Move gradually on PCAST report recommendations: ONC work group

A work group of the federally chartered Health Information Technology Policy Committee concluded in a presentation delivered last week to the Office of the National Coordinator for Health Information Technology that it was feasible to move in the direction pointed to by a White House technology advisory council but that the ONC should proceed by making incremental changes from its present technological course.

In December, the President's Council of Advisors on Science and Technology issued a 108-page report that called on ONC to use its leverage to create and adopt a universal exchange language and use so-called meta-data tagging to facilitate records search and retrieval. The tags also could host privacy and security constraints that would follow the data from user to user.

Dr. William Stead, associate vice chancellor for strategy and transformation and director of the Informatics Center at Vanderbilt University Medical Center, Nashville, served as vice chairman of the work group appointed in January by then-ONC chief Dr. David Blumenthal. Stead, in presenting a draft of the letter at the April 13 policy committee meeting, summarized the work group's review in three points.

One was that the PCAST report describes a nationwide use of advanced technology and provides “a compelling vision for how that technology could be beneficially used as an important aspect of the learning health system” advocated by the ONC's recently released national healthcare IT strategic plan.

Another was that there are “major policy and operational feasibility concerns with the proposed technology.”

A lack of time for accomplishing the PCAST's goals while dealing with several other IT challenges the healthcare industry currently faces was an issue when the PCAST report was first released, and it remains a key problem, as communicated by the workgroup.

The PCAST exhorted the ONC to “move rapidly” and “act boldly” with an eye to leveraging the Stage 2 and Stage 3 meaningful use guidelines of the federally funded EHR incentive payment program to develop a “comprehensive ability to exchange healthcare information.”

The work group concluded, however, there is “inadequate time to prepare detailed regulations and testing criteria” to meet all of the goals set out in the PCAST report by 2013, when Stage 2 criteria for the federally funded EHR incentive program are to go into effect.

Still, the work group concluded that “it is possible to implement the new exchange architecture in a series of incremental steps” with some changes made by 2013. One example was the transfer of data to a patient's personal health record using tagged "continuity of care document" or "continuity of care record." The CCD and CCR are two commonly used standard data profiles for transmitting patient care summaries.

The group also said ONC could use the Stage 2 criteria development process “to identify meta-data standards for other specific Stage 2 transactions.”

Another looming problem involves privacy policy, according to the work group. The PCAST called for potentially letting patients attach directives limiting the movement of specific granular data elements, such as a sensitive prescription, diagnosis or lab test result information, to their records.

In a 2002 revision of the HIPAA privacy rule, HHS rulemakers stripped away the need for providers, payers and claims clearinghouses to obtain patient consent for the disclosure of a patient's medical records for treatment, payment and the catch-all category of “other healthcare operations.” Despite persistent pressure from privacy advocates ever since, patient consent has not been restored for those disclosures.

The work group noted that “substantial privacy and security concerns” were raised about placing granular consent technology under patient control. “Among the concerns are the feasibility of patients meaningfully exercising highly granular privacy controls and the effect of such controls on clinical care,” the work group report said.