The Language of the Health Internet

The President's Council of Advisors on Science and Technology (PCAST)on December 8, 2010 released a report entitled "Realizing the Full Potential of Health Information Technology to Improve Healthcare for Americans: The Path Forward." You can watch the video of the event here. One of the striking features of the report is that it calls for the creation of a "universal exchange language" to enable healthcare providers to share health information in real time, and a "digital infrastructure for locating patient records" while still providing for patient privacy and security. Keith Boone gives a great opening post into the standards this entails.

The report advocates for the use of open standards and some type of XML variant in the development of a healthcare language that can be used to exchange data. This will be the language of the Health Internet. Using an XML-based approach might allow health IT to expand beyond EHR systems used in physician practices to a more widespread use across the entire healthcare industry. The report says:

We believe that the natural syntax for such a universal exchange language will be some kind of extensible markup language (an XML variant, for example) capable of exchanging data from an unspecified number of (not necessarily harmonized) semantic realms. Such languages are structured as individual data elements, together with metadata that provide an annotation for each data element.

A universal exchange language will certainly help with broader adoption of a robust system for health information exchange. The report calls out certain advantages to using a universal language:

• It will improve healthcare quality, by making it possible for a physician to integrate accurately all of a patient’s medical information.
• It will improve healthcare quality and decrease costs, by making it possible for third-party innovators to compete to create widely applicable services and tools serving patients, providers, payers, public health officials, and researchers.
• It will provide much stronger privacy protection than available under current approaches, allowing persistent privacy assurances (including applicable patient preferences) to be attached to different kinds of information and using data-level encryption to prevent access of data by unauthorized persons.
• It will not require universal patient identifiers, nor will it require the creation of Federal databases of patients’ health information.
• It will simplify the regulatory burden on providers, by decreasing the focus of meaningful use regulations on ad hoc list of data items.
• It will help U.S. industry leapfrog to the front of the pack internationally in health IT, by providing exchange standards that can be more broadly adopted by others.
• It will facilitate public health and medical research, by providing a secure way to de-identify data.
• It will not require that existing systems be replaced, but only be modestly upgraded or augmented by “middleware.”

All of these points ring true. And the report further calls for more stringent data exchange requirements for future stages of meaningful use criteria. "The steps that must be taken can be accomplished with the required time frame. It can be accomplished via an evolutionary transition from traditional EHRs to a tagged data element model, along with a more rapid transition for the more limited purpose of data exchange by means of a universal exchange language," according to the report. "We note that these steps are not intended as an alternative to ONC's important work in promoting the adoption of electronic health records. Rather, they are complementary to that work and will accelerate adoption."

I am in favor of the direction this report takes and will conduct deeper analysis over the coming weeks. There will still be a great deal of debate over how to best implement the recommendations in this report, but an important discussion has been given the spotlight, and I believe this will help drive the agenda forward. One thing is for certain - this report brings health information exchange to the forefront of the discussion on meaningful use of certified electronic health records.

...