INFORMATICS
The Trusted Exchange Framework and
Common Agreement (TEFCA) is an
example of efforts to pave a smoother
road. “TEFCA purports to advance a
nationwide ‘network of networks’ that
would allow APHL and public health
agencies to connect one time and provide
and receive data and services using a
single agreement,” Loonsk explains.
“There would not be a need for additional
point-to-point agreements.”
APHL is working to improve TEFCA in
conjunction with the Council of State
and Territorial Epidemiologists (CSTE),
the Association of State and Territorial
Health Officials (ASTHO), the National
Association of County and City Health
Officials (NACCHO), and the American
Immunization Registry Association (AIRA).
In a June 17, 2019 letter to the Office of
the National Coordinator for Health IT
(ONC), the groups advocated for more
input from the public health sector.
“Public health is a government-organized
and population-focused activity that
has both a different legal basis and
different needs than purely patient or
provider orientations,” they wrote. “In
the TEFCA…processes are cited that will
impact public health, but in which public
health has had no representation and, in
some circumstances, has been actively
excluded.”
The group’s efforts have yielded results so
far. For example, “push” data exchanges
were added to TEFCA. These are called
“push” because data is electronically
pushed to a recipient’s system. These
point-to-point notifications bring data
from the public square to better inform a
patient’s treatment plan.
PublicHealthLabs
@APHL
“Push” transactions are the basis of
most data exchange in public health
and clinical care. By contrast, a “pull” of
information starts with a user actively
searching for relevant data. A query to a
centralized repository is an example.
“Public health has been used to getting
data and when it does give data back,
doing so though broad public websites,”
Loonsk says. Now, both “push” and “pull”
have a place in protecting public health.
As other legal frameworks are built,
Greene has a few requests for those on
the construction crew:
• Government entities can make it easy
on providers to disclose information
to them for such systems by clearly
articulating their legal authority to
collect the information, providing
specificity about exactly what
information is needed, and working
with health information technology
vendors to make processes as
automated as possible.
“Push” and “Pull” for Safe,
Effective Data Sharing
“These data are not necessarily easier
to deliver, but they are much more
valuable to receive,” Loonsk says. “As an
example, in electronic case reporting
(eCR) when a case is reported for a
provider, a ‘Reportability Response’ is
returned and attached to the patient’s
chart. The Reportability Response can
include information about condition
reportability, the status of that condition
in that jurisdiction, potential outbreaks,
additional investigation or testing needs,
and management and treatment.”
• Health care providers in the private
sector should seek to leverage their
health information technology to
improve their public health reporting.
Health care providers should educate
themselves about whether their
electronic health record systems or
health information exchanges can
automate electronic case reporting—
for example, potentially improving
compliance and freeing up resources.
the history of
privacy protection
1996 HIPAA
2003 Privacy and Security Rules defines
public health information
2008 Route not Read hub
2009 HITECH
2012 AIMS
2013 National User Group
2015 Semantic memo
2016 21st Century Cures Act
says. “(The work being done) has the
potential to dramatically improve public
health reporting nationwide. It may take
some time, but these activities will make
reporting easier on health care providers
and improve the quality and quantity of
data that health care agencies receive.”
Loonsk concurs. “Reporting from EHRs
has the potential to make public health
surveillance and outbreak management
more complete, more timely and more
effective while, at the same time, reducing
the reporting burden on providers. It can
also dynamically give providers of care
long sought information from public
health about the status of their patients’
illnesses in the community.” n
• Health IT vendors should work closely
with public health authorities to best
incorporate public health activities
into their technology to health care
providers, so that public health
reporting is user friendly and legally
compliant.
He is enthusiastic about the possibilities
ahead. “I see a move towards greater
electronic public health reporting, such as
electronic case reporting, as public health
use cases get added to existing health
information exchange structures.” Greene
APHL.org
Fall 2019 LAB MATTERS
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