Health Agencies Say Interoperability is Key to Sustainable Infrastructure

Leaders across the departments of Health and Human Services (HHS) and Veterans Affairs (VA) are driving data interoperability to improve health outcomes and advance the infrastructure required for sustained success at scale.

“The fragmentation of the health care industry on the supply and demand side is the biggest challenge we all face,” Micky Tripathi, National Coordinator for Health Information Technology at ONC, said during Digital Medicine Society’s virtual event. “There is certainly the danger of just too much regulation that then stifles that innovation.”

Within the federal health sector, Tripathi noted that agencies are looking to modernize regulatory processes and bolster interoperability to ensure both speed and safety of vital health services. ONC is driving standards-based APIs across the market to advance interoperability and provide patients and providers with access to health data and records.

“That’s why we support the ability to have the exchange using APIs as well as networks,” Tripathi said. “As far as the 21st Century Cures Act, the trusted exchange framework network that will be going live in Q1 of 2022 supports more of the backend connection, so that you have the automated ability to have record share in the background with authorized parties as well.”

At VA, Kimberly McManus, presidential innovation fellow with VA’s Office of Information and Technology, said the agency is boosting data interoperability to successfully collect, analyze and share critical health data. McManus explained that the agency is driving a new framework to break down traditional silos to democratize data access and improve the ability to scale valuable digital health technologies throughout the system.

In 2020, the agency launched a new cloud native enterprise data and analytics platform, called “Rockies,” to ease the burden of data access, integration and organization while enabling a heterogenous ecosystem for data analytics.

“The platform allows that systematic curation organization and integration of diverse data sources from the electronic health record data, to mobile application data, to the future sensor and imaging data, that will allow us to deliver higher quality care faster to veterans,” McManus added.

COVID-19 only accelerated agencies’ modernization journeys. VA had to scale up digital services like telehealth to keep pace with the rise in demand. In the first few months of the pandemic, VA experienced a 1,000% increase in telehealth visits and a 24% increase in secure messages.

“VA is continuing to strive and modernize that data infrastructure, so that we can really push forward with that concept of anywhere to anywhere, meaning that veterans and health care providers can be located anywhere and can communicate effectively through digital tools,” McManus said.

VA developed a new suite of digital tools, based on the agency’s modern cloud-based data infrastructure and DevSecOps approaches, to improve information sharing, symptom screening, vaccinations, clinical trials and other applications and services to quickly deliver care and support veteran health outcomes. Of these tools, VA launched its COVID Patient Manager, which is a SMART on FHIR application for guiding patient care for COVID-19 patients.

“In a health care system in 2021, data really serves as the basis for how decisions are made and how care is delivered,” McManus said. “A common trend that we’ve seen is the need to take data from disparate sources … and combine and merge this data to develop crucial insights.”

As health agencies modernize platforms, the Food and Drug Administration (FDA) is looking to cloud and security to bolster digital tools and services. Kevin Fu, acting director for medical device cybersecurity at FDA’s Center for Devices and Radiological Health (CDRH), said that the agency recently released a document on how to communicate computer security vulnerabilities with patients.

“Patients play a very important role in having a voice on a computer security and privacy,” Fu said. “There are wonderful, sweet spots when you can get interoperability and security at the same time but more often than not, they’re competing properties. So, it’s very difficult to get both at the same time.”

Tripathi expressed that a foundational piece of security is user understanding of risk. ONC is looking into new educational and training programs to provide a better knowledge of risk management when it comes to data sharing.

“We should be really cognizant of the security and privacy issues related to information going outside the boundary of HIPAA,” Tripathi said. “There’s a lot of concern about how we get the right education to individuals so that they have the knowledge of what it is they’re getting into and what risks they might be taking.”