Leadership Trailblazer Spotlight: Micky Tripathi, HHS’s Office of the National Coordinator for Health Information Technology
May 02, 2023 | ASTHO Staff
What messages are critical for state and territorial health agencies as public health moves towards a goal of accelerating data modernization?
We are entering a whole new world of digital capabilities in healthcare including delivery, public and population health, medical science—the whole spectrum. We are able to update the way information is shared across that entire ecosystem. Public health should start working from a digital foundation rather than paper, bricks, and mortar. Certainly, all of our workflows and processes were originally created and constructed that way. We can completely rethink the way that information sharing happens.
Public health doesn't have to choose between having shared information technology, infrastructure, and applications while still being able to control the data. You can have them all at once.
Public health currently functions in a decentralized federated system where each jurisdiction has authority for their own activities. Historically, it has been a point of friction because there are significant barriers to how we can aggregate information. Looking at the ways technology is evolving, especially cloud-based technologies, public health can get a lot more “system-ness” out of our system without violating jurisdictional authorities.
What is that optimal future state for public health data information systems, particularly with considerations for public health authority and data privacy?
There is a lot of overlap between jurisdictions, but there are also a lot of specific, local requirements. Updating allows us to determine which of those requirements are based on current needs and how many are just vestiges of times past. We've been working a lot with the community on building a public health data model based on the United States Core Data for Interoperability (USCDI), an ONC-promulgated standardized set of data classes and elements requiring the healthcare delivery system—the source of considerable data needed by public health agencies—to support the USCDI.
Creating shared requirements promotes efficiency and increases participation on both sides. If we align data standards that are already supported in the healthcare delivery system, have interoperability in ways that are already supported by the healthcare delivery system, there’s no reason we can’t implement something similar in public health.
Opportunities like the Trusted Exchange Framework and Common Agreement (TEFCA) offer public health agencies the ability to participate in a network, to share information with other parties on your own terms—joining a network doesn't mean you lose control. But it does decrease costs; when you think about all of the ad hoc interfaces that public health agencies use, all of them take time, money, and all of them are redundant. When jurisdictions build their own interfaces to the same electronic health record (EHR) vendor, that's an unnecessary cost for both sides.
If public health could be connected to a single network, the efficiency would allow them to do what is in in their heart of hearts—public health and not information technology management.
ONC’s work also supports CDC’s Data Modernization Initiative, in particular the North Star Architecture, which aims to help jurisdictions interface with vendors in one spot, exchange data more easily—at a much lower cost on both sides.
How will data modernization help public health prepare for the next emergency?
Jurisdictions were overwhelmed by the volume of data that came in during the COVID-19 pandemic, which is just shocking when we live in a world of cloud infrastructure that is highly extensible, scalable, and—for practical purposes—almost limitless in terms of storage. The North Star Architecture would allow for a large amount of highly extensible capacity behind the scenes that can support those spikes seamlessly and allow nearly instantaneous scale up both across and through jurisdictions. Increased capacity as we saw during the pandemic would no longer be an issue.
What about the role of the private sector?
There is absolutely an opportunity for the private sector to participate in public health data modernization. If you look at the North Star Architecture model, there’s an opportunity to create a marketplace of applications and tooling. Jurisdictions or CDC could build something that works really well for them and decide to share it with other jurisdictions on the cloud. Participants in the network can then use it in whatever way they want according to the agreed-upon transparent set of rules.
From there, it’s not hard to imagine a model that lets the private sector bring tools—such de-identification, data normalization, geolocation, and case investigation tools— to the public health community. It would also be easier to sell their products to jurisdictions because, as we know, customer acquisition in public health is not easy.
States are exploring and formalizing the role of health information exchanges (HIEs) as health data utilities. What recommendations do you have for them?
HIEs come in two major varieties: regional (for a state or smaller jurisdiction to support local communities) and nationwide. The concept connects providers to patients and other stakeholders, enabling them to share information via local network. The health data utility part of that is the connection with the state in the same way we have common infrastructure for distributing water and electricity.
From ONC’s perspective, a local HIE can provide valuable network capabilities either by gathering or sharing information back to stakeholders. From our perspective—and my own extensive experience with them—HIEs can be highly variable, and utility will vary from state to state. So public health agencies need to evaluate HIEs in the same ways that they would evaluate any vendor or partner.
Health and racial equity for all is a significant strategic priority for public health. How do these tools address that challenge?
ONC requires that certified EHR vendors support the USCDI, which means they must support CDC’s dataset of race/ethnicity—arguably the most comprehensive standardized dataset for race/ethnicity across the country. I daresay a lot of providers don’t make use of the dataset or the capability that such data offers, such as measuring differences in communities according to race, ethnicity, language, and other significant factors.
We regularly add data elements to the USCDI. To date, we've added social determinants of health (SDOH), sexual orientation and gender identity (SOGI), and most recently, different types of status related to health equity such as disability and pregnancy status.
We should think about health equity implications as we build systems and processes in the same way we do for safety, privacy, and security—from the ground up.
ONC’s concept—health equity by design—means first and foremost that data is available and public health agencies can make the best and most appropriate use of that information to build their systems. This also extends to ensuring agencies are using, for example, sets of algorithms that don’t have strong implicit bias in them in the way that they're delivering information or providing guidance to public health practitioners. That’s the opportunity that using shared infrastructure and shared approaches brings.