We spoke with Micky Tripathi, the national coordinator for health information technology at the U.S. Department of Health and Human Services (HHS), about the latest developments in medical technology, and the importance of interoperability for health information.
Micky Tripathi
National Coordinator for Health Information Technology, U.S. Department of Health and Human Services
As the National Coordinator for Health Information Technology at HHS, Micky Tripathi leads the formulation of the federal health IT strategy and coordinates federal health IT policies, standards, programs, and investments.
How did the Office of the National Coordinator for Health Information Technology (ONC) begin and what is it for?
We were founded in 2004 in an executive order by then President [George W.] Bush, and then we were put into law in the HITECH Act under President [Barack] Obama, so you can already see our origins are pretty bipartisan. Who’s opposed to health information technology, right?
I think of our mission as being both horizontal and vertical. Horizontally, we work with federal agency partners across the U.S. government to coordinate health IT strategies and policies, and try to align those policies to make sure we’re presenting as much of a unified front as possible. Vertically, our mission is more about about working with the industry market to try to get an open architecture, standards-based interoperability type of system that allows information to be shared securely and appropriately to benefit patients.
We’re a staff division in the Department of Health and Human Services, which is a very large agency comprising operating divisions and staff divisions. Staff divisions — like ONC – support the operating divisions and work directly for the secretary to help further the administration’s and secretary’s priorities.
Ultimately, ONC is working hard to have the right resources to be able to do the best that we can on behalf of the American people.
What are some policies that ONC has put into place that have advanced regulating the healthcare IT industry?
It’s really important to understand the foundation of what regulatory policies and approaches have already been put into place. One of our key authorities that Congress has directed us to do, is in the HITECH Act, which designated ONC with the responsibility to certify electronic health records.
It’s a voluntary program in statute, but it does give ONC authority to create a certification program for electronic health records. That certification program now covers 97% of hospitals and almost 80% of ambulatory practices across the country. That certification covers baseline things like security, protection of privacy, as well as supporting functions like electronic prescribing or being able to get electronic lab results, so that you’re not faxing them back and forth, to help with clinical decision support like drug interaction or allergy checking.
In terms of patient access, there are specific requirements in electronic health records that require that patients have the ability to get their information electronically. If you’ve gone to a provider and logged onto a patient portal, it will have all of your labs, your meds, your notes, all those things — those aren’t a random collection of data, those are actually required by ONC. We required a portal be available and that it support a pretty broad set of data, so that you as a patient have access to that information conveniently and in near real time, and that you have the ability to download it so you can actually add it into your phone’s health record.
The last set of things that certification covers is interoperability — requiring standardized ways for exporting and importing data, so that when you go to a specialist, for example, your PCP and specialist can share that information. That certification is now a vastly important part of the healthcare delivery system.
The second set of regulations added on by the 21st Century Cures Act in 2016 require that we have healthcare finally discover the internet, as I like to colloquially say. ONC now requires that electronic health records have standard APIs. We also require that providers and other entities share information with each other, so not only do they have the tools for sharing information, they’re actually obligated to share the information with other parties.
Why is it so important for the healthcare system have a strong focus on interoperability?
You want providers to be acting on the best possible information as they’re making diagnostic and treatment decisions for you. Even if you showed up to the emergency room unconscious, you want your provider to be able to have as much information as possible so they can make the best-informed decision and recommendation about the care you’re receiving.
In terms of access, what that means is you want your information to be portable, because otherwise you’re locked into a particular provider. That’s a key use case for interoperability, to be able to say, “I need the information to go where I want to be.” You don’t need to go where the information is because it’s locked in one place.
From a health equity perspective, as you move down the socio-economic ladder, more and more patients either don’t have insurance, or have bare minimum insurance, and so they end up having their care and information fragmented. That places a premium on interoperability so that patients are able to get the best appropriate care regardless of the urgent care center or emergency department they go to.
Ultimately, interoperability preserves privacy and security, but also assures patients that their information is going to be available at the right time, in the right place.