ONC Wants Feedback on MetaData Use

EHR Incentive Program Could Require Tagging Data Elements Howard Anderson (ismg_editor) • June 23, 2011

The Office of the National Coordinator for Health IT will soon seek feedback on using certain existing standards for metadata for specific purposes, such as to indicate a patient's privacy preferences, within electronic health records. ONC will then consider the comments before deciding whether to require the use of metadata in certain circumstances for stage two of the HITECH Act EHR incentive program.

At the Health IT Standards Committee meeting June 22, Farzad Mostashari, who heads ONC, revealed a game plan for taking baby steps toward carrying out the vision for a health information exchange architecture, based on a new universal exchange language, as articulated by the President's Council of Advisors on Science and Technology. PCAST's ambitious vision for a single national approach to health information exchange, which has proven to be controversial, endorsed, among other things, the use of mandatory metadata tags to describe specific data elements within EHRs to ease information exchange.

Earlier, a workgroup that reviewed the PCAST report recommended that ONC take a go-slow approach to testing the council's recommendations (see: Tests of New HIE Architecture Slated).

EHR Incentives Criteria

Mostashari noted that ONC is contemplating whether to include in the stage 2 EHR incentive criteria a requirement to use metadata only in conjunction with providing patients access to their records, such as through a portal. The metadata would describe, for example, a patient's identity, a patient's privacy preferences for how the data can be shared as well as "provenance," or the source of the data.

"Our hope is, very soon, to be able to put out a notice of proposed rulemaking specifically on these [meta]data elements for us to have the opportunity to really process and share input from the broadest range of stakeholders possible," Mostashari said. ONC would then use the feedback to help it determine whether to include any metadata requirements in stage two of the EHR incentive criteria. The Department of Health and Human Services is slated to issue criteria for stage two at year's end.

"There's broad recognition that it would be useful in a variety of implementations, including within an organization, to have data [elements] that can be tagged [with metadata], Mostashari said.

A "power team" subcommittee recommended using some metadata standards from Health Level Seven, including elements of its Clinical Document Architecture, Version 2. Mostashari said ONC wants to determine whether existing standards can be "repurposed with some modifications to meet the goals."

Using existing standards and taking a go-slow approach to tagging data elements within EHRs fits in well with the ONC's general philosophy of "keeping an eye on the prize but feet on the ground," Mostashari said. "Let's find a place to get started."