Federal efforts to encourage electronic health record adoption among medical practices should broaden to include a "universal exchange language" that allows real-time access to networked health data, says a report from the President's Council of Advisors on Science and Technology.

Data in EHRs--which federal policy encourages physicians to adopt through a combination of monetary incentives and promises of future Medicare reimbursement penalties for not adopting them--is mostly locked up into proprietary formats. Efforts to date to enable data exchange have been inadequate,  and federal requirements for inter-EHR systems communication have been only "very modest," the report says.

Future waves of "meaningful use" guidelines for EHRs from Office of the National Coordinator for Health IT and the Centers for Medicare and Medicaid Services should include standards for a nationwide health data extensible markup language, the council recommends.

The national coordinator's current effort toward information exchange has focused on the semantics of data elements at the expense of its syntax (the data format and exchange protocols), the report states. But, "a large body of experience in other domains suggests that creative and entrepreneurial energies are best unleashed by standardizing a syntax that is broadly extensible into different semantic spaces," it adds.

It should be the role of the federal government to create such a data exchange language because while the ability of medical care providers to exchange and integrate health data offers great advantages for patients, there's no economic benefit in it for individual providers, the report stays. "Market forces are unlikely to generate appropriate incentives for the necessary coordination to occur spontaneously," it says.

For the government to successfully do so, however, the Centers for Medicare and Medicaid Services will require major modernization of its IT platforms, the report adds. It'll need to modernize without "replacing one inflexible architecture with another," which, the report says, is "a common trap in federal IT acquisitions."

For more:
- download the PCAST report (.pdf)
- read a White House press release on the report (.pdf)
- ONCHIT will accept comments on the report through Jan. 17--read instructions for submitting thoughts (.pdf)

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