This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

  Today in Health it we continue our series where we're looking at the keynote addresses from the Chime Summer Forum, and today we have an interview by Russ Brazel of the current ONC IT Coordinator for Health it, which is Mickey Tripathy. My name is Bill Russel. I'm a former CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping Health IT staff current.

And engaged. I wanna thank our sponsor for today's Sirius Healthcare. They reached out about this time last year and said, we love what you're doing and appreciate your mission to develop the next generation of health leaders. The rest is history, as they say. If you believe in our mission and want to support the show, please shoot me a note at partner at this in health it.com.

All right, here's today's story. So Russ Brazel sat down. With, uh, Mickey Pathy, who is a couple months into the ONC IT coordinator role, and tomorrow we're actually gonna look at seven of the people who have held that role and the panel discussion that they had, and that's gonna be interesting out of itself.

Russ was able to get a half hour to sit down with Mickey. . This is a phenomenal interview, ends up just chockfull of information for all of us who are wondering what is going on around those things. Like 21st Century Cures Act, information blocking tef fca, health equities, you name it, which is all part of the role that the IT coordinator for O one C that is in charge of in and of themselves, but is

Uh, responsible for really moving forward in their time in office. And so he started the question with, give us an idea of stepping into the role and what are some of the things you did through the, uh, through the pandemic itself. And it's not a frontline agency. They didn't do any care, they didn't do any distribution of the vaccine or anything like that, but they did all the backend stuff, all the things like helped with vaccine scheduling and, and some of the things that they did showed up in

You know, Google searches and pharmacy partners and epic work and whatnot, they're also supporting the vaccine credential initiative, not from a government initiative standpoint, but supporting the private sector in their move forward. They are shoring up the public health data systems. The systems do not service as well as they should have through the pandemic, and they are obviously coming alongside and trying to figure out

How to shore those up for any future challenges that we might have in this area, 21st Century Cures Act. Obviously they're front and center and he goes into that in some detail. And then health equities is also something they did and are continuing to look at. I think one of the interesting things to note here is that while the appointments changed from administration to administration, there's very stable group of people working just underneath those appointments that have been around for 10 years or so.

So they add the continuity to the various administrations as they come and go. That group is working remotely right now, but they are still engaging with us and Mickey gives us a bunch of ways that we can engage with the ONC. He knows that there's a lot of questions out there around things like information blocking Tef fca, the EHR certification.

I. Requirements and the local implementations, how these things get rolled out is so important and he wants us to engage with the ONC. We can engage through Chime, we can engage directly, we can engage in a lot of different ways. They're constantly collecting information and it helps to shape the policy moving forward.

They did get into the, what they call the hot topic of information blocking. One of the first things he points out is, yeah, the rule went into effect on April 5th, but it's also four and a half years since the passage of the 21st Century Cures Act. So . It. That's a really long time to implement a law. And he wants to remind us that it is a law, right?

So it's not an executive order. This is something that was passed as a bipartisan law in Congress. And Mickey goes on from there to point out that he really believes that we've got a passing grade in terms of the work that's been done so far, but not a really good grade. And a lot of that has to do with the delay that we experienced and some of the challenges.

With implementing something during a pandemic, but regardless, he goes on to say it's a complex law, right? There's joint responsibility for policy and enforcement, differentiated process for penalties, undefined process for determining the appropriate disincentives that apply to providers. There's just a lot of moving parts, and they're right now working with the OIG on Enforcement.

The ONC defined the rules, and that's what went into effect on April 5th. And the OIG would be responsible for enforcement. And there's a draft rule out there, uh, and it was put out there last year, and the final rule is expected in September. Enforcement will commence roughly two months after the final rule.

So the ONC is working tightly with the OIG. To put together a really tight process to collect the feedback and to come up with the final rule. So the law puts out there that the, uh, coordinator process to define the appropriate disincentives, which they have the law specified civil monetary penalties for two types of actors, the technology developers and health information networks.

And appropriate disincentives for providers is to be defined by the secretary and the, he notes that the, the category is pretty broad. We have monetary penalties, but it, it could be broader than just monetary penalties, right? The secretary will define that and they're putting together a process also around that to identify what the right disincentives are and the process that they need to put in place around that.

They're working really hard around communication. And if you're paying attention, Mickey's showing up everywhere. He is in every trade journal talking about this, making sure to get the word out. He's also encouraging us to reach out to them if we want something more specific. They are aggressively trying to get the word out around this, what does it mean?

