Tagging the data
Over the next couple of blog posts, I want to discuss the PCAST report on health information technology a little further.
You recall that the President's Council of Advisors on Science and Technology plopped down its tome on health information technology Dec. 8. It recommended that the feds push harder on health information exchange by adopting an XML-based universal exchange language that enables meta-data tagging for record identification, aggregation and privacy protection.
The presidential advisers want to see their changes rolled into the upcoming meaningful-use requirements. The Stage 2 requirements—along with a "roadmap," if not all of the specifics, for Stage 3—are in development now.
Gary Dickinson is an IT consultant and co-chairman of the electronic health-record work group of Health Level Seven, the healthcare standards development organization. When this PCAST recommendation came out, I called to get his take on the proposal.
"We’ve spent a lot of time in this very area, and this seems to be moving in the direction we’ve been espousing for a long time," Dickinson said. Think of this as a container and its contents. The container could be the HL7 Continuity of Care Document standard and the messages inside the container using XML.
"To put it into everyday, ordinary language, 'meta data' is a way of describing actual data, the things we use in healthcare, and tagging is a way to have a generalized exchange mechanism, such as a generalized container, where the container is used universally and the content will change," Dickinson said. Take a patient care summary of an office visit as an example.
"The container would allow you to capture that summary record inside, and in that container you'd have a diagnostic code, some patient identification information, the symptoms reported by the patient and the particular things that were observed during that encounter, such as vital signs, and orders to the lab and a follow up with a specialist."
Each data element would have its own tag, Dickinson explained. "The tag would say this is a diagnostic code. Or it could be free text, but it would still be tagged, it would have this tag on it that says this is a diagnosis or a problem and it would tell you how it was encoded, whether it was encoded in ICD code or CPT4."
"You could tag the container with certain kinds of security," Dickinson said. "What they’re talking about is somehow bringing patient consent in with the data. For example, if you were reporting HIV results, or drug testing, those elements within the container could be further protected. You would know on receipt, here is the data, but by the way, the patient has requested that certain privileges be applied to the data."
"That’s the challenge we have right now," Dickinson said. "We want the patient to provide data for research and the patient may put certain permissions on it. I want Dr. Smith to see this but I don’t want Dr. Jones to see that."
