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The Office of the National Coordinator for Health IT plans to publish “very soon” a proposed rule promoting the wider use of existing metadata standards so it can get feedback on the experience from various organizations, said Dr. Farzad Mostashari, the national health IT coordinator.
The use of metadata, or elements that describe data, is considered key to fueling more complex health information exchange.
The Health IT Standards Committee endorsed activities by ONC to explore the use of simplified and existing types of metadata standards, including for patient identity, provenance and privacy flags. It also recommended at its June 22 meeting that ONC seek feedback and evidence from real-world implementations. Provenance is the tracing of the source of data so a recipient can know if it is trusted.
ONC wants to learn about organizations’ experience with metadata from the public comments it would receive from the proposed rule before it publishes the larger proposed regulation for standards and certification criteria for stage 2 of meaningful use likely at the end of the year, he said at the committee meeting.
ONC is trying to accelerate the process to give industry the longest time possible to understand the implications of the use of metadata standards in their health IT products. “Our hope is very soon to put out a notice of proposed rulemaking specifically on these data elements for us to have an opportunity and process to share input from the broadest range of stakeholders possible before the potential inclusion of these in the NPRM that comes out with the standards and certification criteria for stage 2 of meaningful use,” Mostashari said. “The goal here is to get something people can respond to in a more structured, formalized official way."
The use of metadata was inspired by the report last December of the President’s Council of Advisors on Science and Technology (PCAST) to accelerate more comprehensive health information exchanges, he said. The Health IT Policy and Standards committees have analyzed the PCAST recommendations and how ONC might begin to incorporate them by building on existing health IT.
The PCAST report called for a universal exchange language, which is an extensible markup-like (XML) language, and other standards to enable healthcare providers to share health information more reliably and effectively in order to modernize and coordinate patient care.
PCAST's report also proposed that health data be separated into the smallest individual pieces that make sense to exchange. These data elements would be accompanied by a mandatory metadata tag or minimal standards that describe the data and the patient’s preferences for the data’s uses and security and privacy protections.
The standards committee has described a simple use case for employing metadata when a healthcare provider transfers a patient summary to the patient, through a patient portal or to their personal health record, which can be used for meeting meaningful use.
Mostashari said the discussion was not about specific application of metadata tags in a particular function.
“Our goal is to make forward progress on a defined limited use case that can help further the identification of what would be the standards and data tags that could be applied in these policy settings,” he said.
Dr. John Halamka, co-chair of the standards committee, said that “ONC is interested in starting us on the ground floor.” Halamka is also chief information officer at Harvard Medical School and Beth Israel Deaconess Medical Center.
The committee recommended Health Level 7’s clinical summary record, Clinical Document Architecture (CDA) release 2.0 , as a standard for patient identity information, with X.509 certificate for provenance and as a mechanism to convey privacy flags, he said.
“We fully recognize that additional work needs to be done on specifying the vocabulary of those privacy flags and to take into consideration input from the policy committee and others," Halamka added. “What we’ve tried to do is pick something that is so simple XML that there shouldn’t be technical barriers. We can suggest even further simplification to the CDA r.2 as it exists and that real-world implementations of these be tried before promulgation is required."
Standards committee member Dr. Carol Diamond, managing director for health at the Markle Foundation, questioned establishing a metadata standard before having reported experience about it. “Standards need to be tested in a real-world environment,” she said.
Mostashari said he hoped that public comments to the proposed rule would supply some of the real-world experience.
ONC could also award breakthrough grants to state health information exchange grantees to try out some of these approaches. Also large delivery networks, such as the Defense and Veterans Affairs departments, and others outside government, may be able to conduct pilots.
“We could potentially do an initiative or innovation challenge grant or other mechanisms for spurring this and also seek comment from places that have already done this,” Mostashari said.