This month's report on health information technology by the President's Council of Advisors on Science and Technology, or PCAST, has startled some in the health IT community and challenged others—while getting everyone's attention.
Particularly arresting and discouraging for some was its call for applying federal persuasion for the healthcare industry to adopt an Internet-friendly "universal exchange language" for storing, retrieving and swapping healthcare data.
Mark Segal is a member of the executive committee of the Electronic Health Record Association, a trade group for EHR software vendors that operates as an independent unit of the Healthcare Information and Management Systems Society. Segal says he worries there won't be enough time for vendors to work on the proposed technical changes to accommodate PCAST's interoperability requirements in time for inclusion in the Stage 2 meaningful-use requirements scheduled to take effect in 2013.
Stage 2 criteria remain a work in progress. Final recommendations aren't expected from a federal advisory committee until next summer, but an outline of what they might include is taking shape. Those expected upgrades will be difficult enough for vendors to pull off in time without adding new ones for data exchange, he said.
The current “regulatory schedule for upgrading meaningful use is constraining," says Segal, who is also vice president of government and industry affairs for GE Healthcare IT. "We believe you need to have the regulations for Stage 2 out well before what's being planned just to enable the changes that are needed. I don't think things will move quite as fast as” PCAST members hope.
John Halamka, chief information officer of Harvard Medical School and Beth Israel Deaconess Medical Center, both in Boston, has blogged here and here at length about the PCAST report and its implications for the government's considerable work to date on promoting interoperability.
Halamka previously was chairman of the Healthcare Information Technology Standards Panel under former HHS Secretary Mike Leavitt. More recently, he served as co-chairman of HHS' Health IT Standards Committee. The good news, Halamka reports, is that the government and the private sector already are using some metadata tagging in their information-exchange planning and development efforts.
He all but dismisses another PCAST recommendation: using metadata for privacy controls, in particular as a way for patients to put the technology to use in recording and enforcing their own electronic consent directives.
"Although this is a noble goal, the reality of implementing this is quite difficult,” he writes.
Halamka notes that the Privacy & Security Tiger Team reporting to HHS' Office of the National Coordinator for Health Information Technology has been working on a framework for meaningful consent. It doesn't require consent for many exchanges—just as the HIPAA privacy rule doesn't—but the tiger team does recommend that patients be given some controls under certain circumstances.
"Their work is truly a prerequisite to the privacy protections suggested by PCAST,” Halamka says. "A phased approach to get us to the goals outlined in the PCAST report would work well."
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