Host Jay Anders, MD sits down with Micky Tripathi, PhD, MPP, National Coordinator for Health IT at HHS to discuss some of the big challenges in health IT today, including interoperability. Tripathi, who has spent the last 20 years working in the private and public sector to drive the adoption of technology in healthcare, shares his thoughts about the fragmentation in healthcare, the need for better information sharing, the transition to value-based care payment models and more.
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But first, Dr. Anders shares a recent experience that underscores healthcare’s ongoing struggle to share healthcare information between providers. Dr. Anders recently lost his 93-year-old mother, who was a complex patient taking 14 medications for 10 medical conditions and being treated by seven different physicians. Before she passed away, Dr. Anders served as his mother’s “walking interoperability platform” to communicate details of her medical history with the various physicians––who collectively lacked an effective way to share her medical records. Dr. Anders saw first-hand that critical patient information is not always communicated effectively, even between medical assistants and their physicians.
Getting hooked on healthcare IT
Tripathi shares some background on his career, which wasn’t always in healthcare and health IT. Twenty years ago he was working as a strategist consultant with Boston Consulting Group, which led him to an engagement working with the Regenstrief Institute to develop a business plan for what eventually became the Indiana HIE. And from there he became “hooked” on the healthcare IT industry and decided that was where he wanted to focus.
Healthcare fragmentation, the pandemic, and EHRs
The biggest challenge in healthcare in the U.S. today, according to Tripathi, is the fragmentation on both the supply and demand side. On top of that, healthcare is fast-evolving and complex, making it challenging for consumers to evaluate care options based on quality and cost in the same way they do in other sectors, such as when buying a car. In terms of health IT, the fragmentation makes it difficult to have interoperability in the same way we have it with ATMs and cell phones. Fragmentation also makes it more difficult for providers to work together, which is why the federal government needs to play a bigger role in bringing people together and establishing standards and conventions.
Tripathi notes that the pandemic shined a bright light on EHRs and has shown that “this stuff can work” to do good things, such as the creation of QR codes for vaccination credentials, which rely on FHIR-based standards and provider vaccination records to deliver a QR code to consumers’ smartphones. On the other hand, it has dramatically shown the lack of interoperability between healthcare delivery systems and public health systems.
While the country has invested $40 billion in EHRs, similar investments have not been made in public health systems. To fix this lack of connection, Tripathi believes we need increased investment in public health systems and a greater sense of urgency to create more modern interoperability that is dynamic, bidirectional, and delivers information in real time.
To address interoperability challenges, Tripathi believes we need a health IT ecosystem that is more of a platform and supports the use of apps to deliver core interoperability and a more flexible user experience. Just like with smartphones, Tripathi favors a platform that delivers core functionality but also offers a seamless opportunity to use apps that give users access to other features. To support this vision, Tripathi believes EMR vendors cannot be allowed to use anti-competitive practices that block customers’ ability to use apps that work on top of their platform.
With the pending enforcement of interoperability as part of the 21st Century Cures Act, Tripathi believes that organizations must move interoperability up on their priority lists and work to make information sharing an “organizational instinct.” Tripathi thinks organizations should not view data sharing in terms of compliance and penalties, but instead providers should consider the opportunities that come with having more complete patient information.
And, Tripathi sees the transition to value-based purchasing models as the single biggest business driver for interoperability. With value-based care, providers recognize they must invest in tools that provide interoperability in order to take better care of patients.
Waving the health IT magic wand
Dr. Anders closes with his signature question, “If you could fix one thing in healthcare, what would it be?”
“I think what I would do is dramatically overnight say that all reimbursement is based on a value-based care model,” says Tripathi. “Interoperability has to be baked into the business incentive.”