Advancing HIE
ONC Works to Harmonize Standards and Elements to Foster Health Data Exchange
By Allison Viola, MBA, RHIA
AS THE MEANINGFUL use program marches forward, the Of- fice of the National Coordinator for Health IT (ONC) continues to sharpen its focus on health information exchange (HIE). One of the main components in the HITECH Act mandated “the use of certified EHR technology for electronic exchange of health information to improve the quality of health care.” As such HIE will become more prevalent in future meaningful use stages. In order to support current HIE efforts under way and those in development, standards must be harmonized and implement- ed. Several organizations have been actively promoting the use of standards for data exchange. For example, Health Level Seven (HL7) and the Council for Affordable Quality Healthcare
have worked to foster standards harmonization and integration
to enable healthcare data exchange.
PCAST’s HIE Recommendations
Another group working to foster HIE is the President’s Council
of Advisors on Science and Technology (PCAST). In December
2010 PCAST issued a report strongly encouraging the use and
integration of metadata-tagged data elements.
“Tagged data elements can be extracted by special software
(known as middleware) from existing clinical systems. Or they
can be produced from enhanced versions of those systems, or
by completely new and innovative applications,” according to
the report. “In this way, all data could be exchanged among all
systems no matter the origin or internal record formats of the
data, and without the necessity of replacing existing legacy software.” 1
However, consideration needs to be given regarding what
“metadata” entail and how metadata and their tagged elements
can improve the exchange of healthcare data.
60 / Journal of AHIMA October 11
Redefining Metadata for HIE
Traditionally metadata has been described as “data about data,”
but as HIE becomes more widespread, the ability to support
metadata becomes increasingly complex as electronic health
records continue to improve and be implemented. As EHR
implementations increase through federal incentives and other
approaches, understanding the origins, sensitivity, and context
of data is significant to maintaining data quality and integrity.
Tagged data elements are individual pieces of data that accompany each data unit that describe the attributes, provenance,
and required security protections of the data. Therefore, during
exchange of data the tagged data element is protected against
unauthorized access or data integrity issues. These tags are then
associated with metadata tags, which group by attribute.
An updated definition of metadata can describe:
x Data, including where it is stored, what elements it con-
tains, when it was created, when it was changed, and who
created it
x Information, including a description of what it contains
and how it is linked to other metadata
x Knowledge, including its importance, whether it is used
extensively, where it is used, and what will happen if the
resource is not there2
ONC’s Recommended HIE Standard
In response to PCAST’s recommendations, ONC’s Health Information Technology Standards Committee formed a metadata
analysis power team to identify metadata elements and standards for the categories of patient identity, provenance, and
privacy. After investigating several options for standards the
team proposed using the HL7 Clinical Document Architecture
