HIE Vendors Question PCAST Approach

Speaking at a HIMSS conference session February 21, two executives of HIE software and service vendors praised some of the concepts in the recently released President's Council of Advisors on Science and Technology (PCAST) Report. But they also raised concerns about the message it may send to the health IT community.

PCAST basically proposes scrapping a lot of the work the industry has already done on interoperability in favor of an entirely new approach: breaking medical records into data elements. Each element would have attached information describing it and allowing it to be searched the way a search engine searches Web site data.

Echoing some of the pushback the report has engendered in the blogosphere, Chris Voigt, vice president of corporate development of MobileMD, and Scott Holbrook, executive vice president of Medicity, said PCAST fails to take into account the progress already being made on interoperability.

“What I didn’t see in the report was talk about standards that the industry has already has been working on such as HL7,” said Voigt. The report offers some very good ideas, he added, but the question is how to implement it in the timeframe they suggest without damaging the momentum the industry already has, he said. (The report suggests its recommendations could be ready for Stage 2 of meaningful use in 2013.) You can’t just set a bar and a two-year timeline, he said. Healthcare just doesn’t move that fast. “You also don’t want to create confusion or entropy and have providers thinking they should hold off because the government has something totally different coming down the pike,” Voigt added.

Medicity’s Holbrook expressed concerns about the PCAST suggestion that data elements should be decoupled from their source structures. “Our concern is that data could be read out of context and lead to misinterpretations,” he said. People have to access that data in its contextual environment to know what is going on with a patient. The alternative, he added, is to preserve the context such as the Clinical Document Architecture (CDA) does today which is more efficient while still being “self-describing.”

Both executives credited PCAST with increasing public awareness and building a discussion around key issues of data standards and exchange. But they want to make sure that if any of its recommendations are adopted, the industry doesn’t have to reinvent the wheel.