ONC Committee OKs Recommendations for Metadata Tagging, Provider Directories

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The Office of the National Coordinator for Health Information Technology's HIT Standards Committee on June 22 approved recommendations for metadata tagging standards to increase data interoperability while ensuring the privacy and security of sensitive data.

The committee also approved recommendations for provider director standards.

The metadata analysis “power team” identified the Health Level 7 Clinical Document Architecture Version 2 (CDA R2) standard as the best standard to use to attach information about the provenance of data, the identity of patients, and the privacy settings on various pieces of patient data, as the information is exchanged among health care providers.

Metadata tagging involves breaking data down into its smallest pieces and then attaching specific privacy policies and information to that data so that it can be exchanged based on the needs of the sending or receiving physicians.

While members of the HIT Standards Committee approved the recommended standard, it was approved with the understanding that this would be the first step in fully analyzing, vetting, and researching metadata standards, including CDA R2, that exist.

The metadata tagging concept was initially introduced by the President's Council of Advisors on Science and Technology's (PCAST) report on health IT in December (see previous article).

At the May Standards Committee meeting, ONC presented its initial analysis of existing standards that could support the transport capabilities recommended by the PCAST report, and requested that the committee review ONC's findings (see previous article).

By approving the recommendations, the Standards Committee now gives ONC the opportunity to seek comments from the broader health IT industry, and feedback on future proposed rulemaking for Stage 2 of the “meaningful use” incentive programs, National Coordinator for HIT Farzad Mostashari said.

Continued work on metadata tagging standards may also happen in the form of pilot projects at large and advanced health care organizations or federal agencies that use electronic health records, such as the Department of Veterans Affairs or Department of Defense, Mostashari said.

Alternative Provider Directory Format Approved

The HIT Standards Committee also approved a recommendation from the privacy and security standards workgroup to use internet-based standards to create a provider directory database, without actually creating a national provider directory, Dixie Baker, chair of the workgroup and vice president and technical fellow at Science Applications International Corp., said.

The privacy and security standards workgroup recommended that the standards and interoperability framework team at ONC consider an approach to structuring and encoding web content, using standards and vocabulary codes to meet the need for nationwide access to directory information, Baker said.

Specifically, health care organizations would create public web pages containing directory information they want to make available for a search. This way, organizations would be easy to find and contact for health information exchange, while still protecting health information and data, Baker said.

Furthermore, organizations could obtain “extended validation certificates” to ensure the validity of the information provided by the organizations, she said.

The privacy and security standards workgroup plans to next tackle the proposed criteria for Stage 2 of the meaningful use program. The workgroup plans to present recommendations on standards for privacy and security criteria at the July meeting of the Standards Committee.

Upgrading Standard Code Sets

Also approved by the Standards Committee was a transmittal letter from ONC to the Department of Health and Human Services detailing which upgraded versions of technical standards that were included in the standards and certification rules for Stage 1 of the meaningful use program would be acceptable to certify in EHRs.

For example, many code sets for laboratory results reporting and immunization reporting have been updated since the final rules were published last July. However, EHRs and EHR modules certified for the older versions will not have to be re-certified for the new versions, in accordance with ONC's letter.

“The purpose of this process is a way to identify and approve acceptable newer versions of minimum standards code sets for voluntary use and permitted testing and certification,” the letter said.

The process was designed by ONC in the standards and certification rule as a way to lessen the regulatory burden for the federal agencies involved in the Medicare and Medicaid meaningful use incentive programs.

By Genevieve Douglas

Presentations and other meeting materials from the tiger team are available at http://healthit.hhs.gov/FACAs by clicking on the June 22 HIT Standards Committee meeting entry on the ONC federal advisory committee calendar and clicking on the meetings link.