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E
PCAST Report Recommendations
1
The Chief Technology Officer of the United States should
• In coordination with the Office of Management and Budget (OMB)
and the Secretary of HHS, and using technical expertise within
ONC, develop within 12 months a set of metrics that measure
progress toward an operational, universal, national health IT in-
frastructure. Research, prototype, and pilot efforts should not be
included in this metric of operational progress.
• Annually, assess the Nation’s progress in health IT by the metrics
developed, and make recommendations to OMB and the Secretary
of HHS on how to make more rapid progress.
The Office of the National Coordinator should
• Move more boldly to ensure that the Nation has electronic health
systems that are able to exchange health data in a universal man-
ner based on metadata-tagged data elements. In particular, ONC
should signal now that systems will need to have this capability
by 2013 in order to be deemed as making “meaningful use” of
electronic health information under the HITECH Act.
1 Excerpted from: PCAST (President’s Council of Advisors on Science and Technology).
2010. Realizing the Full Potential of Health Information Technology to Improve Healthcare
for Americans: The Path Forward. http://www.whitehouse.gov/sites/default/files/microsites/
ostp/pcast-health-it-report.pdf.
281
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282 DIGITAL INFRASTRUCTURE FOR THE LEARNING HEALTH SYSTEM
• Act to establish initial minimal standards for the metadata associ-
ated with tagged data elements, and develop a roadmap for more
complete standards over time.
• Facilitate the rapid mapping of existing semantic taxonomies into
tagged data elements, while continuing to encourage the longer-
term harmonization of these taxonomies by vendors and other
stakeholders.
• Support the development of reference implementations for the
use of tagged data elements in products. Certification of indi-
vidual products should focus on interoperability with the reference
implementations.
• Set standards for the necessary data element access services (specifi-
cally, indexing and access control) and formulate a strategic plan
for bringing such services into operation in an interoperable and
intercommunicating manner. Immediate priority should be given
to those services needed to locate data relating to an individual
patient.
• Facilitate, with the Small Business Administration, the emergence
of competitive companies that would provide small or under-re-
sourced physician practices, community-based long-term care fa-
cilities, and hospitals with a range of cloud-based services.
• Ensure that research funded through the SHARP (Strategic Health
IT Advanced Research Projects) program on data security include
the use of metadata to enable data security.
The Centers for Medicare & Medicaid Services should
• Redirect the focus of meaningful use measures as rapidly as pos-
sible from data collection of specified lists of health measures to
higher levels of data exchange and the increased use of clinical
decision supports.
• Direct its efforts under the Patient Protection and Affordable Care
Act toward the ability to receive and use data from multiple sources
and formats.
• In parallel with (i.e., without waiting for) the NRC study on IT
modernization, begin to develop options for the modernization and
full integration of its information systems platforms using modern
technologies, and with the necessary transparency to build confi-
dence with Congress and other stakeholders.
• When informed by the preliminary and final NRC study reports,
move rapidly to implement one or more of the options already
formulated, or formulate new options as appropriate, with the goal
of making substantial progress by 2013 and completing implemen-
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283
APPENDIX E
tation by 2014. CMS must transition into a modern information
technology organization, allowing integration of multiple compo-
nents and consistent use of standards and processes across all the
provider sectors and programs it manages.
• Exercise its influence as the Nation’s largest healthcare payer to ac-
celerate the implementation of health information exchange using
tagged data elements. By 2013, meaningful use criteria should in-
clude data submitted through reference implementation processes,
either directly to CMS or (if CMS modernization is not sufficiently
advanced) through private entities authorized to serve this purpose.
• By 2013, provide incentives for hospitals and eligible profession-
als to submit meaningful use clinical measures that are calculated
from computable data. By 2015, encourage or require that quality
measures under all of its reporting programs (the Physician Quality
Reporting Initiative, hospitals, Medicare Advantage plans, nursing
homes, etc.) be able to be collected in a tagged data element model.
The Department of Health and Human Services should
• Develop a strategic plan for rapid action that integrates and aligns
information systems through the government’s public health agen-
cies (including FDA, CDC, NIH, and AHRQ) and benefits payment
systems (CMS and VA).
• Convene a high-level task force to align data standards, and popu-
lation research data, between private and public sector payers.
• Convene a high-level task force to develop specific recommenda-
tions on national standards that enable patient access, data ex-
change, and de-identified data aggregation for research purposes,
in a model based on tagged data elements that embed privacy rules,
policies and applicable patient preferences in the metadata travel-
ing with each data element.
• As the necessary counterpart to technical security measures, pro-
pose an appropriate structure of administrative, civil, and criminal
penalties for the misuse of a national health IT infrastructure and
individual patient records, wherever such data may reside.
• Appoint a working group of diverse expert stakeholders to develop
policies and standards for the appropriate secondary uses of health-
care data. This could be tasked to the Interagency Coordinating
Council for Comparative Effectiveness Research.
• With FDA, bring about the creation of a trusted third-party noti-
fication service that would identify and implement methods for re-
identification of individuals when data analysis produces important
new findings.
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284 DIGITAL INFRASTRUCTURE FOR THE LEARNING HEALTH SYSTEM
Other or multiple agencies
• AHRQ should be funded to develop a test network for compara-
tive effectiveness research. The FDA, and also other HHS public
health agencies, should enable medical researchers to gain access
to de-identified, aggregated, near-real-time medical data by using
data element access services.
• HHS should coordinate ONC activities with CDC, FDA, and any
other entities developing adverse event and syndromic surveillance
networks.
• The Department of Defense and the Department of Veteran Affairs
should engage with ONC and help to drive the development of
standards for universal data exchange of which they can become
early adopters.
