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D.C. Report: PCAST Workgroup Expresses Concerns on Universal Exchange Language

April 25, 2011
by Sharon Canner
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Sharon CannerSr. Director of Advocacy

PCAST Workgroup Echoes CHIME Concerns on Universal Exchange Language. Members from the HIT Policy and HIT Standards Committee concluded this week that recommendations first laid out in the President's Council of Advisors on Science and Technology (PCAST) report are too ambitious, echoing CHIME’s comments submitted in January. According to the PCAST workgroup, an end-to-end universal exchange standard that utilizes metadata tags instead of standardization is simply not feasible for Stage 2 Meaningful Use inclusion. "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 group said. This same sentiment was expressed by CHIME’s comments: “A larger question is whether it’s possible for semantic aggregation to truly replace standardization.”

While the PCAST Workgroup acknowledged the chasm between the goal and reality, it did offer two alternatives to begin incorporating PCAST recommendations into MU Stage 2. Alternative one would foresee 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. Alternative two suggested that the Office of the National Coordinator could use Stage 2 EHR certification criteria to identify metadata standards for other specific Stage 2 transactions. The workgroup said that they believed these alternatives could be adopted with enough time for testing and inclusion with Stage 2 requirements. Other issues the workgroup emphasized also speak to CHIME January comments, including patient identity matching initiatives, semantic efforts, policies for trusted intermediaries, patient/user identity assurance and authentication, security standards and policies, and privacy policies.

ONC Strategic Plan Changes Recommended. As called for by the HITECH Act, the ONC is required to update the Federal HIT plan originally released in June 2008. CHIME comments, submitted earlier this week, highlight several areas for attention, including alignment among HHS regulations affecting the timeliness of patient access to information. The timeliness standard under the HIPAA provisions “is significantly different from that under the electronic health record meaningful use regulations recently adopted by HHS (30 days for information maintained onsite vs. three business days).” On the usability of EHRs, clinical decision support and health information exchange and telehealth tools, CHIME recommended carefully looking at these areas as a means to “keep healthcare CIOs engaged about how their constituent physicians, nurses, and other clinicians are interfacing with EHRs and re-engineering their work processes.”

Reinforcing comments submitted to ONC in February on Stage 2 Criteria, CHIME urged that Stage 2 Meaningful Use objectives not be implemented before 30 percent of eligible hospitals and eligible professionals have achieved Stage 1 objectives. On privacy, the letter advocated standards for a national privacy regulatory environment that would apply to all health information exchange. Said the comment, “We consider this yet another example of how the current HIPAA pre-emption policy creates problems by essentially allowing geographic variation in privacy rules, which complicates compliance and makes it more costly.” Deadline for response has been extended to May 6. To view all responses to-date, click here.