The report reached the following six major conclusions:
-- HHS's vigorous efforts have laid a foundation for progress in the adoption of electronic health records, including through projects launched by ONC, and through the issuance of the 2011 "meaningful use" rules under HITECH.
-- In analyzing the path forward, PCAST concluded that achievement of the President's goals requires significantly accelerated progress toward the robust exchange of health information. The initial approach to meaningful use has focused on driving physicians to adopt EHR systems rather than on developing capabilities for broader sharing of patient data. Though the rule expresses an intent to require more robust exchange of health information among providers at later stages of meaningful use, its initial requirements that EHR systems communicate with each other are very modest.
-- There's a need to establish a "universal exchange language" that enables health IT data to be shared across institutions and to create the infrastructure that allows physicians and patients to assemble a patient's data across institutional boundaries, which adhere to privacy safeguards. Federal leadership is needed to create this infrastructure.
-- Creating the required capabilities for a "universal exchange language" is technically feasible, as demonstrated by technology frameworks with demonstrated success in other sectors of the economy. PCAST recommends using "tagged data elements," which breaks down information into units of data that are accompanied by a mandatory "metadata tag" that describes the attributes, provenance, and required security protections of the data. Universal exchange languages for metadata-tagged data, called "extensible markup languages" are widely and successfully used.
-- ONC should move rapidly to ensure the development of these capabilities; and ONC and CMS should focus meaningful use guidelines for 2013 and 2015 on the more comprehensive ability to exchange healthcare information. ONC should push for 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.
-- Finally, as CMS leadership already understands, CMS will require major modernization and restructuring of its IT platforms and staff expertise to be able to engage in sophisticated exchange of health information and to drive major progress in health IT.