In the discussion “Zeitgeist Talk on the Current and Future State of Health Data Interoperability,” held at the 13th annual DPHARM conference in Boston, Micky Tripathi, PhD, MPP, national coordinator for health information technology, US Department of Health, answered questions from Amy Cramer, MMCi, BSN, CPHQ, founder, board of directors co-chair, Vulcan, HL7 FHIR® Accelerator, on the current status of USCDI and TEFCA and the next steps to advance evidence generation systems.

The following has been edited for length and clarity.

Cramer: What got you excited about HL7? Specifically, the fast healthcare interoperability resource and the Argonaut accelerator?

Tripathi: Back in 2014, I was a part of the health IT policy committee. There was a report cast on who could provide technical advice and strategic advice to the federal government. One of the things that was pointed out was that healthcare needs to discover the internet and the internet needs to discover healthcare. In other words, healthcare needs to move to an application programming interface (API)-based framework, like the rest of the internet economy. During a meeting, a group of us got together and decided to take the initiative. I was asked to be the project leader for the API. That’s when I got involved and it was really exciting.

Cramer: I want to talk a little bit about CDI. What can you tell us specifically about USCDI?

Tripathi: The USCDI is the US Core Data for Interoperability. It’s the minimum data set that is required to be supported by all certified electric health record systems. The idea is that it needs the 80/20 rule. Hopefully, all of us agree that we should have a minimum data set across the country that’s basically the least common denominator that you can count on, whether it be in Juneau, Alaska, or Portland, Maine.

Cramer: One of the things we hear from our scientists a lot is getting specific data elements and lab data is a great one to move in. When you receive data, you can put anything you want in there. If you don’t get those research resources, it’s hard to get out. The calendar of events for a research study is very dynamic and very different from clinical care. So, when can we have our research resources? What’s your expectation for that?

Tripathi: We don’t have a fixed timeline currently. I think it’s sort of driven in part by our ability to work with our agency partners on things like the USCDI+, for research and for clinical trials, for example, there’s very specific data elements that are much more exacting than the general kind of data that we use for the USCDI, and in some ways are used for clinical care. I think that’s where we rely on accelerators, like Vulcan, for example, to be able to identify some of these things and say, these things aren’t yet at the level of maturity that we need for set standards. Let’s accelerate those through the process to get those more standardized. That puts us in a position of being able to say that these are at a level of maturity now that we’re able to put them in the pipeline.

Cramer: Let’s talk about TEFCA, it stands for Trusted Exchange Framework and Conference Agreement.

Tripathi: TEFCA is from the 21st Century Cures Act 2016 to establish a nationwide model for network-to-network interoperability. Think about the way that cell phones and ATMs work today. We have the user experience of there being a single cell phone network across the country, right? That’s our experience. We don’t worry about any Verizon phone, I bought AT&T. They don’t think about that for a minute. And that’s because there’s a ton of work that’s gone on behind the scenes such as governance, technical specifications, and industry collaboration that makes sure that those systems are connected, even though it’s actually a set of private networks that connect on the back end. That was essentially the direction that Congress gave us to say do the same thing with clinical interoperability networks. There are a number of them out there, there are state and local ones, some of which are on their last breath, but some of which have sustainability, and they will continue going forward.

Cramer: There are people out there that are critical of TEFCA, and they are colleagues that we highly respect. They feel that the way TEFCA is set up will set back inoperability two years. What would you like to do to respond to people that we respect in that space?

Tripathi: We have ongoing discussions with all of the individuals who we are talking about here, and we certainly appreciate their points. I think a part of that criticism is two things. One, I think it reflects comments back on our draft rule, which was published. We have those to get feedback and comments. I would encourage everyone to wait until you see a final rule before you make your judgements about TEFCA. We’re the ones that have been very invested in FHIR from the beginning. So, the fact that we would do anything to undercut the adoption of FHIR APIs seems to not have a lot of credibility. The second thing that is important for us all to understand is that FHIR APIs have will have great difficulty scaling without the networking infrastructure that TEFCA provides. You can have a FHIR API, and let’s say what you want to do is access information from 1000 different provider organizations across the country. First question you’re going to have is, where are the data use agreements on all of those? Second question, who’s handling the onboarding and the security for that kind of exchange? Again, am I going to have to do that? And is every CRO going to have to do that with the same set of providers? Third, where are the electronic endpoints for those 1000 providers? I need an electronic address. My technical team is going to say, what’s the URL? Where do I point this? That was enough for them to make the phone call and write it down? Or say, please email me your electronic address. Fourth, where are patients’ records? You need to know to order the patient records and where the addresses are. Without the infrastructure of TEFCA, you’ll have to figure that all out on your own.

Reference

Zeitgeist Talk on the Current and Future State of Health Data Interoperability. September 21, 2023. DPHARM 2023, Boston.