A Health and Human Services Department advisory panel has taken the first steps to enabling people who are enrolled in federal and state health and social services programs to easily find out if they are eligible for benefits from other programs.
As part of its preliminary proposals, the panel at a July 19 meeting highlighted a minimal set of standards, services and data elements that would be needed for the various government agencies to streamline the process needed to electronically exchange information for deciding eligibility and enrollment in those programs.
The health reform law enacted earlier this year required that kind of interoperability. The enrollment work group, a panel of the Health IT Policy and Standards committees, must finalize its recommendations by Sept. 30 to meet the health reform law's requirements.
Web-based services
The panel suggested using Web-based services for quick verification of enrollment and eligibility data. Some states already use online services to share this information among a number of their health and human service programs, and can provide models with the systems they have in place, said Steve Fletcher, Utah chief information officer and a member of the panel.
"We can start with these services and evolve in the future to make them more capable and find a means to roll this out as quickly as possible," he said.
In addition, a translation service could assist those programs still running on legacy information systems to support data exchange and standard formats, such as Health Level Seven (HL7) versions and extensible markup language, he said.
Easier enrollment
The identified standards and core data elements are meant to simplify enrollment by various means, including electronic matching across state and federal databases such as those at the Social Security Administration and the Internal Revenue Service.
The enrollment and eligibility data also needs to be clearly defined to assure that it eliminates duplicate matches and provides reliable information so it can re-used for a variety of programs. Among the core data elements that are used across programs are name, date of birth, address and Social Security number.
Business rules
Business rules, which incorporate the policies and practices of a program, are another building block to modernize state eligibility and enrollment systems by establishing "consistent methods across programs for how to calculate what makes an individual eligible", said Cris Ross, a panel member and chief operating officer of the Lab Hub Initiative, a venture of SureScripts e-prescribing network provider and Quest Diagnostics lab services.
The business rules promote the use of standard data elements and verification and help to deal with ambiguity of information and differences in data so program officers can make decisions about eligibility, he said.
To guide them, the panel is using the National Information Exchange Model (NIEM) to define, analyze and bring into line nine common enrollment data elements across six programs, such as Medicaid and the Children's Health Insurance Program, and existing standards, such as HL7.
NIEM is a technical approach to information sharing that federal agencies developed initially to share homeland security information quickly and securely. The Office of the National Coordinator for Health IT is applying NIEM to healthcare exchange, said Douglas Fridsma, MD, acting director of ONC's Office of Standards and Interoperability.
Using NIEM, Fridsma is distinguishing what are the current existing models, definitions and metadata among the programs and their data elements.
"We want to figure out how many are shared and how to represent this in exchange and which ones need to remain unique," he said. "What are the differences so that we don't inadvertently aggregate or share data that isn't essentially the same data element," he said.
