Wednesday, September 15, 2010

Filling Gaps in HIE Services

Just as the NEHEN Board did a gap analysis of the capabilities needed to support meaningful use, the Massachusetts eHealth Institute Ad Hoc HIE Working group discussed the services that need to be procured to meet ONC's HIE goals. Here's what they discussed.

a. Aggregation, Analysis and Reporting - No procurement is needed but a contract/service level agreement between the service providers and the state HIE would be helpful.

Immunization, Syndromic Surveillance, Reportable Lab Registry
-EOHHS (Department of Public Health) will provide virtual gateway / HL7 gateway access to immunization registry for ambulatory users

-EOHHS (Department of Public Health) will provide virtual gateway / HL7 gateway access to immunization, syndromic surveillance, and reportable lab registries for hospitals

-Boston Public Health Commission will provide access to immunization, syndromic surveillance, and reportable lab registries for all users.

Quality Data Center - EHRs are required to provide this functionality,
although some organizations may choose an outsourced vendor at their own
expense to aggregate data from multiple EHRs. Hospitals already have internal and external processes in place to aggregate and report quality data to CMS.

b. Directory Services - Procurement is needed
-The Commonwealth should procure directory services (providers, payers, public health entities) to meet local needs and should adopt regional/national standards for these directories when they become available.

c. Routing - Procurement is needed
-NEHEN connects 10,000 providers today, about half the providers in the
Commonwealth and 90% in Eastern Massachusetts. This would not need to be
"re-procured" because it is already paid for by the private sector. However, NEHEN and other existing networks should conform to the standards and service levels agreed to by the state HIE governance body.

-The Commonwealth should procure routing services for the 50% of providers without current routing capability.

d. Consent - Procurement will be needed to prepare for 2013
-A consent repository will likely be needed for 2013/Meaningful Use Stage 2 to record facility specific opt in consent for disclosure of healthcare information. However, the requirements for Stage 2 data exchanges are not yet known and the policy is a work in process by the Privacy and Security Tiger Team and the Massachusetts eHealth Institute Ad Hoc Privacy and Security Work Group. Procurement should be done in 2011 when the technology needs and policy guidance becomes clearer.

e. Public Key Infrastructure Services - Procurement is needed
-The public and private sectors in the Commonwealth should align their existing PKI projects to create a single identity management service to support secure routing among providers, payers and public health.

f. Vocabulary Services - No procurement is needed
-The HIT Standards Committee Vocabulary Task Force, the HIT Standards Implementation Workgroup, and the ONC Standards and Interoperability Framework contractors are working on a national repository of vocabularies and codesets to support all HIE needs. The Commonwealth should leverage this Federal effort.

Now that we have defined Governance characteristics and completed the above gap analysis, we'll have a discussion with the Commonwealth's HIT Council which should lead us to creating a governance body, finalizing a sustainable business/operating model, and procuring the services needed to have a Statewide HIE in 2011.


Anonymous said...

John - Do you see NEHEN making any use of NHIN Direct? Thanks

John@Chilmark said...

John, where is the consumer in all of this? Yes, you do mention consent, but that is all, no where is there a discussion/procurement initiative for helping consumers - let's call them citizens as it is their tax dollars! - and how they will benefit from the HIE that will be put in place.

We, as a country, as HIT leaders and the architects of policy must not lose sight if this and unfortunately, this post does just that - ignores the citizen.

John Halamka said...

To answer these two questions

1. Yes, NEHEN plans to integrate NHIN Direct protocols once the reference implementation is available

2. MeHI does have a Consumer Engagement working group which reviewed and endorsed all these data exchange capabilities as foundational to care coordination, safety, quality, and patient engagement.