ONC seeks input on EHR metadata

By Mary Mosquera
09:44 AM

The Office of the National Coordinator for Health IT has released an advance on a proposed rule about the use of existing metadata standards to support electronic health information exchange and to get feedback on the experience from various organizations that may have applied them.

ONC is considering inclusion of certain metadata standards in Stage 2 of meaningful use.

The use of metadata, or elements that describe data, is considered key to fueling more complex health information exchange. 

The advance notice of proposed rulemaking (ANPRM) offers ONC's first draft views on the adoption of metadata standards, using the scenario where a patient obtains a summary care record from a provider’s electronic health record or requests for it to be transmitted to their personal health record. 

ONC released the document late Aug. 5 and will publish it in the Aug. 9 Federal Register, after which the public will have 45 days, or until Sept. 23, to comment.

“We believe that the use of metadata holds great promise and the adoption of metadata standards can help rapidly advance electronic health information exchange across a variety of different exchange architectures,” ONC stated in the advanced proposed rule document.

Farzad Mostashari, MD, the national health IT coordinator, said in June that ONC wants to learnd about organizations' real-world experience with metadata in comments from the proposed rule before ONC publishes the proposed regulation for standards, implementation specifications and certification criteria for Stage 2 of meaningful use likely at the of the year.

Some current standards contain metadata tags, such as the Health Level 7 Clinical Document Architecture Release 2 (HL7 CDA v.2) and ASTM’s Continuity of Care Record, summary care record formats either of which providers can use under Stage 1 of meaningful use.

Increasing trust

Under the proposed rules scenario, a set of standards for metadata could be wrapped around or attached to a summary care record when patients seek to download their health information from a provider’s patient portal or transmit it directly to their individual PHR.

ONC is focusing on the metadata for that single scenario - patient identity, or data elements about a patient; provenance, or data about the source of the clinical data; and privacy, data about the type and sensitivity of clinical information.

“If these metadata are available, they could potentially increase the level of trust that providers would place in clinical information they receive through patient-mediated exchange, such as from a PHR, and could enable patients to more easily sort and re-share their own health information,” the proposed rule said.

Following the scenario for patients seeking their information, the physician’s EHR technology would have to be capable of creating a summary of care record and assigning metadata to the care record before the patient receives it, according to the proposed rule.

This capability may also be able to be extended to other directed transfers of summary care information, such as associated with transitions of care, ONC said. 

The use of metadata took on a higher profile with the report last December of the President’s Council of Advisors on Science and Technology (PCAST) to accelerate more complex health information exchanges.

The PCAST report called for a universal exchange language, which is an extensible markup-like (XML) language, and other standards to enable healthcare providers to share health information more reliably and effectively in order to modernize and coordinate patient care. 

The PCAST report also recommended that health data be separated into the smallest individual pieces that make sense to exchange. These data elements would be accompanied by a mandatory metadata tag or minimal standards that describe the data and the patient’s preferences.The advisory Health IT Policy and Standards committees analysed the PCAST recommendations and how ONC might begin to incorporate them by building on existing health IT.

ONC also presented in the proposed rule a list of questions it hopes that the public will comment on regarding other technical aspects of metadata, including incorporating the function in vendor technologies and additional elements and standards for metadata, to help guide it.