Will Metatags Improve Electronic Health Records?

The ONC is seeking input on metadata standards that it believes can advance electronic health information exchange across different architectures and allow patients to more easily manage their own health information.
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The Office of the National Coordinator for Health Information Technology (ONC) is soliciting public comments on a set of "metadata" standards intended to facilitate exchange of health information. The move signifies the U.S. Department of Health and Human Services (HHS) is getting ready to propose rules for metadata that could be incorporated in Stage 2 of the "Meaningful Use" incentive program for electronic health records.

Building on the recommendations of the Health IT Standards Committee and Health IT Policy Committee--advisory panels to the HHS secretary--ONC is looking for answers on 20 specific questions about elements of metadata in electronic health information. ONC defines metadata as "data about data," or "data that provides more information or detail about a piece of data."

"We believe that the use of metadata holds great promise and the adoption of metadata standards can help rapidly advance electronic health information exchange across a variety of different exchange architectures," ONC said in its advanced notice of preliminary rulemaking, a prelude to a formal regulatory proposal.

ONC is asking for public comment on testing or use of metadata standards as they relate to patient identity, provenance, or privacy. They "also request public comments on any additional metadata categories, metadata elements, or metadata syntax that should be considered."

ONC said the "immediate scope" of its notice is how metadata is associated with "summary care records," or how patients get a summary of their records from a provider's EHR, either on paper or through an electronic transmission to a personal health record.

"The HIT Policy Committee suggested that it would be practical to include this capability as part of the EHR certification requirements to support meaningful use Stage 2..." ONC said. "Additionally, the HIT Policy Committee noted that if these metadata are available, they could potentially increase the level of trust that receiving providers would place in clinical information that they receive through patient-mediated exchange, such as from a PHR [patient health record], and could enable patients to more easily sort and re-share their own health information."

The Standards Committee and Policy Committee made their recommendations based on a December 2010 report from the President's Council of Advisors on Science and Technology (PCAST), which called for the creation of a universal exchange language to support secure exchange of health information across institutions. PCAST said that federal officials should incorporate this language into the latter phases of meaningful use.

PCAST described the universal exchange language as “some kind of extensible markup language (an XML variant, for example) capable of exchanging data from an unspecified number of (not necessarily harmonized) semantic realms. Such languages are structured as individual data elements, together with metadata that provide an annotation for each data element.”

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