Those of you keeping a close eye on the Office of the National Coordinator for Health Information Technology (ONC) and its activities might have noticed the advance notice of proposed rulemaking (ANPRM) that was published on Tuesday, August 9, 2011, requesting public input on a set of proposed metadata standards recommended to ONC by the HIT Standards Committee.

The immediate focus of the ANPRM is the association of metadata with summary care records, but we also welcome input on the use of metadata relative to other electronic health information contexts. To better inform future proposals, we expressed our interest in learning about stakeholders’ relevant metadata implementation experience and requested public comment on the results of any real-life testing or use of the metadata standards discussed the ANPRM.  The ANPRM builds upon the recommendations of the Health IT Policy and Standards Committees, which put forth analysis on how ONC could accelerate health information exchange consistent with the vision laid out by the President’s Council of Advisors on Science and Technology (PCAST) in the report it issued in December 2010.  The PCAST report envisions a robust health information exchange ecosystem in which patients and providers are able to privately and securely exchange health information across organizational boundaries.

ONC is considering a series of prototypes and pilots to put some of our recommendations to the test. Two of these initiatives – the Query Health initiative and the Data Segmentation initiative – are slated to launch through the Standards and Interoperability (S&I) framework this fall. These initiatives have the potential to improve the quality, safety and coordination of health and health care. Information can be found on the S&I Framework wiki and will be updated frequently so check back often!

• Query Health initiative: The Query Health initiative aims to define and deliver the standards and services for distributed population health queries from certified electronic health records (EHRs) and community records originating in the routine course of patient care. As a result, requesters will be able to create and securely distribute queries to network data partners who subscribe to the published queries. Network data partners will execute the query against a standard clinical information model and securely return the results of the query to the requester. Standards will also include sustainability and extensibility for the clinical information model, as well as the terminology that enable the queries and results expression. Ultimately, this initiative will enable population analyses to inform both clinical and payment strategies for their health systems and practices, in alignment with the HITECH and Affordable Care Acts. Providers will be able to calculate quality measures for populations. From a HITECH perspective, Query Health will leverage the standards and policies that enable the Meaningful Use of patient care and health information exchange.

• Data Segmentation initiative: The ONC Offices of the Chief Privacy Officer and Standards and Interoperability are currently planning an initiative on data segmentation of sensitive information. This project aims to make progress on the persistent privacy issues raised in the PCAST report. The goal of this project is to enable the implementation and management of health information disclosure policies originating from a patient’s request, statutory and regulatory authority or organizational disclosure requirements. The project aims to examine and evaluate the standards needed for sharing individually identifiable health information (including standards recommended by the Health IT Standards Committee through the use of metadata tagging of privacy attributes in standard clinical and policy records and record segments). The initiative will develop use cases that define the current need for data protection services, such as a patient’s directive not to disclose substance abuse records in accordance with 42 CFR Part 2, and will then extend current standards-based software models to demonstrate interoperability. Testing will be based on a reference model aligned with a set of use cases and functional requirements developed by the S&I community.

We are also actively piloting the concepts included in the PCAST report through our State Health Information Exchange (HIE) Program. The Indiana HIE Challenge Grant, through the Regenstrief Institute, is developing tools and approaches to capture, index and search on key metadata, parsing information from patient summary care records. This will allow more detailed query at the data element level. The approach builds on existing data flows from legacy systems while using middleware and improved metadata to increase searchability and usefulness of patient level information by clinicians. The initiative is also developing a user interface allowing patients to have more granular control over the management and sharing of their health information. Initiatives in other states, including Montana, will be generating patient care summaries from EHR systems and making these query-able to answer population health questions, creating a rich environment to test metadata standards.