Transport

Things are going crazy in the immunization registry world. EHR vendors are now implementing HL7 messages and doing them quite well. Transport has now become the major issue. The CDC has not specified the method of sending HL7 data. The HL7 language was charted to specifically avoid transport issues and so this is left to each state and vendor to figure out. (Personally I would love to see a national standard, but there isn't one so we have to figure it out on our own.)

Here are the transport options I see being done right now:

File upload directly to registry
Users login to registry and upload HL7 files that have been exported.
Benefit: Easy for users to load data.
Drawback: Manual process that stops if the user forgets to load data.

File upload to secure FTP directory
User uses third-party application to load HL7 file into SFTP/FTPS location.
Benefit: fairly easy to setup.
Drawback: Normally a manual process, although it may be automated.

PHIN-MS
Sender and state install PHIN-MS and applications on both ends transfer file.
Benefit: PHIN-MS is free software provided by CDC.
Drawback: Not a simple application, takes a certain level of effort to install and configure. May not be supported on all platforms, or be accepted by all sending systems.

HTTPS method
Simple HTTPS method is used by several states and some EHR systems.
Benefit: Simple to implement by vendors so it can be automated.
Drawback: only limited supported in the industry.

Web Services method
Uses HTTPS.
Benefit: Industry standard and is fairly easy for EHR vendors to implement.
Drawback: There is not a standard web services definition that has been adopted by state registries so this still has to be negotiated with each vendor.

I personally like the simple HTTPS method, because, well it's simple. Besides that I think the Web Services is probably the best solution for the nation, if we can just get it standardized.

Everything's Amazing

I am writing this post from 38,018 feet over Arkansas. This is the first time I have used WIFI while in an airplane. This reminds me of this clip Everything's Amazing and Nobody's Happy.

It is so easy to forget how amazing everything is. When we do our job right in public health, nobody notices. And this is how it should be. So it was a great opportunity to attend the the National Immunization Conference and to see what everyone has accomplished.

There is so much more to do. I'm now excited to go back to work and to complete my goals for this year.

MIROW Ad-Hoc Meeting

Just attended a MIROW Ad-Hoc Meeting to discuss topics that need to be covered in the coming years. The Modeling of Immunization Registry Operations Workgroup has met every year to create a recommendation documentation that registry managers can use to implement improvements. These documents have proven to be an invaluable start in many areas.

We started the meeting by discussing how the documents have been used. The Data Quality Assurance document has been the most used. Some time was also spent discussing MOGE Status, especially now that it's evident that there are two kinds of MOGE: provider and jurisdictional. I will write more about this later.

Next the subject for this year's MIROW was discussed: IIS & VFC Integration. This document will hopefully be out in the Fall, barring another pandemic like H1N1.

Then the meeting was opened up to brainstorming. Ideas were given about what the next MIROW meetings could be about. Some of the ideas:

• User training. This would be a continuation of the presentations given yesterday.
  
• MOGE - determining denominator
• Inventory. Improving data quality as it relates to inventory.
  
• AFIX.
  
• New healthcare act. How will this change VFC?
• Lead, BMI, Newborn hearing. How should registries approach this?
• EMRs
• Patient deduplication. Hasn't been dealt within the past because it is not registry specific and could be a real can-of-worms.
  

National Immunization Conference

I am preparing to attend the National Immunization Conference in Atlanta, GA. I will be there for the entire conference.

Sessions I plan to attend:

• Monday 2:00 PM: Exploring Scanning as a Method of Data Capture
  
• Monday 3:30 PM: Assessing MOGE Status Through National Change of Address Data
  
• Tuesday 11:00 AM: Enhancing Immunization Surveillance Through Data Exchanges
  
• Tuesday 4:00 PM: Immunization Information Systems: Evaluating Performance and Standards Adoption
• Wednesday 9:00 AM: Immunization Information System Interoperability with Public Health Systems
  
• Wednesday 2:00 PM: Growing Pains: Lessons Learned during Immunization Information System Software Transition
  
• Thursday 10:30 AM: Immunization Information System Provider Feedback
  

I will also be attending an AIRA workshop on Sunday, and the AIRA AD HOC meeting on Monday. Look forward to seeing you there!

Public Health Project Tracking

Keeping track of public health projects is critical. I have been using a personal system for the past 3 months to dramatically increase my productivity and reduce my stress. I designed the system after reading Getting Things Done by David Allen. Since my work is entirely electronic my system is built to work in that world.

I am now working on allowing access to this same system to my colleagues. It is currently still in Beta testing, but my plan is to eventually offer this as a free service to all Public Health professionals.

My hope is that this system will improve the capacity of these professionals so they can make a bigger impact on public health.

HL7 Transport Protocols

When HL7 was created in the late 1980's the computer world was a very different place. The global Internet was in it's infancy, web pages had not yet been created, and email stayed within the organizations network. Every organization had it's own proprietary network protocols. For this reason the HL7 committees did not want to dictate what kind of network to use, but instead allow each organization implement their network/transport layer as they needed.

Fast forward to 2010 and you now find that all networks support the standard Internet protocol, TCP/IP. In the 1990's, HL7 did develop the Minimum Lower Level Protocol (MLLP). Although MLLP is not an official HL7 standard it has become so widely used that it is commonly referred to as a TCP/IP connection. While the MLLP is a great protocol, it does not support encryption, so it is not good for use on the global Internet.

Which is why today, many Immunization Registries will accept HL7 messages but use a variety of transport protocols to accept them.

New HL7 Guide

Health Level Seven (HL7) was designed to help hospitals and other health organizations transmit health information in a standard way. Immunization registries use a subset of HL7 messages for sending vaccination information. The goal is that if all registries and all medical record systems use the same standard it will improve the process of creating new interfaces.

What HL7 has done so for immunization registries:

1. Created a common message structure.
2. Standardized code sets.
3. Delineated business use cases.

What HL7 does not yet address:

1. Vaccine program specific information.
   
2. Specific state requirements.
3. Message transport.

Because of these gaps, AIRA has been working with the CDC to create a new Immunization Guide that addresses the gap in the HL7 standard. The new guide is due out this Spring.