ONC’s Micky Tripathi offers vision for health data exchange 

During a Center for Connected Medicine presentation, he calls TEFCA only a first step in boosting access to clinical information.

The Center for Connected Medicine’s Top of Mind Online program examines how health systems are using digital health technology to improve patient access to medical services. During the opening presentation, ONC's Micky Tripathi and UPMC's Dr Rob Bart discussed policies making data interoperable and timely, plus the priorities in utilizing data to improve patient access.

Dr. Rob Bart, UPMC and ONC's Micky Tripathi during CCM Top of Mind 2022 Online

The Trusted Exchange Framework and Common Agreement is an “incremental step forward” toward easing the flow of healthcare data to clinicians when and where they need it, says Mickey Tripathi, national coordinator for the health information technology. 

But enabling robust health data exchange and improving interoperability will require building on local, regional and national networking efforts of the past decades, as well as taking the extra step of easing access to data from a variety of sources, not just electronic health records systems, he says. 

A key goal of interoperability is to help make sure it’s no longer a chore to gain routine access to patient data that can help improve the quality of care...removing the “friction” that now impedes data sharing.

Clinicians should not have to think about how to obtain all pertinent information about a patient “in the same way that you don’t have to think about what network underlines your cell phone,” Tripathi says. “That’s where I’d like providers to be.” Rather than worrying about how the “plumbing” of the network works, doctors should focus on the quality of care, he stresses.  

Tripathi says his office’s role is to figure out how the government can help “incrementally move us to the next level of interoperability, building on everything that’s already been done.”   

The ONC leader made his comments in a Thursday presentation that was the first of a three-part Top of Mind Online Virtual Learning Series on patient access sponsored by the Center for Connected Medicine. This first session focused on enabling access through data sharing. Part two, to be offered March 22, will focus on healthcare infrastructure, and part three, yet to be scheduled, will focus on patient access innovation. 

The goals of TEFCA 

TEFCA, for which the final version 1 was released in January, is designed to establish the infrastructure and governance needed for networks to securely share basic clinical information with each other and enable patients to more easily access their healthcare information. 

It aims to establish the equivalent of a utility for healthcare information interoperability, with larger networks called Qualified Health Information Networks, or QHINs, signing legal contracts with ONC’s recognized coordinating entity, The Sequoia Project. QHINs will execute certain corresponding policies within their own networks, reaching down the “last mile” to include smaller entities.  

If TEFCA is successful in improving the sharing of patient data from all sources, clinicians will be able to “practice the best possible medicine every single day and be able to have the information available to them in a way that they don’t have to make a special effort to figure out where the heck that information is,” he adds. 

Working with software vendors 

Healthcare providers should make clear to their EHR vendors and other software companies that they want to achieve a high level of interoperability, the ONC director stresses. The Sequoia Project will offer forums at which vendors and healthcare organizations can share their ideas and concerns to help pave the way for an effective nationwide infrastructure that everyone can trust, he explains. 

Tripathi highlights the need to “reconceptualize the healthcare delivery system based on electronic data, not making electronic a system that was based on paper data, which is kind of where we are today.” 

EHR systems need to be better integrated with other systems that handle clinical data, he says, so that “access to this world of electronic information is not limited by the EHR system that I’m on. The EHR is just my conduit to the ability to do a whole set of things, some of which are provided by the EHR, but a whole bunch of things are provided outside of the EHR technology.”  

Fast Healthcare Interoperability Resources (FHIR) specifications for application program interfaces can play a critical role in this connectivity, he says. But healthcare organizations and others must “think as creatively as possible” about how they’re going to make APIs available and put them to good use, he adds. 

Maintaining privacy 

As a wider variety of health data is shared, maintaining privacy will become a more critical issue, according to Tripathi. 

“We know that we’re unleashing more and more data outside of the walls of what HIPAA covers,” he points out. “So how do we deal with that as a society?” 

ONC can take a lead role in working with federal and private-sector partners to help ensure that data is appropriately used, the ONC director says. 

A key goal of interoperability efforts, Tripathi says, is to help make sure “it’s no longer a chore” to gain routine access to patient data that can help improve the quality of care. And that requires removing the “friction” that now impedes data sharing, he says. 

Technology should not be “a point of friction that forces you to do really inefficient things … as you try to make healthcare better for all your patients,” he adds. 

The COVID-19 pandemic has illustrated the importance of the public health system participating in all data networking efforts, Tripathi says. Cloud computing can play an important role in developing a shared infrastructure, advanced computing capabilities and “almost limitless scalability and search capacity” while also preserving local control of data,” the ONC director notes. “ONC’s role is helping to enable the technology capabilities and helping to bring the parties together to develop common rules of the road.” 

Visit the CCM website to hear more and register for Top of Mind 2022 Online.

Related content:

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A freer flow of health information holds promise of achieving ROI

FHIR to play crucial role in long-term TEFCA strategy

ONC touts dawn of new era of interoperability with TEFCA

Qualified Networks emerge as the lynchpin for TEFCA

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