The Office of the National Coordinator for Health IT is testing the use of certain metadata standards in pilots with Indiana and Montana through the state health information exchange program.

For example, Indiana and researcher Regenstrief Institute are developing tools and methods to capture, index and search on key metadata from patient summary care records. This will enable more detailed query for information at the data element level.

The pilots are among activities, including prototypes, that ONC has started or plans for the fall to test some of its recommendations around metadata, according to Dr. Farzad Mostashari, the national health IT coordinator, in an Aug. 17 online announcement.

The use of metadata, or elements that describe data, is considered key to fueling more complex health information exchange.

The Indiana approach builds on existing data streams from legacy systems while using middleware and improved metadata to increase the ability for clinicians to search and use patient information. The Indiana pilot is also developing an interface that will give patients more granular control over managing and sharing their health information, he said.

Montana and other states will make patient care summaries generated from electronic health records (EHRs) able to be queried for population health questions through the testing of metadata standards.

On Aug. 9, ONC published an advance notice of proposed rulemaking (ANPRM), which offers ONC’s first draft views on the adoption of metadata standards and seeks comments from those who have real-life experience establishing and testing metadata standards. In the proposed rule, ONC uses the scenario where a patient obtains a summary care record from a provider’s electronic health record (EHR) or requests for it to be transmitted to their personal health record (PHR).

ONC’s Standards and Interoperability Framework community will launch two projects that rely on metadata and will produce prototypes for their use.

“These initiatives have the potential to improve the quality, safety and coordination of health and health care,” Mostashari said.

The Query Health Initiative will come up with the standards and services to be able to distribute queries from certified EHRs to network data partners for population health information. Network data partners will carry out the query through a standard clinical information model and then securely return the results to the requester.

As a result, providers will be able to conduct population analyses and calculate quality measures for populations, he said.

The Data Segmentation Initiative will evaluate the standards needed to be able to block sensitive information at a patient’s request from data that is being shared to protect privacy. The project is designed to examine the standards needed for sharing individually identifiable health information, including standards recommended by the Health IT Standards Committee for metadata tagging of privacy attributes in standard clinical and policy records and record segments.

The S&I community will develop use cases to define the need for data protection services, such as a patient’s directive not to disclose substance abuse records, and extend current standards-based software models to demonstrate interoperability. Then a reference model based on the use cases and functional requirements will be tested.

The use of metadata took on a higher profile with the report last December of the President’s Council of Advisors on Science and Technology (PCAST) to accelerate more complex health information exchanges. The PCAST report recommended 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.