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Immunization Information Systems (IIS) have been around for many years. Almost every state in the Union has one. Given the maturity of these systems, it is not surprising that most of them pre-date the HIE movement. In fact, many of them have evolved into proto-HIEs with provider portals, information exchange through web services, and even more comprehensive information than just immunizations. But as more and more providers refocus their information exchange on their regional or state HIE, the IIS may find itself interacting more with the HIOs than with the providers they are used to supporting.
What types of strategies should HIEs and IIS consider when thinking about system-to-system interoperability? It comes down to the data source and the data destination:
If data is flowing from EHR system to EHR system (lower left of matrix), the transaction is of limited interest to public health and can best be accommodated by a “push” transaction, like the use of Direct. Similarly, if the source and destination are both IIS (upper right of matrix)—like the case of interstate sharing of immunization data – a variety of system-to-system “push” or “pull” strategies are possible. But the more typical data flows are from EHR systems to IIS.
When the EHR system is the source and the IIS the destination—like a Stage 1 Meaningful Use submission—once again, a “push” strategy will work just fine, whether it’s via Direct, web services, SFTP or some other means. When the IIS is the source and the EHR system is the destination (upper left of matrix) query/response, often using web services, is likely the best solution (a publish/subscribe strategy where a provider “registers” to receive updates for a particular patient is an example of a “push” strategy that also satisfies this case). Stage 3 Meaningful Use will likely require this type of bi-directional interoperability.
So what does this mean for HIEs? An HIO needs to work with the public health agency in its jurisdiction to decide first which use case (data source/data destination pair) is going to be satisfied, and then to identify the right strategy to support it (the matrix is a good start). They also need to determine what role the HIE will serve in facilitating the interface between the provider and the IIS. Since often both the providers and IIS are used to a more direct relationship, the intermediation of an HIE in that relationship needs to be carefully examined and the implications understood. Even though this might represent a significant change for both the IIS and early-adopter providers in the long run everyone benefits from fewer interfaces and greater leverage of HIE implementations.
Noam H. Arzt, PhD, FHIMSS, is president and founder of HLN Consulting, LLC, San Diego, and does consulting in healthcare systems integration, especially in public health. This article originally published on the HIMSS.org News page.
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