White House calls for standard language for health data exchange

The White House has called for a "universal exchange language" to enable healthcare providers to share health information in real time, in order to modernize and coordinate diagnosis and treatment while incorporating privacy and security of personal data.

To accomplish that, the Office of the National Coordinator for Health IT and the Centers for Medicare and Medicaid Services should 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, according to a White House report published Dec. 8.

In the report, the President's Council of Advisors on Science and Technology (PCAST), a group of presidentially appointed experts from universities, industry and other organizations, urged the adoption of standards so healthcare providers can accelerate the exchange of patient records.

The federal government has made progress in laying the foundation for adoption of electronic health records (EHRs) through the incentive program under the HITECH Act, according to the PCAST report, "Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward."

However, information for the most part is still held captive in proprietary systems, and providers cannot share and act upon the data to make better healthcare decisions, said Eric Lander, PCAST co-chair and president of the Broad Institute of Harvard and the Massachusetts Institute of Technology.

Among its recommendations, PCAST said that ONC should "move more boldly" to make sure that EHRs are able to exchange health information in a standard manner based on metadata-tagged data elements.

"ONC should signal now that systems will need to have this capability by 2013" in order to be considered a meaningful user, the report said.

Dr. David Blumenthal, the national health IT coordinator, said that ONC has started the process to develop the universal standards that promote interoperability and enable communication across EHRs. ONC will also examine how it should modify its standards and certification criteria to assure that certified EHRs can perform the functionality for interoperability, and how the framework for meaningful use can assist with the capability.

"We said in our meaningful use regulation that the next phase would emphasize health information exchange," he said in a briefing. "The PCAST report pushes us forward and sets new goals for us."

At the same time, privacy and security are paramount.

"We have to keep patients and consumers first along the way," he said. "They will value the benefits of interoperability but worry about the risks."

The report proposes that health data be broken down into the smallest individual pieces that make sense to exchange or aggregate. These data elements would be accompanied by a mandatory "metadata tag" that describes the data, the patient's preferences around the data and required security and privacy protections.

Universal exchange languages for metadata description, called "extensible mark-up languages" are widely used in other industry areas.

The tagged data element method allows a more sophisticated privacy model, in which privacy rules, policies, and patient preferences are bound to each separate tagged data element, according to the report. For example, a patient with diabetes may decide to make her blood sugar information available to any of her doctors and to emergency physicians requesting that information, but not details about her past treatment for cancer

Blumenthal said that the tagging of health information with patient preferences "needs to be complemented by a range of policies that provide a complete and comprehensive package of solutions to the privacy and security challenges that we face."

ONC is asking for public comments about the report through Jan. 17.