On Monday, March 29, Micky Tripathi, Ph.D., the new-ish National Coordinator for Health IT, opened the annual meeting of the Office of the National Coordinator for Health IT (ONC), which is being held remotely this year, because of the COVID-19 crisis. Tripathi, who most recently served as Chief Alliance Officer for Arcadia, a health care data and software company focused on population health management and value-based care, the project manager of the Argonaut Project, an industry collaboration to accelerate the adoption of FHIR, and a board member of HL7, the Sequoia Project, the CommonWell Health Alliance, and the CARIN Alliance, spent several years as president and CEO of the Massachusetts eHealth Collaborative (MAeHC), a non-profit health IT advisory and clinical data analytics company. He was also the founding President and CEO of the Indiana Health Information Exchange, a statewide HIE partnered with the Regenstrief Institute, an executive advisor to investment firm LRVHealth, and a Fellow at the Berkman-Klein Center for Internet and Society at Harvard University. Tripathi was announced as the new National Coordinator on January 20, the day that President Joe Biden took office.
In the opening keynote address of the ONC annual conference, Tripathi focused on some of his core priorities right now: an ongoing focus on leveraging healthcare IT to support ongoing work to end the COVID-19 pandemic; a strong new emphasis for the agency on health equity; and ongoing efforts to help the U.S. healthcare industry achieve authentic interoperability.
At the top of his address, Tripathi stated that “This year’s meeting pushes on a number of different dimensions of health IT. If you look across the agenda and the schedule for the next two days,” he said, referring to the annual meeting’s program, “we’ve got a focus on COVID, which remains a top priority for ONC and HHS [the Department of Health and Human Services, the umbrella federal health agency]. We have a couple of sessions devoted explicitly to health IT and the pandemic. We also have a number of sessions on health equity, which is a top priority for ONC and this administration; we have sessions on SDOH [the social determinants of health], and one on algorithmic bias in AI and ML [artificial intelligence and machine learning]. A couple of sessions on information-blocking. We continue to support the upcoming applicability date. And a session on the rule itself. We also have a session from the industry itself on preparedness for the rule. We have a few sessions on basic interoperability nuts and bolts. And we’ll be talking about clinician burden as well, including on workflow automation to reduce clinician burden.”
In summarizing ONC’s priorities, Tripathi said that, “If we think about all the other things that ONC does, we want to take health IT to the next level. All of you have been part of a collective investment we’ve made as a society, including through $40 billion in federal government investment in information systems, so that EHRs [electronic health records] are now virtually ubiquitous, while we’re at the beginning of FHIR-based capabilities,” referencing the FHIR—Fast Healthcare Interoperability Resources—standard. So now we have the unique privilege of being here at a place in time to take advantage of all the investments. So, interoperability. We have 21st-Century cures Act, which speaks to interoperability.”
Referencing the ongoing evolution around interoperability, Tripathi said, “We should recognize that there’s been tremendous progress around interoperability. I don’t think the industry’s gotten enough credit for that. One of the reasons is that most of the interoperability out there in high volume on nationwide networks, is still around treatment only. I think the lack of recognition of what has been accomplished is also because we haven’t figured out yet how to integrate all the different layers of interoperability—so, figuring out how local, state, and regional HIEs fit into elements like Carequality, CommonWell, DirectTrust. So I think that 21st-century Cures gives us the opportunity to eliminate some of the confusion and doubt around interoperability, and helps us to get rid of reasons for not moving forward. Information-blocking is helping to instill an attitudinal change about data-sharing in authorized ways with parties authorized to get information. In think that information-blocking helps us to clear that up.”
What’s more, Tripathi said, “As much as we can push forward on APIs [application programming interfaces] for various use cases, will help us with richer interoperability patterns, and enhanced usability. We need richer interoperability patterns, for bidirectional information exchange; patterns like CVS [concurrent version system] hooks, etc., that will help align things with the rest of the Internet economy,” he said.
“And finally, TEFCA”—the Trusted Exchange Framework and Comment Draft Agreement, Draft 2, which ONC continues to shepherd forward. “Our focus is, how can we use TEFCA to make interoperability easier and help networks connect to each other, so that a user doesn’t have to think about the pipes underneath their interoperating. That’s what we want to do with TEFCA, so that we know what will constitute nationwide interoperability, and we can just put the pieces together.”
Engaging industry partners, creating “health equity by design”
Meanwhile, with respect to federal health information technology, we’ve focused hard on engaging partners in our national health IT plan,” Tripathi told the virtually assembled audience on Monday. “With the growing embrace of FHIR-based technologies, is that our federal partners are learning the value of electronic health records. The downside is that our partners are learning the value of electronic health records—I’m joking, but there’s an opportunity to fall into entropy. So we spend an increasing amount of time working with our federal partners to help them accomplish their goals, using standards, etc., and so that industry isn’t split apart by different federal agencies with different priorities. We want to collectively push forward on an inoperability paradigm based on open standards, etc. “
On a different yet related topic, Tripathi told his audience that “One thing we’re working on hard now is health equity by design. That term borrows from a software engineering principle—basically, that we should take health equity concerns and place them at the beginning of design, to get it built into the basic operating system for clinical, operational, and business purposes. That’s important as we work with our federal partners to make sure that health equity is a prime, ground-level consideration, in everything that we do from a policy perspective.”
Tripathi took a moment to share about his experience so far working in the Biden administration. “A lot of people are asking, how are things going at ONC?” reported. “I’m thrilled to be here, I love my job. I’m thrilled to be working directly for the people. I have tremendous colleagues here at ONC and across the agencies. I feel tremendous about it, and am very proud of everything the federal government is about, and the contributions we can make to support the country. But finally, it’s not all about us, it’s all about you. We can’t do better unless we hear from you, both about the things we’re doing well, but also about where you think we can do better.”
Early on in his keynote address, Tripathi made a brief reference to an article published on Sunday, March 28 in the Washington Post. Reporters Dan Diamond, Lena H. Sun, and Isaac Stanley-Becker had opened the article by reporting that “The Biden administration and private companies are working to develop a standard way of handling credentials — often referred to as ‘vaccine passports’ — that would allow Americans to prove they have been vaccinated against the novel coronavirus as businesses try to reopen.”
Diamond, Sun, and Stanley-Becker wrote that “Proof of vaccination ‘may be a critical driver for restoring baseline population health and promoting safe return to social, commercial, and leisure activities,’ according to the March 2 slides prepared by the Office of the National Coordinator for Health Information Technology and obtained by The Post. But officials at the session — attended by more than 150 staff from the health, defense, homeland security and other departments, and even far-flung agencies such as NASA — warned of the ‘confusing array’ of efforts underway to create credentials.” And though Tripathi did not grant the Post reporters an interview, they quoted him as having said, during a virtual meeting hosted by the Health IT Leadership Roundtable on March 11, that “he didn’t like the term ‘vaccine passports,’ adding that ‘passports are something that are issued by governments. … I think of them as vaccine credentials or certificates.’”
