An Interoperability Update from the Top – A Conversation with Micky Tripathi

Micky Tripathi, National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services

In this episode of Friends of Project Healthcare

Host Eric Thrailkill is joined by Micky Tripathi, National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, to shed some light on why electronic health records (EHRs) have been widely adopted, how they are being regulated, and why new policy changes are working to improve interoperability. 

As leader of the Office of the National Coordinator (ONC), Micky is always finding innovative ways to improve the flow of health data in a safe and efficient way to aid in better health outcomes.

The world of health technology in the United States is constantly changing and full of regulation. The Office of the National Coordinator is on a mission to create systematic improvements in healthcare through access exchanges and the use of data. Established through an Executive Order in 2004, the ONC is responsible for advancing the use of health information technology and creating expectations for data sharing. 

Since the 21st Century Cures Act of 2016, the ONC has been hard at work developing the rules and interpretations used by the industry to allow electronic exchange of data critical to the industry.

According to Micky, just a decade ago, there were roughly 10% of providers utilizing electronic health records. “Now, 97% of hospitals and over 80% of ambulatory providers have an electronic health record that’s certified by my office,” he said. “A remarkable sea of change in a relatively short period of time.”

Growth for the adoption of EHRs was inspired, in part, through the use of incentives to the providers. By allowing providers to have the purchasing decision, and through implementing meaningful use regulations, the demand for the technology was created slowly. “But then we need[ed] to address the supply side, which is the technology vendors,” Micky explained. “We need[ed] to make sure that the technology vendors actually support[ed] that capability. And that’s where certification came in.”

One of the requirements for certification that the ONC created was a standard open API requirement. “EHR vendors were required to support and provide it to their customers,” Micky shared. “And it has to support a minimum data set that we call the USCDI, the US Core Data for Interoperability. This allows innovators to have now the fertile field to be able to say,”I can build an app or whatever technology I wanna build, and have some assurance that it’ll work.”

The last piece came together under TEFCA, the Trusted Exchange Framework and  Common Agreement. “That’s nationwide network interoperability.” 

He compares it to wireless cellular networks, where an AT&T and Verizon customer, on the surface, communicate with each other seamlessly. “Through a set of regulations,” Micky explained, “they set requirements for them to connect with each other so that you and I have an experience of it being a single network, even though it really is multiple networks, multiple proprietary networks underneath. And that’s what we want[ed] to do in healthcare.”

For Micky, the measure of success for achieving that goal will be when providers start thinking about health IT the same way. 

Recently, the ONC approved the first group of Qualified Health Information Network (QHIN) candidates to implement TEFCA, with the goal of creating “a network of networks model” to support national healthcare interoperability. 

At the time of his interview, Micky shared that six organizations volunteered to be the first six qualified. “And that means that they are now approved to implement TEFCA and they are all committed to implementing the infrastructure and going live before the end of this calendar year. And so far we’re on track.”

In fact, Micky shared there were even more organizations still who have applied to join the network and are working through the approval process. “Three to five years from now,” he said, “I hope that we have a trusted governance model for a nationwide network that allows that backbone, that backend of information, to just flow across all provider organizations and other authorized parties.”

This conversation was captured at the 2023 ViVE Conference in Nashville, TN. Stay tuned for more exciting interviews from the event.

About Micky Tripathi: Micky Tripathi is the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, where he leads the formulation of the federal health IT strategy, policies, standards, programs, and investments. Dr. Tripathi has over 20 years of experience across the health IT landscape. He holds a PhD in political science from the Massachusetts Institute of Technology, a Master of Public Policy from Harvard University, and an AB in political science from Vassar College. Prior to receiving his PhD, he was a Presidential Management Fellow and a senior operations research analyst in the Office of the Secretary of Defense in Washington, DC, for which he received the Secretary of Defense Meritorious Civilian Service Medal.

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