How do you implement it? And, uh, getting as much feedback as they possibly can. So the conversation then shifts to health equities. And Russ asks him to describe the approach to health, equities and social determinants of care. And Mickey goes into describing some of the things that are going on. It's important to note that what the ONC does here is part of a broader address of health equities by this administration.

So there's a health equities task force, there's a health equities council. There's just a bunch of different things going on within the government. ONC works in and out of all of those things to support those with respect. To the ONC specifically, they're working to build out health equities by design, right?

So by design is designing things with the fundamental principles in mind from the start, it's first principle thinking. Uh, he talks about the framework to think about the end-to-end problem. They are working on that right now. Equities lead to disparities, which leads to outcomes, right? So it's not just about addressing equities leads to bad things.

Within the healthcare system, he knows that the ONC can't solve this problem in and of themselves. There's a causal chain that they are looking at and trying to address. . So what can the ONC do? The ONC is trying to motivate health IT capabilities to support healthcare stakeholders in their efforts. Data collection, data curation, interoperability, policies, infrastructure and governance, teca and those kind of things.

And even around applications, they don't supply applications. But they have policies which impact them. So they're looking at that as well. One of the things he notes and he gives credit to John Halamka on this, uh, I think it's come probably from somewhere else prior to that, but he said, it's not about predicting the rain that matters, but it's about building arcs In reference to Noah and the arc, we can all predict that there are health equities.

It's now a time to build arcs and one of the things that they're doing is using their megaphone and they're identifying organizations around the country that are. Doing really good things around this, identifying bias and algorithms and scheduling. He talks about UCSF and others, and so he shares those stories and they're gonna use their megaphone around those stories.

So if you have some of those stories, bring them forward. You then start talking about the U-S-C-D-I structured data version two, which is coming out later this summer, which is an important part of the interoperability standard. And along those lines around interoperability, he talks about the need for

Uh, sharing the social determinants of health data, not only within healthcare, but across the agencies that support the health equities within our community. Uh, it is a broader interoperability initiative. As you look at it, they closed the interview with a really great question around what is his vision for maybe the next four years, maybe the next eight years.

He said, if you do your job, what is this going to look like? . And Mickey gives a phenomenal answer. He talks about not only the visionary aspects, but also the practical aspects of the role, and he wants CIOs to be able to think about innovation again. So much of the CIO's jobs is thinking about the day-to-Day operations, and he wants to enable us to start thinking about innovation again, and part of that is putting that infrastructure in place so it just becomes common.

The way the EHR was a heavy lift, but now is pretty common and it gives us the ability to be really innovative around that EHR, and we're starting to do some really neat things on the edge of the EHR itself. He's hoping by the time they get to the end of this administration, that they solve the last inch of interoperability.

He. Mentioned A-U-S-C-D-I version 10. That baseline now becomes the lowest common denominator regardless of the setting. A lot of people are connected to commonwealth care quality, but he's saying that the people at the front lines or the common person within the chain doesn't recognize that those things exist, and they're still saying it's just easier to

Fax it. And so we need to make people aware of what is out there. He wants to break down the silos between clinical admin, public health, and research for commodity data, basic data, break down those silos so that we can take advantage of that data. In the case of the next public health emergency, they want to take advantage of platform thinking, platform business, and we interviewed John Halamka coming up here.

Around this concept. He is the president of the Mayo platform. So we are starting to see people think about platforms, and one of the things that happens to the end user in the platform is they stop thinking about the technology itself. It's not just about a portal. It becomes about identifying the app which is best suited for your needs that can plug into this data liquidity platform around our own healthcare.

And one of the last things that he mentions is to mitigate health equity and intercept it more upstream in the process. And he said he doesn't wanna oversell that, but he wants the goal to be ambitious. And I love that about Mickey. I, I believe that he is balancing the pragmatic with the visionary, with the, uh, aspirational.

And that is a fantastic attribute for someone in that role. And my so what for this is, I. Engage. Engage. The ONC is asking for your input. They want to know what's going on. This is probably where we went wrong with meaningful use. We did not really know what we were getting ourselves into. And I think with this we are much further down the road.

We are a lot smarter than we were before and we can provide some really good input back to the ONC and they're asking for it and we should give it. Alright, that's all for today. If you know of someone that might benefit from our channel, please forward them a note. . They can subscribe on our website this week, health.com, or wherever you listen to podcasts.

Apple, Google Overcast, Spotify, Stitcher. You get the picture? We are. . Everywhere. We wanna thank our channel sponsors who are investing in our mission to develop the next generation of health leaders, VMware Hillrom, Starbridge Advisors, McAfee and Aruba Networks. Thanks for listening. That's all for now.