The vision of the President's Council of Advisors on Science and Technology for establishment by 2013 of a "universal exchange language" to accelerate health information exchange is not feasible, a workgroup of industry stakeholders advising federal officials concludes.

It is possible, however, "to implement the new exchange architecture in an incremental fashion," according to the final report of the PCAST Workgroup, which includes members of the advisory HIT Policy and Standards Committees.

But for now, end-to-end implementation of a new way to exchange health data may be ahead of its time. The presidential advisors in their recommendation made last December noted that universal exchange languages that use "metadata tags" to describe attributes or security protections of individual pieces of data are common in many industries.

But how the advisors envision use of a universal exchange language in health care just isn't seen elsewhere, according to the PCAST Workgroup. "We are unaware of any real-world environments (either in healthcare or other sectors) where the combinations of technologies envisioned for the end-state have been placed into operation."

The workgroup does recommend establishing a new exchange architecture with a universal exchange language and interlinked search capabilities, coupled with privacy and security safeguards. But the PCAST recommendations from December are difficult to reconcile without operational examples and concrete plans, and there is an absence of stakeholder consensus about the recommended approach, according to the workgroup.

Consequently, the workgroup recommends two alternatives to start incorporating PCAST recommendations in Stage 2 of meaningful use:

* Stage 2 criteria could contain metrics for the use and promotion of patient portals, providing patients with access to their health information and the option to obtain an electronic copy of their data using tagged data elements.

* The Office of the National Coordinator could use Stage 2 EHR certification criteria to identify metadata standards for other specific Stage 2 transactions.

"For each of these two alternatives, the workgroup, which includes members of the HIT Standards Committee, believes that the necessary technical decisions can be made with sufficient time to be tested and included in Stage 2 of meaningful use," according to the workgroup report. "The workgroup believes that this approach to Stage 2 of meaningful use is consistent with the PCAST report's direction to act boldly."

In addition, accelerated emphasis on several issues for Stage 2 is important, the workgroup contends. These issues cover patient identity matching initiatives, vocabulary efforts, policies for trusted intermediaries, patient/user identity assurance and authentication, communications protocols such as the Direct Project, security standards and policies, and privacy policies.

And existing data exchange initiatives can be used to accelerate development of these issues, according to the workgroup. "Continued efforts through the NwHIN Exchange (Nationwide Health Information Network), HIE organizations, vendor exchange efforts, the Direct Project, Beacon Communities and SHARP grants will create critically important building block concepts and provide operational experience."

To get ready for Stage 3, the workgroup recommends ONC develop more specific privacy and security policies to build public trust in the new exchange architecture, and develop syntactic and semantic standards to support components needed for higher levels of data exchange.

Both of these initiatives could be tested via pilots involving the Veterans Administration, Department of Defense, Indian Health Services and the NwHIN Exchange. "In order to be considered for Stage 3 of meaningful use, it is necessary that pilot projects be operational no later than October 1, 2012, so that there will be at least six to nine months of operational experience prior to the date when Stage 3 decisions must be made," according to the PCAST workgroup report.

The next HIT Policy Committee meeting is scheduled for April 21.

--Joseph Goedert


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