ONC chief Micky Tripathi talks public health data systems and 'health equity by design'
Speaking on Thursday at Sirona Strategies' Health IT Leadership Roundtable, newly-minted National Coordinator for Health IT Micky Tripathi offered an overview of ONC's strategic priorities for the near future, and described how the agency is doing tactical work on wider Biden administration policy goals.
Of course, said Tripathi, "Job number one is COVID-19 right now. We are supporting all of the work related to the execution of the executive orders … [and] make sure that every single one of those is hitting the mark in terms of the priority, the urgency, the importance and the execution."
Systems 'stretched to their limits'
There have been a flurry of executive orders from the White House since President Biden took office, of course, but one of the most potentially consequential is entitled "Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats."
Among the seven or eight executive order workgroups Tripathi and other ONC leaders are involved with, they're co-leading a task force focused on that one – which puts the focus on improving public health data systems.
"One of the sections of the executive order calls for a review of interoperability and connectivity related to public health data systems," said Tripathi.
"So we've launched a work group that we're co-leading with the CDC and working in very close partnership with them to take a look at what have we learned from this pandemic – what the gaps are, what the uses have been [of] one of the of the public health data systems that are in place today."
As has been reported, many of those information systems "were very much stretched to their limits in many cases," he said. "Because we had to use some of those public health data systems for things that they weren't originally designed for, which also taught a lot of lessons, I think, along the way."
So ONC and CDC have "a lot of work there," he said. "What was the systems' performance? What was the original intent of those systems? How did they actually perform? What did we learn from that in terms of gaps? And then how do we think about the future of public health data systems?"
'Health equity by design'
If the COVID-19 crisis shone a spotlight on a patchy public health reporting structure, it has also cast a glaring light on public health disparities across underserved communities in the U.S.
So Tripathi said another major early goal for ONC would be to seek ways to address that. Specifically, he referred to the concept as "health equity by design."
As he explained it, health IT policymakers have often, in many areas "embraced technology and moved forward with standards and processes that didn't explicitly take into account the consequences that our actions and activities might have on health equity.
"And then you catch up later, and you sort of do some measurement, and you realize, 'Oh wow, this created some health disparities we didn't realize, and now we have to go back and rectify and mitigate,'" he said.
"What I think we all need to work on and move toward – and certainly within the ONC, we're doing our best to do this – is thinking about health equity by design," said Tripathi.
That means, from the very beginning of any policy or technology development process, "saying what are the health equity considerations here and how do we bake that in as a fundamental design criterion so that we have fewer surprises down the road?" he explained.
"That cuts across the board as we think about where standards are developed. When you think about the granularity of social determinants of health – race, ethnicity and language data – what are the workflows associated with getting that data? How do we do that in a way that protects privacy so that people don't have concerns or don't have hesitancy about giving their information?"
That's especially true as new AI-enabled decision support tools emerge and evolve.
"I think everyone's familiar with the issues with algorithmic bias," said Tripathi. "And that is a bigger and bigger issue the more that algorithms are embedded in, you know, in all the technologies that we use."
Getting vaccine credentials right
As for other immediate priorities, "vaccine credentials or vaccine certificates, as some people call them," are also top of mind for ONC.
"We have something like 10 percent of the population having had their full complement of vaccinations," said Tripathi. "That number is growing rapidly. And I think as anyone who's been following the press knows, that there is a question, both within the U.S. as well as in other countries, on the idea of being able to offer proof in some way of your vaccination status as a public health measure and to be able to resume to people's day to day activities."
Tripathi mentioned at one point that he's not a fan of the term vaccine passport. Among the many connotations of that word, "passports are something that are issued by governments," he said. "Right now, the 'passport' is not issued by the federal government, so I think of them as vaccine credentials or certificates.
"We're working with our federal partners on just sort of understanding the landscape and trying to best evaluate what are the various considerations there and how do we work with our federal partners on thinking about that."
Tripathi emphasized that "there are a number of considerations that absolutely have to be a part of the ecosystem, however that unfolds. Privacy is a huge one. Security is a huge one. Protection against fraud is a huge one.
"And equally important is health equity considerations," he added. "How do we make sure that whatever is available is accessible to everyone so that no one is left behind or feeling like they can participate in the return of their day?"
It's worth remembering, after all, that 20% of U.S. adults don't own a smartphone.
Info blocking rules start date nears
Meanwhile, Tripathi also reminded stakeholders that April 5 is less than a month away.
"We're working very hard on information blocking," he said. "The applicability date of April 5 is just around the corner. So we're doing a lot to make sure that we're reaching out to the market and providing education, providing outreach to the market, so that market is best prepared."
While healthcare organizations still have their hands quite full managing the demands of the ongoing pandemic (and so should appreciate that there's still no enforcement mechanism in place for the info blocking requirements) Tripathi highlighted the rules' value, and their importance for helping shape an emerging data ecosystem.
"It's all about platform economics," he said. "It's all about supporting an innovation economy and being able to support open-platform [sorts] of approaches to things."
Tripathi said he's cognizant that the information blocking regs "go a bit deeper than a lot of the other regulatory activities that we've had in the past from an ONC perspective.
"It's attacking something that's a bit more deeply ingrained in the culture of providers, vendors, health information networks and others in the healthcare delivery value chain," he said. "And so we just have to recognize that this is going to take time, and it's going to be something that people are going to sort of move toward. And we certainly recognize that."
Still, said Tripathi, "it's something that needs to be taken seriously."
Focus on Health Equity
In our ongoing coverage, we report on the challenges, opportunities and success stories as work continues to build a healthcare system that works for everyone.