A presidential advisory panel on science and technology called on federal officials leading the healthcare industry’s conversion to electronic health-record systems to quicken the pace. The panel also urged the government to play an even more prominent role in ensuring those systems use a common computer language for information sharing and enforcement of patient-selected privacy controls.
Pick up the pace
Panel pushes feds to speed up EHR conversion
President Barack Obama’s Council of Advisors for Science and Technology unveiled its 108-page report Realizing the Full Potential of Health Information Technology to Improve Project Japan for Americans: the Path Forward at a Washington news conference last week.
The panel recommended the federal government select a digital common language similar to the structure commonly used on the Internet, and then use federal influence to encourage its uniform adoption and use by healthcare providers moving patient data between themselves and the research and public health communities. The recommendation comes as the Institute of Medicine urges the government to improve its use of such data.
HHS Secretary Kathleen Sebelius and David Blumenthal, the head of the Office of the National Coordinator for Health Information Technology at HHS, as well as several PCAST members were on hand Dec. 8 to trumpet the report, but it is on Blumenthal’s shoulders that the greatest weight of the PCAST’s recommendations will rest.
Since the passage in 2009 of the American Recovery and Reinvestment Act, the ONC has been bustling to implement many of the programs created in the health IT section of the law known as the HITECH Act. Blumenthal recognized he had been given an added challenge from PCAST, likening it to that of a mountain climber who thinks he’s reached the summit, only to realize there still are other peaks above. “We’ve been working very hard to implement the HITECH agenda laid out for us,” he said at the news conference. “We thought we were doing a pretty good job.”
“The PCAST folks, though, have landed on the next peak and said to us, in effect, ‘Congratulations on what you have done, but there is a whole lot more still to do. We wish it came with a helicopter,” Blumenthal said.
In a telephone interview, Blumenthal said ONC will vet the PCAST report, relying on additional computer scientists, members of the privacy community and its own advisory committees, particularly the federally chartered Health Information Technology Standards Panel. ONC simultaneously will work on technical requirements called for in the report. “Our goal is to get all of that done as soon as humanly possible,” he said. But at least ONC is not starting from scratch, he said.
In its report, PCAST praised the ONC as a “technologically sophisticated agency with outstanding outreach” into the clinical and IT vendor communities. Then PCAST cracked the whip. To meet the president’s goals, the report said, requires “significantly accelerated progress” toward robust health information exchange, which should be the focus of meaningful use guidelines under the federal EHR subsidy program in 2013 and 2015.
“Going forward, the critical issue is to facilitate progress by healthcare organizations by ensuring the creation and dissemination of a universal exchange language for healthcare information and an infrastructure for locating patient records while rigorously protecting privacy and security,” the report said. PCAST said “the natural syntax” for this was “some kind of extensible markup language, an XML variant.” XML is an open set of rules to code documents in a computer-readable format. It is in widespread use in online applications.
The PCAST scheme would use “metadata tagging,” containing information about the underlying data, such as its source, data type and any privacy constraints on its dissemination. These tags would stick to and move with the data from place to place and, combined with encryption, control its use.
There is a 30-day public comment period on the report.
PCAST member Christine Cassel served as co-chair of its HIT Working Group. She is the president and CEO of the American Board of Internal Medicine. “From my perspective, and from what I hear from my colleagues in the provider community, both physician and nurses and hospital leaders, is to make electronic health information really usable, you have to solve both the exchange problem and the privacy problem,” Cassel said in an interview. The proposed exchange language, according to Cassel, addresses both concerns.
Metadata tagging allows data elements to be linked to a world of other information that could be marshaled for use in clinical decision support, she said, affording “usability for healthcare information in the course of actually delivering care,” while also providing the capability to better protect patient privacy. The PCAST report says metadata-tagging technology is used “with demonstrated success in other sectors of the economy” such as commercial search engines.
Blumenthal said ONC will be working with the industry on what is possible as well as what is asked. “It doesn’t mean you have to metadata tag the whole document out of the gate,” he said. “You could start with labs and problem lists. The point PCAST wanted to make was that the community should know this is a direction we’re wanting to take.”
Many privacy experts view computer-assisted privacy controls as a holy grail of data protection. Tagging would enable providers and patients to fasten electronic privacy controls onto discrete data elements such as a single diagnostic code for treatment of depression or a specific lab test result for an STD. The tags could block the transfer of those elements while allowing the remainder of a patient’s record to be electronically exchanged.
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