services.
Where the individual agencies might not have seen solutions, or known from whom they could seek help, together they could see inexpensive, straightforward strategies to overcome what initially look like big barriers to health information exchange.
Williams encouraged CIOs and other private-sector health IT leaders in the audience to share their HIE implementation problems, as well as their triumphs with one another and with HHS, so the best ideas could be collectively utilized.
"Share the pain. Let us know the things that are worrying you and bothering you and aren't working, so we know that that's going on and maybe connect you to someone with the right resources," Williams said. "When you've figured out a solution that works, share it with each other -- and with us. Share pain and pleasure; it's about finding common solutions to common problems."