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Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, March 07, 2012

It Will Be Interesting To See Where This Idea Actually Leads. A Simple Approach To Summary Care Records From The US.

The following appeared a little while ago.

Get Ready for Metadata in Meaningful Use Stage 2

MAR 1, 2012 11:45am ET
The Office of the National Coordinator for HIT’s proposed rule for Stage 2 of the electronic health records meaningful use program begins the process of including use of metadata as criteria for compliance.
In December 2010, the President’s Council of Advisors on Science and Technology called for metadata to be part of Stage 2. The ONC rule, in its current non-published version on pages 34-35, pushes limited use of metadata.
In the proposed rule, ONC calls for adoption of the Consolidated CDA standard for summary of care records, which essentially is a revamped Continuity of Care Document. This standard includes several metadata elements, including two that are proposed for use--data provenance and the ConfidentialityCode. Provenance gives information about the history or origin of data, like a date/time stamp. The ConfidentialityCode describes what kind of data is being electronically sent--N for normal, R for restricted and V for Very Restrictive.
The full article is here:
The article provides a link to an article with some explanations of what is planned:
The article is available here at no cost.
Here are the first few paragraphs of a detailed discussion of the area and why it now matters for the US.

Metadata and Meaningful Use

By Allison Viola, MBA, RHIA, and Shefali Mookencherry, MPH, MSMIS, RHIA
It should come as no surprise that when in August 2011 the Office of the National Coordinator for Health IT (ONC) issued an advance notice of proposed rulemaking on the use of metadata standards the health IT community expressed a collective gasp. Despite so many health IT and healthcare reform initiatives under way, ONC indicated it was considering recommendations to add the use of metadata-tagged data elements in stage 2 of the meaningful use program.
ONC issued the notice in response to a December 2010 report released by the President's Council of Advisors on Science and Technology. In that report PCAST outlined strong recommendations to speed the growth of health information exchange through the use of metadata tags.
The PCAST report called for a universal language for exchanging health data, an extensible markup language (such as a variation of XML) where health data would be separated into the smallest individual pieces that make sense to exchange. These data elements would be accompanied by mandatory metadata tags or minimal standards that describe the data and the patient's preferences for the data's uses, security, and privacy protections. Such a solution would enable healthcare providers to share health information reliably and effectively.
What's more, PCAST urged the federal government not to wait. ONC "should signal now," PCAST wrote, that EHR systems must have the ability to exchange health data in a universal manner based on metadata-tagged data elements by 2013 in order to qualify for use in the meaningful use program.
In principle, the healthcare industry agrees on the value of greater metadata use. A range of entities have recognized that metadata tagging has the potential to increase the usefulness and integrity of data for health information exchange by better describing the information being shared. However, PCAST's recommendation that ONC "move boldly" is too bold for many. In responding to ONC's advance notice, commenters cited multiple barriers to the quick implementation of metadata requirements.
The release of the proposed rule on stage 2, expected this month, will be the first test of how quickly ONC intends to include metadata in the meaningful use program. But ultimately the question of applying metadata to discrete pieces of health information is a matter of when, not if.
The full long article is here:
So there you have it - an improved Clinical Summary Sharing Document supported by embedded information of the information provenance and sensitivity.
At a high level it sounds pretty good to me! This again follows the KISS principle rather better than the PCEHR proposals.


Anonymous said...

Why the PCEHR can't use the standard CDA confidentiality codes I don't know.

Grahame Grieve said...

The standard CDA confidentiality codes are normal, restricted, and very restricted. They apply to the document, and are fixed by the document author. The PCEHR is the *personally-controlled* EHR, which means that the document access is controlled by the person, not the author of the document. That's not to every one's liking, but as long as the PCHER is personally controlled, the standard CDA confidentiality codes aren't applicable. (not that those 3 values are that useful anyway - the code list is extensible, and most real projects define their own)

Anonymous said...


There is some missing logic here. The confidentiality code not part of the access control of the documents in the PCEHR. This does not imply that it should always be set to some particular value. All it means is that the PCEHR should ignore it.

In fact this decision inhibits document sharing across domains (where the PCEHR is one domain). If the document requires a confidentiality code in a different domain (such as within a hospital) then it cannot be copied to the PCEHR without creating a new document.

Grahame Grieve said...

You want the PCEHR to *ignore* the stated confidentiality of the CDA document? Really?

Yes, I agree that the decision inhibits sharing. But it's not the confidentiality code decision, but the *personally-controlled* decision that prevents such sharing. But that's a political decision which had known costs.