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Arien Malec Profile picture
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16 Jan, 4 tweets, 2 min read
Here, by the way, was the #HITAC recommendations letter in question.

healthit.gov/sites/default/…

See page 25-26
For example:
And:
Also note, with specific reference to API blocking terms, our recommendation:
(dunno why the official transmittal had redlines?)

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More from @amalec

Arien Malec Profile picture
17 Jan
1/
Thinking about this tweetstorm, one of the issues I’ve run into as an engineering leader is what to call the software engineering stuff that’s “agile” given that the Agile Community(tm) has killed the brand.
2/
And by & large, I’ve taken to call it “DevOps”, because the DevOps community have taken up much of the mantle @KentBeck & the XP community started with. & Kent has independently focused on safe small changes deployed to production. Which is DevOps.
3/
Much of the art here is making changes safe enough to deploy to production continuously. And to do that, we need to design incrementally, test obsessively, take architecture seriously so we decompose dependencies. & we need to automate everything & do it all the time.
Read 12 tweets
Arien Malec Profile picture
6 Sep 20
1/
If I were public health interoperability czar with the power to pull the Levers Of Power

A 🧵
2/
ELR:
- Unify FDA, CLIA & CMS powers to tie payment & lab certification to reporting, work w/ CDC to create a registry of reportable tests & include public health reporting in analyte machine test scenarios
- Require reporting of demographics & contact info as COP
3/
- Create a certification fast lane to the LOI/LRI specifications & create test methods that go all the way to lab reporting
- Create a long-term funding mechanism for public health, create certification criteria & tie grant to certification & prod deployment
Read 8 tweets
Arien Malec Profile picture
11 Jun 20
1/ Sorry for the top quote, but imma thread(*):

I'm on the "Intersection of Clinical and Administrative Data Task Force" which is a joint task force of NCVHS and HITAC.

So, there are *two* FACAs that deal with health technology standards.

(*) yes, I verbed "thread"
2/
NCVHS was created forever ago, but it's mission was updated w/ HIPAA to advise the secretary on, among other things, the administrative transactions created for HIPAA (& as a reminder, the privacy & security stuff in HIPAA was sideline in the day…
3/
b/c HIPAA was about insurance portability & administrative efficiency & health data privacy came along for the ride).

HITAC, defined in Cures was the update to HITSC/HITPC which was created for HITAC. Fhew.

Anyway 2 FACAs advising on standards tells you a lot.
Read 15 tweets
Arien Malec Profile picture
15 Apr 20
1/
Participating in #HITAC call and will summarize here.

CDC rolling out eCR more rapidly & working on an eCR Now FHIR app for electronic case reporting. Epic streamlining implementation to 3 days.

May 1st for delivery of FHIR app...

@JoshCMandel are you involved?
2/
There's a process for submitting eCR triggers emergently & it seems to work, across a relatively small network.

Not clear if eCR Now is CDC Hooks based, will get the community rev'd up on this one. cc: @aneeshchopra @JoshCMandel @Farzad_MD @GrahameGrieve
3/
Speakers in the public health community explicitly noting that the Promoting Interoperability (née MU) program established the baseline for syndromic surveillance & dropped many of the feeds in place.
Read 31 tweets
Arien Malec Profile picture
15 May 19
1/
A tweetstorm that will make some people mad. I apologize in advance.

There are two perspectives on the IHE SOAP-based specifications (primarily XDS, XCA and XCPD), not mutually exclusive
2)
 a) They have worked in practice, so should not be ripped and replaced
b) They are legacy technology and we should work on more modern alternatives.

A 3rd perspective, enshrined in #TEFCA #QTF is:
c) We should continue to make them the core of our health infrastructure
3)
The world "legacy" makes people mad -- my perspective is that technology moves on regardless of whether we like it or not. Some standards, particularly low level networking standards, have stood the test of time, some have... not
Read 13 tweets
Arien Malec Profile picture
16 Mar 19
1/
#CuresNPRM pricing policy recommendations.

To start with, a basic question: are market forces for interoperability good, or nah?
2/
There are three basic positions that I hear articulated

a) "making money on interoperability is immoral"
b) "making 'unreasonable' profit on interoperability is immoral"
c) "extracting monopoly rents as an interoperability gatekeeper is immoral"
3/
These are obviously *very* different stances, and the inability to articulate and distinguish them causes real problems. I often hear a silent assumption that all fees are monopoly rents and ipso facto immoral.
Read 11 tweets

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