Dr. David Blumenthal, the national health IT coordinator, expects to aggressively pick up the pace on health information exchange following the recent call from the White House for a common language and format for exchanging data between electronic health records systems.
To that end, the Office of the National Coordinator for Health IT will create an advisory panel to see how to implement some of the ideas laid out in the White House report. The work group, comprised of members of ONC's Health IT Policy and Standards Committees and other privacy and security experts, will make recommendations to both committees by April.
The report, published Dec. 8 by the President's Council of Advisors on Science and Technology (PCAST), directed ONC and the Centers for Medicare and Medicaid Services to develop the technical definitions and descriptions for the standard language and include them in requirements for meaningful use of electronic health records in 2013 and 2015.
The administration is absolutely committed to achieving interoperability, and it's "not a minor issue" for them, Blumenthal said at a standards committee meeting Dec. 17.
"We are going to move forward with a great deal of aggressiveness on health information exchange and interoperability, and even faster than we had expected based on the council's report," he said.
However, he added, it will be up to the committee to pick a path that is "technically as refined and as open to innovation, but as reliable, as we can make it."
The standards committee will weigh the proposals that eventually emerge for a universal exchange language. The report urged that it be based on extensible markup language (XML) so it can be machine-readable, in structured data format and include code sets or controlled vocabularies for each data element.
"Ultimately, when we are setting standards for the second stage of meaningful use, we're going to be relying on this committee," Blumenthal said.
Information for the most part is still held in proprietary systems, and providers cannot share and act upon the data, according to the report, "Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward."
It proposed that health data be broken down into the smallest individual pieces that make sense to exchange or aggregate. These data elements should be accompanied by a mandatory "metadata tag" that describes the data, the patient's preferences around the data and required security and privacy protections.
Other "directional" themes from the PCAST report included development of middleware to exchange information between EHRs, PHRs, and other repositories, John Halamka, committee co-chair and CIO of Beth Israel Deaconess Medical Center, said at the meeting.
Data elements should also be able to be separated out from their original documents, such as in problem lists and laboratory results, and used for other purposes.
"If we want to aggregate information across multiple information sources so that we can have an accountable care organization, a community of care coordination, or a population health analysis," he said "being able to discern how an individual data element relates back to a patient's gender, zip code or something that would indicate how the data was gathered, by whom and for what purpose is reasonable."
The report also described search engine technology as a mechanism to order or index data at a national level instead of using a document registry or database exchange.
Data elements and their metadata might be appropriately searched and organized through search engines, but would have to incorporate patient privacy protections and controls for users, Halamka said.
