(meta-data) "TAG, You-Are-It" (ONC, CMS, DHHS) !

This December 2010, the President’s Council of Advisors on Science and Technology (“PCAST”) released its Report titled “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward,” and, boy, it makes meaningful use look like a walk in the park!

The Report notes, among many other things, that the current structure of available health IT systems is inadequate, resulting in user difficulty, unavailability of relevant information, such as best practices, limited capability for sharing data across systems, patient concerns regarding improper access, and the inability to search or aggregate and de-aggregate data where necessary for research, public health, quality improvement, or patient safety. In essence, current health IT systems cannot easily support the desired outcomes. The Report identifies key legislation and regulations responsible for moving the development of health IT forward, namely, HITECH and the “meaningful use” EHR Incentive Program, as well as demonstration projects to develop experience and the necessary conditions for progress. However, the Report stresses the urgency of accelerating and redirecting much needed federal groundwork for HIE.

The Report notes the successes of early adopters of integrated EHR systems (i.e., Kaiser Permanente and VHA), while recognizing areas of functionality still in dire need of improvement, such as interoperability. It finds data exchange and aggregation central to accomplishing potential health IT benefits yet rejects current HIE models as being “ill-suited” as the basis for a national health information infrastructure due to durability and interoperability concerns. PCAST considers new technologies, such as “cloud-based” EHR products, patient personal health records, and data aggregation “middleware” products for interoperability that have potential to remove barriers and create solutions, as well as other promising models for data exchange.

PCAST rejects standardized health record formats and service-oriented architecture (SOA) in favor of metadata-tagged data elements and data-element access services (DEAS), the advantages of which the Report describes in detail. Such “tags” are small pieces of information accompanied by a larger “megadata tag” which groups them by attributes as well as required privacy and security protection.

The Report argues that a universal exchange language based upon tagged dataelements (i.e., DEAS and metadata-tagged data) is more sophisticated and better for privacy and security.

For example, DEAS would require authentication of an individual into the system and allow only access to information based upon the role he or she is assigned. To obtain access to encrypted tagged data elements, based upon a patient’s privacy choices, the individual would have to have the proper credentials and role. It is also crucial to note that the Report rejects that such a system would require “universal patient identifiers” or create a central repository of patient information.

Furthermore, the Report explores how HIPAA is ill-equipped, and possibly detrimental to medical research and care, to handle the changes in health IT and how HITECH both partially remedies and exacerbates this situation, such as accounting of disclosures which will “stifle innovation”.

Finally, the Report argues that federal leadership is necessary to combat economic concerns and incentivize information exchange and development of health IT systems. Adopting standardized metadata, aligning economic incentives (such as through “meaningful use”), encouraging technological innovation and competition, supporting development of network infrastructures through appropriately designed pilot projects, and developing a regulatory health IT structure along with regulatory oversight all are suggested by the Report as necessary.

PCAST detail several layers and roadmaps for government agencies to progress towards the realization of a national health IT infrastructure. It also recommends guidelines for transitioning from existing EHRs and information exchange systems to the new tagged data element model advocated by the Report, and addresses generation of necessary early design choices by ONC and the Report’s vision for future CMS meaningful use requirements. The Report concludes with specific short and mid-term recommendations for ONC, DHHS, CMS, and other agencies in order to realize the objectives outlined in the Report towards establishment of a national health IT infrastructure.   In response, ONC, for one, appears to have already set up a PCAST Report Workgroup, and the first meeting is scheduled for January 14, 2011.

 To review PCAST’s summary of Recommendations of who should do what next, click Continue Reading below.

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