Healthcare IT professionals aren't short on opinions when it comes to last week's report from the President's Council of Advisors on Science and Technology, or PCAST. Among its recommendations, the report calls for the use of meta-data tagging as a way to promote patient privacy.
Howard Landa is the chief medical information officer for the Alameda County (Calif.) Medical Center and a pediatric urologist for Kaiser Permanente in Hawaii. He also is vice chairman of the Association of Medical Directors of Information Systems, a professional association for physicians in applied medical informatics.
"I think they underestimate what it's going to take to get to that level of specificity," Landa said. "I think we're moving toward that, but any data standards that exist, whether it's on the level of diagnosis or treatment, (are) still not complex enough to really exchange data at a meaningful level.
"I just don't see a business case for this at any provider level," Landa says. "You're talking about a lot of money and work."
Duane DeCouteau is a programmer working for the Veterans Affairs Department on a pilot information exchange project with Kaiser Permanente in San Diego. As part of the project, DeCouteau is developing the OASIS/XSPA (Organization for the Advancement of Structured Information Standards/Cross-Enterprise Security and Privacy Authorization) reference implementation to automate patient consents for the release of their medical records.
According to DeCouteau, the healthcare industry hasn't moved faster on developing and deploying privacy technologies because policymakers haven't insisted upon it. Meanwhile, he said, policymakers wring their hands and say they can't set the policy because proven technology isn't available.
"The technology to do this is there," he says, ranging from recording and enforcing simple opt-in decisions on health information exchange to more-complex privacy controls such as tagging and constraining specific diagnostic codes.
By early 2011, a veteran will be able to opt in electronically, automating a process that the VA does manually, he says. "By September, we're supposed to have the full-blown capabilities in places. It can do whatever they want it to do."
Robert Dolin is chairman of Health Level Seven International, the primary developer of the Continuity of Care Document format for clinical messaging inside a larger framework—the Clinical Document Architecture. The CDA is used to move clinical documents such as discharge summaries, progress notes and laboratory results among providers; it uses XML for encoding documents. XML is the language family PCAST specified for health information exchange.
Dolin says that HL7's work on a templated CDA is complementary to what PCAST is specifying.
"When I look at the PCAST report calling for metadata-tagged elements, it's beautiful," Dolin says. "That is the basis for a templated CDA."
A template could be used to standardize the way to record and transmit any particularly useful document, but could be as specific as a single diagnosis.