CHIME asks ONC to think harder about metadata


By Mike Miliard
10:50 AM
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The College of Healthcare Information Management has urged ONC to "study the complex issues" surrounding metadata standards "more closely," imploring officials to work with industry partners to develop and test those standards before any broader regulatory action is taken.

Writing in response to an advanced notice of proposed rulemaking on the use of metadata standards to support health data exchange, CHIME officials told the Office of the National Coordinator for Health IT that current thinking around metadata standards needs further investigation through established processes before being codified into regulations.

[See also: ONC seeks input on EHR metadata.]

Metadata is descriptive information that helps computer systems understand where data originated and how it has changed over time; it describes what data means and how data should be used. That ability will enable health information to "follow" the patient when it is needed, no matter the time or the place, without compromising privacy concerns.

Two initiatives being undertaken by ONC to help inform metadata and health information exchange include Query Health and Data Segmentation. Together, these pilot projects are expected to advance understanding of how metadata could be used within healthcare, but they are very early in development.

CHIME officials believe that these and other initiatives hold promise, but that metadata standards currently being considered for use are underdeveloped. They recommend that ONC investigate metadata standards using an inclusive volunteer network of technical experts established through the Standards Interoperability Framework.

“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,” said officials in comments submitted Wednesday.

“CHIME recommends that ONC push forward with Query Health, Data Segmentation and other initiatives relating to metadata inside the established Standards & Interoperability (S&I) Framework in order to fully vet the range of possible standards and assemble the needed implementation processes,” they added.

[See also: ONC to run metadata tests via HIEs.]

CHIME comments acknowledged the work conducted by ONC and industry partners since meaningful use Stage 1 certification criteria were adopted. CHIME members are among the health IT stakeholders who have been active participants in ONC pilots, such as the Direct Project.

“For those of us working on expedient and scalable ways to do agnostic EHR-to-EHR CCD (CDA family) exchanges, metadata is a very important component to get right,” said George T. Hickman, executive vice president and CIO at Albany Medical Center in Albany, N.Y. “We’re making strides in New York to demonstrate use cases with implementable outcomes for exchange, but to undertake an industry-wide pilot project that requires vendors to develop and providers to implement metadata standards is more than a stretch.”

Instead, CHIME urges ONC to use its existing channels of collaboration to test standards and protocols more extensively in preparation for Stage 3 of meaningful use.

“What we’re saying is not news to the Office of the National Coordinator,” said Sharon Canner, senior director of advocacy programs with CHIME. “In June, the HIT Standards Committee recommended that ONC conduct further testing and evaluation prior to proposing any metadata standards in rulemaking.”

CHIME officials agree that metadata holds great promise to help advance electronic health information exchange across a variety of different architectures, and so the organization has offered its services to help ONC establish implementation guidelines to ensure that protocols can scale across the provider community.

Click here to read CHIME’s comments (PDF).