CHIME: Don't tie metadata to meaningful use

The College of Healthcare Information Management Executives is counseling federal health information technology policy makers to go slowly and not tie the use of metadata tagging to future meaningful-use criteria for electronic health-record incentive payments.

The Ann Arbor, Mich.-based association for chief information officers and other healthcare IT leaders, presented its opinion in a two-page response (PDF) to a formal advance notice of proposed rulemaking issued by the Office of the National Coordinator for Health Information Technology last month.

The ONC is considering regulations on the use of metadata tagging as recommended in a December 2010 report by the President's Council of Advisors on Science and Technology, or PCAST. Under the terms of the American Recovery and Reinvestment Act of 2009, providers can receive federal incentive payments if they use a certified electronic health-record system in compliance with federally established meaningful-use criteria. Criteria for Stage 2 of the program, which is scheduled to start late next year, and for Stage 3, which won’t begin until at least late 2014, have yet to be developed.

"We do not believe that the meaningful-use regulatory schema is the appropriate venue to mandate unproven standards or incomplete protocols," CHIME's response noted. "Presently, we do not believe there is consensus around HL7 CDA R2 header syntax or any other metadata standards that could be implemented across the healthcare ecosystem in time for Stage 2 meaningful use." The organization recommends that the ONC push forward with Query Health, data-segmentation and other initiatives relating to metadata inside the established Standards & Interoperability Framework for the purpose of fully vetting the range of possible standards and assembling the needed implementation processes. The S&I Framework is a government-created initiative to achieve interoperability of health information technology.

Additionally, according to CHIME, the ONC "should engage hospitals, vendors and health information organizations to determine feasibility for future meaningful-use certification. However, we do not foresee this scenario happening before meaningful use Stage 3."

Still, CHIME offered a backup pledge if the government goes ahead with adding metadata requirements to the federal health IT regulatory mix.

"If ONC is confident robust metadata standards currently exist, CHIME would like to offer its services and assist in establishing implementation guidelines to ensure that protocols can scale across the provider community," the organization stated.