ONC leader Tripathi says health IT agency focused on 'healthy equity by design'

A medical worker looks at the camera holding a tablet computer
New healthcare interoperability regulations will open up a digital ecosystem that enables patients to engage with healthcare on their smartphones and through health apps. (Getty/ FG Trade)

As the federal national coordinator for health IT, Micky Tripathi, Ph.D., has a full plate.

He's tasked with strengthening health data sharing as the nation continues to combat the COVID-19 pandemic as well as implementing new interoperability regulations.

Addressing health equity also will be a top priority as he leads the Office of the National Coordinator for Health IT (ONC), the health IT arm of the Department of Health and Human Services (HHS), the interoperability veteran said Thursday.

"I like to think about it as health equity by design. Right now, in many areas we have embraced technology and moved forward with standards and processes that didn’t explicitly take into account the consequences on health equity," Tripathi said during a virtual event hosted by the Health IT Leadership Roundtable.

"I think what we need to work on, and at ONC we're doing this, is health equity by design, where, from the beginning, we look at what are health equity considerations and how do we take that in as a fundamental design criterion so that we have fewer surprises down the road."

As an example, when developing standards around the collection of social determinants of health data, regulators need to consider the best ways to gather those data while still protecting patients' privacy.

"We don't want people to have hesitancy about giving their information," he said, adding, "Also, think about new technologies and the issues around algorithmic bias. There are algorithms embedded in all the technology we use. Health equity is a key priority for us and one area we're focusing a lot of attention on."

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Health equity also ties into how technology is being used to address the COVID-19 pandemic, including the development of digital vaccine credentials, or what some call "health passports" that offer proof someone has received the COVID-19 vaccine in order to board a plane or cross international borders.

"I don’t like to refer to them as 'passports.' I think of them as vaccine credentials or certificates," Tripathi said. "There are health IT implications and considerations with that approach. Privacy is a huge one, and security as well, including protection against fraud. There also are health equity considerations to make sure it’s accessible to everyone, so no one is left behind."  

In late January, Tripathi was tapped as the new national coordinator for health IT under President Joe Biden's administration. The ONC is an HHS agency that regulates the nation's health IT framework.

An expert on interoperability, privacy and technology standards, Tripathi, as the ONC coordinator, will oversee the implementation of major interoperability regulations that will change how providers, insurers and patients exchange health data.

The new regulations, which go into effect April 5, will open up an app ecosystem that enables patients to engage with healthcare on their smartphones and through health apps.

The new policies, including a ban on information blocking, represent the "hard levers" ONC can use to influence the market, Tripathi said.

The issue of information blocking goes "a bit deeper than other regulatory activity in the past," Tripathi said.

"We're attacking things that are more deeply ingrained in an organization's culture, both providers and vendors. We recognize that this is going to take time. On the other hand, this needs to be taken seriously and it gets more at the heart of how organizations think about information sharing, which is fundamentally different," he said.

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But regulations aren't meant to set the pace of progress, Tripathi said, noting that ONC can also use "soft levers" to motivate the industry to advance faster.

"One of my concerns is that I don’t want the industry to wait until the last minute to implement things. The 'bully pulpit' is one of those soft levers to encourage people to keep moving forward by working with standards bodies and implementation communities," he said, noting advances with Fast Healthcare Interoperability Resources standards for data exchange.

"I want the industry to focus on things that are important to their customers and stakeholders. Don’t just wait for a regulation to require it," he said.

ONC's Trusted Exchange Framework and Common Agreement (TEFCA), mandated by the 21st Century Cures Act, is another soft lever ONC can use, he said.

The agency has released two drafts of TEFCA as a framework designed to improve data sharing between health information networks and as a single "on-ramp" for nationwide data sharing.

The voluntary framework aims to eliminate the burdens of costly point-to-point interactions healthcare organizations currently face by creating a common set of practices to allow providers, patients, payers and health IT vendors to securely communicate with one another.

"There is no requirement that people participate in TEFCA. We have to think about, how do we make it attractive to the industry to voluntarily participate in that? The trick for us, when we think about TEFCA, is to add value to the overall system, but we don't want it to be an additional tax on providers and technology vendors," Tripathi said.

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What should the health IT industry expect over the next four years?

There won't be "revolutionary" changes, Tripathi said, such as an entirely new electronic health record system.

Instead, stakeholders should look at the digital economy in other industries as a guidepost to how the healthcare industry can make it easier for patients to control their health data.

"If we can move our way toward a platform type of approach, where we have open sharing of data, the ability to have both governance models and data exchange models and non-standards based exchange in a way that serves the industry as large and serves patients, then I think we’ll have accomplished something. We’ll have an opportunity then for innovation to happen in ways that deliver value," Tripathi said.