President’s Advisors Tackle Health Data Exchange

A report from an advisory body to President Obama recommends use of a "universal exchange language" to facilitate the exchange of health information while protecting privacy.

Use of such language could give patients more control over the dissemination and use of their medical information in an automated fashion.

Universal exchange languages for metadata descriptions, known as "extensible markup languages" are widely used, notes the President's Council of Advisors on Science and Technology. "The best way to manage and store data for advanced data-analytical techniques is to break them down into the smallest individual pieces that make sense to exchange or aggregate," according to the 108-page report. "These individual pieces are called 'tagged data elements' because each unit of data is accompanied by a mandatory 'metadata tag' that describes the attributes, provenance, and required security and privacy protections of the data."

This means that privacy rules, policies and applicable patient preferences "are innately bound to each separate tagged data element and are enforced both by technology and by law," the report continues. "For example, a patient with diabetes may decide that her blood sugar information should be available to any of her doctors and to emergency physicians requesting that information should she have a problem while traveling in another state--but that details of her past treatment for cancer should remain private and not be shared."

Development of a universal exchange language for health care would not require creation and assignment of universal patient identifiers or a centralized federal database of patient information, according to the advisors. It also would not require physicians to replace existing EHRs, "virtually all of which could be made compatible through 'apps' and other 'middleware.'"

The council further recommends rapid development of these capabilities to make electronic health records meaningful use criteria for data exchange more comprehensive in 2013 and 2015. "The steps that must be taken can be accomplished with the required time frame. It can be accomplished via an evolutionary transition from traditional EHRs to a tagged data element model, along with a more rapid transition for the more limited purpose of data exchange by means of a universal exchange language," according to the report. "We note that these steps are not intended as an alternative to ONC's important work in promoting the adoption of electronic health records. Rather, they are complementary to that work and will accelerate adoption."

Implementation of the advisory council's recommendations would not require physicians to replace existing EHRs, "virtually all of which could be made compatible through 'apps' and other 'middleware.'" according to the report, available here.

--Joseph Goedert