Is a Universal Exchange Language in Our Future?

The report on health IT released in December by the President’s Council of Advisors on Science and Technology (PCAST) has drawn a fairly cool response from the industry establishment. One suggestion, in particular, has raised the hackles of hospital organizations and software vendors alike: Universal exchange using metadata-tagged data elements. What does that mean, you ask? 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.

The PCAST report states: “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.”

As Vince Kuraitis principal and founder of Better Health Technologies, LLC, notes on his blog, that aspect of the report has become something of a “political piñata” with groups ranging from HIMSS to American Hospital Association to the Radiological Society of North America telling the Office of the National Coordinator that the radical suggestion is an attack on existing health IT stakeholders. HIMSS’ comment to the Office of the National Coordinator said, “We believe that the PCAST approach could lead to substantial and negative disruptions that will impose clinical and financial costs that are not offset by reasonably foreseeable benefits.”

I saw this dynamic at work at last week’s eHealth Initiative conference in Washington, D.C. A few people mentioned the PCAST metadata approach in a positive light; others asked questions about how seriously it would be taken, while others dismissed it.

Speaking from the payer perspective, Charles Kennedy, M.D., vice president for health information technology for WellPoint, said that attempts to get value from advances from health IT in the utilization management process always run into problems with the heterogeneity of systems. “This is what the PCAST report stressed,” he said. As an industry we are challenged by a lack of semantic interoperability. Until we get to that point, we will be stuck in the equivalent of the early generation of PCs before the Internet really took off with e-commerce.

During a panel discussion at the eHealth Initiative conference, Charles Jarvis, vice president of healthcare services and government relations, for NextGen Healthcare, was asked about the PCAST approach and said it was an interesting idea but “not the right fit for this market.” Nevertheless, David Blumenthal, M.D., the national coordinator for health information technology, made sure to mention in his talk to the group that ONC is bringing in software experts to study the implications of the PCAST suggestion.

I’d be interested to hear what Healthcare Informatics readers think of the PCAST report. Please leave a comment below to share your thoughts.