HHS Accelerates AI, TEFCA in 2024

The Department of Health and Human Services (HHS) has made significant strides in integrating artificial intelligence and advancing the Trusted Exchange Framework and Common Agreement (TEFCA) over the past year, Assistant Secretary for Technology Policy and National Coordinator for Health IT Micky Tripathi told GovCIO Media & Research in a Q&A.

Tripathi reflected on these accomplishments, noting the transformative potential of AI in enhancing internal processes and improving healthcare outcomes. TEFCA has made substantial progress in achieving nationwide network interoperability, connecting hospitals, clinicians and public health jurisdictions across the country.

Tripathi outlined HHS’s data and technology priorities for 2025, focusing on the continued expansion of digital infrastructure, interoperability and AI transparency, all aimed at improving patient care and healthcare system efficiency.

How did HHS’ realignment this year shift your tech strategies?

Tripathi: HHS underwent a reorganization to focus on two key areas: consolidating cybersecurity efforts and enhancing technology policy. The cybersecurity responsibilities were spread across various parts of the agency, and the reorganization aims to centralize these activities to improve accountability, leadership and resource concentration.

As part of the restructuring, the Administration for Strategic Preparedness and Response (ASPR) became the central hub for cybersecurity resources in the healthcare sector. The reorganization also created the Office of the Chief Technology Officer, which will focus on innovation in technology and work closely with the Chief Information Officer’s office. Additionally, a Chief AI Officer role was established to coordinate AI activities both internally and in the department’s broader mission. The creation of the Chief Data Officer role further supports a forward-looking strategy for data use across HHS. By consolidating these functions, the department aims to foster better collaboration among closely related areas.

How is HHS prioritizing AI moving into 2025?

Tripathi: Like many large organizations, AI is beginning to take root in various parts of HHS. Last year, HHS published an AI use case inventory as part of President Biden’s executive order, which identified 163 different AI applications. The department is now working on the next round of use cases, set to be published in December. Spoiler alert, they’re going to be a lot more than we had last year.

The agency is already using AI in a wide variety of ways. For example, it helps analyze comments on regulations, reviews policies more quickly and processes grant applications. The Centers for Disease Control and Prevention (CDC) is using AI to improve tuberculosis screenings for immigrants. Some agencies, like the Indian Health Service, also use AI, while HHS policies primarily focus on the private sector’s use of AI technologies. New regulations, set to take effect on Jan. 1, 2025, will require transparency regarding AI technologies in electronic health record products, which the department believes will greatly assist providers as AI becomes more integrated into patient care.

Can you talk a little bit about this year’s updates to TEFCA?

Tripathi: TEFCA is a nationwide network interoperability initiative. The 21st Century Cures Act directed the Office of the National Coordinator for Health IT (ONC) and the Administration for Strategic Preparedness and Response (ASTP) to establish a nationwide approach to network-to-network interoperability, similar to how cell phone networks connect with each other, allowing users to experience a single network regardless of their provider. The goal was to apply the same concept to private sector networks.

Network-to-network interoperability went live in December 2023, and in less than a year, millions of transactions have taken place over the TEFCA-based exchange. Seven approved networks are currently live, with three more set to go live soon. By the end of the first quarter of 2025, 10 networks will be operational. More than 400 hospitals, over 100,000 individual clinicians, more than 5,000 ambulatory practices, 200 long-term post-acute care and behavioral health centers and over 50 public health jurisdictions are already exchanging information via TEFCA. We are excited about its collaboration with the private sector and looks forward to even more activity as these three new networks come online and existing networks expand.

How do partnerships boost interoperability?

Tripathi: The CDC has been a tremendous partner, and we’ve been closely collaborating with them. Our teams are integrated to support their goals with the CDC Data Strategy and the Data Modernization Initiative, a significant federal investment to improve public health infrastructure across the country.

More than 50 public health jurisdictions—state, local, territorial and tribal—are now live on TEFCA, utilizing modern, secure network infrastructure for electronic case reporting. This is a major step forward for public health. During the pandemic, many public health jurisdictions lacked modern technology, leading to overwhelmed systems that either shut down or relied on outdated methods like faxing and phone calls—far from the system we expect in the U.S.

In collaboration with the CDC, we are working on nationwide data standards, known as the U.S. Core Data for Interoperability. These minimum data standards are required for electronic health record vendors to support, making information sharing easier and more efficient. This effort helps integrate public health with the healthcare delivery sector, ensuring that both clinical care and public health use the same standards. Most of the data public health relies on comes from clinical systems like hospitals and physician offices, so aligning these standards will streamline data access and enable more effective public health actions.

What are your tech and data priorities in 2025?

Tripathi: We’re targeting three key areas. First, we will continue to build the digital foundation. The U.S. has invested heavily in EHRs, with 97% of hospitals and 80% of physician offices now using certified EHRs, a significant achievement. Over the past decade, both public and private sectors have worked hard to reach this point, but we must keep strengthening this digital infrastructure.

Our healthcare system is increasingly digital, and we must ensure that it remains strong with no long-term gaps. The Post-Acute Care and Behavioral Health sectors didn’t benefit from incentive funds from Medicare and Medicaid, so we’re focused on helping them adopt key technologies and data standards. These minimum standards are updated annually, and we aim to continue expanding them to make information sharing easier.

Second, we aim to simplify interoperability. By establishing standard network interoperability and APIs, we’re working to make data sharing as seamless as the technologies that power our cell phones and apps. We want interoperability to be that simple. The electronic health record systems we require to use the Fast Healthcare Interoperability Resources (FHIR) APIs are also now being adopted by health insurers for claims data. Our goal is for patients to experience the same ease in healthcare that they do when tracking a pizza order — knowing where their care is at every step.

Finally, we are working extensively on AI to ensure transparency. It’s important that providers feel confident in using AI technologies, which we believe will greatly benefit both patients and providers. By increasing transparency, we help ensure that providers trust the AI tools in their EHR systems and are able to use them effectively to improve patient care.