Tuesday, December 14, 2010

Is This A Really Major Change For Health IT in the USA or Not? I Suspect It Might Be.

I think the answer is yes. And the flow on effects for Australia could be substantial indeed.

This announcement appeared a few days ago.


President's Council of Advisors on Science and Technology

On December 8, PCAST released a report entitled “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward.”

The press reaction has been quite positive. Examples include:

PCAST calls for universal exchange language

By Joseph Conn

Posted: December 8, 2010 - 11:30 am ET

The President’s Council of Advisors on Science and Technology issued a report calling on the federal government effectively to continue its work in facilitating the development of a nationwide capability to exchange health information, while specifically calling for it to promote the adoption of a common language to do so, including the use of data tagging for privacy and security protection.

In a letter to President Barack Obama accompanying the 108-page report, Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward (PDF), the council’s co-chairmen, John Holdren and Eric Lander, fully endorsed the potential benefits of health IT.

The widespread use of the technology and its attendant available data will help clinicians diagnose and treat patients, help patients take better control over their health, streamline public health monitoring, enhance the ability to conduct clinical trials, pare costs and create "new high-technology markets and jobs."

To achieve these objectives, the chairmen said, PCAST has concluded "it is crucial that the federal government facilitate the nationwide adoption of a universal exchange language for healthcare information and a digital infrastructure for locating patient records whole strictly ensuring patient privacy."

More here:



President's Advisors Tackle Health Data Exchange

HDM Breaking News, December 8, 2010

A report from an advisory body to President Obama recommends use of a "universal exchange language" to facilitate the exchange of health information while protecting privacy.

Use of such language could give patients more control over the dissemination and use of their medical information in an automated fashion.

Universal exchange languages for metadata descriptions, known as "extensible markup languages" are widely used, notes the President's Council of Advisors on Science and Technology. "The best way to manage and store data for advanced data-analytical techniques is to break them down into the smallest individual pieces that make sense to exchange or aggregate," according to the 108-page report. "These individual pieces are called 'tagged data elements' because each unit of data is accompanied by a mandatory 'metadata tag' that describes the attributes, provenance, and required security and privacy protections of the data."

This means that privacy rules, policies and applicable patient preferences "are innately bound to each separate tagged data element and are enforced both by technology and by law," the report continues. "For example, a patient with diabetes may decide that her blood sugar information should be available to any of her doctors and to emergency physicians requesting that information should she have a problem while traveling in another state--but that details of her past treatment for cancer should remain private and not be shared."

More here:


and lastly here:

White House calls for standard language for health data exchange

By Mary Mosquera
Wednesday, December 08, 2010

The White House has called for a “universal exchange language” to enable healthcare providers to share health information in real time, in order to modernize and coordinate diagnosis and treatment while incorporating privacy and security of personal data.

To accomplish that, the Office of the National Coordinator for Health IT and the Centers for Medicare and Medicaid Services should develop the technical definitions and descriptions for the standard language and include them in requirements for meaningful use of electronic health records in 2013 and 2015, according to a White House report published Dec. 8.

In the report, the President’s Council of Advisors on Science and Technology (PCAST), a group of presidentially appointed experts from universities, industry and other organizations, urged the adoption of standards so healthcare providers can accelerate the exchange of patient records.

The federal government has made progress in laying the foundation for adoption of electronic health records (EHRs) through the incentive program under the HITECH Act, according to the PCAST report, “Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward.”

However, information for the most part is still held captive in proprietary systems, and providers cannot share and act upon the data to make better healthcare decisions, said Eric Lander, PCAST co-chair and president of the Broad Institute of Harvard and the Massachusetts Institute of Technology.

Among its recommendations, PCAST said that ONC should “move more boldly” to make sure that EHRs are able to exchange health information in a standard manner based on metadata-tagged data elements.


ONC is asking for public comments (http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__regulations_and_guidance/1496) about the report through Jan. 17.

More here:


Now I understand fellow blogger Dr Eric Browne has more than a few reservations about the idea.

See here:

Recasting e-health in the USA

2010-December-11 | 11:35 By:

On December the 8th, 2010 the US President’s Council of Advisors on Science and Technology (PCAST) published an extraordinaryReport to the President realizing the full potential of health information technology to improve healthcare for Americans: the path forward“. This report is extraordinary for a number of reasons.

Firstly, PCAST is not comprised of government bureaucrats with little technical understanding, but by some of “the nation’s leading scientists and engineers”.

Secondly, PCAST concludes that “achievement of the President’s goals requires significantly accelerated progress toward the robust exchange of health information“. The report specifically denies a requirement for any national health record; it specifically denies any need for a national patient healthcare identifier; and specifically shuns the current shift towards exchanging documents in favour of exchanging structured atomic data tagged with context and privacy metadata.

Read the full blog here:


Now I don’t have Eric’s deep understanding of the issues he is concerned about, the rather large bunch of government and industry experts involved in developing this document suggests that pretty much all the bases would have been covered - or do I have too much faith?

Whatever is true my suspicion is that this may be a game changer.

I strongly recommend a read and making up your own mind.

(I was also amused to read that PCAST does not believe SOA technologies, so much beloved of NEHTA are up to it in the long term for their needs for Health Information Exchange!).

I note there is also a period of public comment on the document - so you can be sure that if they have it wrong they will be told! Something we could use a bit more of I have to say.

ONC wants PCAST report feedback

By Joseph Conn

Posted: December 13, 2010 - 11:30 am ET

The Office of the National Coordinator for Health Information Technology is seeking public comment on a report released last week by the President's Council of Advisors on Science and Technology.

The formal request for information was published in the Federal Register (PDF). The comment period will be open through the end of the business day Jan. 17.

More here:




Tom Bowden said...

Hi,Tom Bowden here, in Toronto where it is currently snowing a lot of the time. I think that this report is VERY significant, in particular because of the doubt it casts on the US' existing strategy and also because of the proposed radical departure from approaches being taken currently. I'd be really keen to read the views of other readers on this Blog, to understand how feasible they think it is. Bear in mind, this report has been prepared for the President, with input from some enormously clever, well-connected and talented people. One way or another it will have a significant impact on what we are doing. Please do read it, discuss it, review it and debate it and tell us your views on it. It is something we should all try and get our heads around fairly swiftly. I'd personally appreciate any comments or insights you have, Kind regards, Tom

Thomas Beale said...

Cleverness I am afraid has nothing to do with generating needed results in e-health. The current disaster zone of e-health standards is proof of that. The problem domain is hard to understand properly, and solutions will only come from a proper R&D / engineering type organisation(s) that properly integrates input from a) health professionals b) software engineers and c) knowledge specialists to create an open health computing platform. It needs to be funded properly and carefully managed.

The efforts we have today for doing this are quite frankly ridiculous, and they waste the time and talent of the poor (and very clever) people who have to spend time in them.

Tom Bowden said...

Hi Thomas,

I am pretty skeptical about what is proposed, but I'd be very interested in others' views as to why it will or will not work. I take it that you view it as deeply flawed. Are you able to share your rationale for this viewpoint. I'd be very interested in what you have to say. I am sure others would be too.