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Dr. Micky Tripathi on interoperability, health equity & how his work with VCs will help him lead the ONC

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The key objectives of the Office of the National Coordinator for Health Information Technology are two-fold: advance the development and use of health IT capabilities and establish expectations for data sharing.

When Dr. Micky Tripathi was named head of the federal agency in January, he took on the ONC’s rather expansive mandate.

Now, three months into his new role, Tripathi has narrowed the agency’s focus to the key items he believes will be most helpful for an industry still battered by the Covid-19 crisis. These include advancing interoperability, strengthening the public health infrastructure and accelerating the implementation of the 21st Century Cures Act.

In a wide-ranging phone interview, Tripathi charted his journey to the top of the ONC and discussed the agency’s plans for the year ahead.

MedCity News: Let’s first talk about your path to the ONC. Starting out with a PhD in political science, when and how did your interest in health IT and public policy grow?

Micky Tripathi, ONC,

Micky Tripathi: I’ve always been interested in policy. I was pre-med. Both my parents are immigrants from India, and both of them are doctors. But as I got closer and closer to that vision, I realized that I was more interested in working at a policy level on more macro issues than I was in working one-by-one, with individual patients.

And so, I made the decision that I was more interested in policy. Although at the time, I was more focused on national security policy, which is where I first started my federal work — in the 1980s, working for the defense department.

One of the things that I learned when I worked in the defense department and carried through in my other career experiences was I really like being at the nexus of technology and interesting, important areas of public interest…where you have significant policy issues to wrangle with.

And then as I started working in health IT, that just kind of grabbed me as being a perfect nexus of all of those things.

MedCity News: You served as an executive advisor to investment firm LRVHealth from 2018 to January of this year. How does that experience influence your role in leading the ONC today?

Micky Tripathi: To me, it’s [been] critical working on that side of the economic equation.

Because healthcare economics is so complicated, it’s really hard to figure out exactly how one makes money, because the payment flows are really not obvious to people from outside of healthcare. So, I think that [experience]…gave me just a lot of really good grounding and the need to really understand in a very, very deep way the economics of any particular service or product that you’re thinking about.

All of the complexities in the interweaving of healthcare regulations, technology trajectories and market forces, and [knowing] how all of those come together, I think is really important. [Otherwise] you’re making policy, but you don’t have that deep appreciation for what it’s like being on the other end, think[ing] about, “If I invest $5 million today, how am I going to make that money back? And what are the time horizons? And what does it take to be able to do that?”

The other thing that I think that it gives me, or gave me, is an appreciation for all of the tiny, little corners and lacuna of healthcare delivery…there are just a ton of small developers who have incredibly amazing ideas that are addressing one tiny piece of a really complex value chain.

And I think it gave me just a lot of appreciation for how you can unpack a very complicated set of things and try to focus on a very, very, very narrow part of it to try to deliver value.

MedCity News: What are the ONC’s key priorities for 2021?

Micky Tripathi: Driving directly from Covid and into the future, I think one really important thing is the public health interoperability investments that are already underway. The good side, if we can call it a good side, of having gone through the pandemic is that I think it’s shone a pretty harsh light on the systemic underinvestment that we’ve made in public health over many, many decades, across many different administrations, Republican and Democrat.

And now, we’ve got a lot of dollars coming into public health for those investments. So, I think one really clear goal is for us to work with all federal partners to try to make sure that those public health dollars are [going toward] enduring interoperability investments — that [they] aren’t going to be just big investments early on, but [ones that] don’t sustain themselves and don’t prepare us appropriately for the next pandemic.

Other things I would point to are getting a much clearer picture of how health IT and interoperability can support the reduction of health disparities. And again, one of the lessons that we saw from the Covid experience is that we have very little data to be able to address the root causes of healthcare disparities.

So I think we at ONC…are spending more time on unpacking that. What are the end-to-end processes that are needed to be able to address healthcare disparity? Starting with better data collection in appropriate ways that aren’t imposing burden, but are getting data that can help us identify those disparities for marginalized, minority, underserved communities.

MedCity News: As demand for interoperability grows, what do you think the ONC’s main role is going to be, especially since it’s going to involve regulating several different players?

Micky Tripathi: It is going to be evangelizing, evangelizing, evangelizing. Obviously, there is a monitoring and enforcement and a compliance piece of [the interoperability and information-blocking rules]. That is fundamental because people need to understand that is the law and that compliance is required.

But to me, it’s not [just] about the stick. It’s about the opportunity. And I think that’s the evangelizing part, which is to say, “how do we educate the industry and help the industry identify what the real opportunities here are for them to be able to move forward? And what are the ways that we, from a federal government perspective, can help them?” Because I know that we ourselves — as much as we try [not to] — we throw up barriers.

Some of them, we can’t help because it’s just a part of being in the government. But some of them, we can, and we just need better input from industry on what are the kinds of things that we can do to help clear the path for them to be able to move forward and serve patients and providers in the country. So, I think really a big part of it is for us to lean way forward [and] talk to as many stakeholders as possible.

MedCity News: How do the Biden administration’s health IT priorities differ from the Trump administration’s?

Micky Tripathi: I think there’s a lot that’s the same. And the reason it’s the same is if you look at the previous administration, really most of what they did was just executing the 21st Century Cures Act, which was signed by President Barrack Obama and strongly endorsed by Vice President Joe Biden at the time.

So, I think there’s a lot of consistency there and a lot of momentum that carries forward into the Biden administration. That said, we certainly want to accelerate it.

The Trusted Exchange Framework and Cooperative Agreement…is one that I think we really need to accelerate. To be totally candid, it’s been a little bit on the back burner for a little while, and I’d really like to bring it forward and to have it be something that is going to help us settle once and for all, a lot of questions related to interoperability networks like, “how does nationwide interoperability work for the entire healthcare delivery value chain, not just provider-to-provider or certain EHR vendors?”

The other things, I think, are things that we’ve touched on, but certainly a focus on equity. And I like to think of this as health equity by design, which is to say that we need to be thinking about health equity from a bottom-up perspective in everything that we do…equity isn’t an afterthought. Equity is fundamental to who we are as a country.

And then finally, this administration has a health plan. And so, everything that we’re doing with health IT is to support that health plan, which is to continue the acceleration toward value-based care.

Photo: sdecoret, Getty Images, HHS’ Office of the National Coordinator for Health Information Technology

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