When the President's Council of Advisors on Science and Technology on December 8 recommended adoption of a "universal exchange language" to facilitate the exchange of health information while protecting privacy, I thought, "This is a game changer for meaningful use."

The belief was strengthened when six days later National HIT Coordinator David Blumenthal told the HIT Policy Committee that the Obama administration strongly supports the recommendation and the committee needs to start seriously looking at the issue as it develops future meaningful use criteria. AND, Blumenthal's office recently asked for public comments on how a quick transition in HIE policies and technologies would affect Stage 2 meaningful use criteria.

Universal exchange languages, known as "extensible markup languages" or XML, are widely used in other industries. Here's how PCAST explained such languages in its 108-page report: "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. 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."

That means, for instance, that a patient's data can be tagged so diabetes-related information can be available to any doctor in an urgent or emergency care situation, but not information about past treatment for cancer.

In a new blog posting on Health Data Management's Web site, Rob Tholemeier of Crosstree Capital Management does a superb job explaining how a universal exchange language works. I see Rob's post as required reading because PCAST also recommended making a universal exchange language part of Stages 2 and 3 of meaningful use criteria. That's a game changer.

And with rumblings that the 2013 deadline for meeting Stage 2 meaningful use requirements is too soon, the volume might get a lot louder if EHRs in less than two years have to support a universal exchange language.

Information Week reports that two members of the HIT Policy Committee, Larry Wolf of Kindred Healthcare and Marc Probst of Intermountain Healthcare, broached the possibility that Stage 2 should be pushed back to 2014 because the time needed to develop the criteria--not even including a universal exchange language--doesn't give EHR vendors enough time to change their products.

But on top of developing and preparing for Stage 2 criteria, can the industry really create and adopt a universal exchange language, revamp a few hundred EHR systems, train all the in-house I.T. staff that will support the EHR with the new language and do all of this before October 2012 when Stage 2 is supposed to start?

That timetable doesn't even take into consideration debates over the appropriateness of XML that surely will erupt. Here's a comment on Rob Tholemeier's blog that bears some studying: "All of the above could be done more easily using JSON instead of XML and in a more compact format. The use of XML adds another layer of complexity that leads to poor implementations. Have a look at how incompatible CCR files from different vendors turn out to be."

Ponder that while I go find out what the heck JSON is ...


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