Episode #3 – Scaling Innovation in AI, Interoperability, and Health Equity, with Micky Tripathi

This episode of Enabling Health Value showcases the US National Coordinator for Health IT, Micky Tripathi. He leads the Office of the National Coordinator (or the ONC) – a staff division in the Office of the Secretary for Health and Human Services responsible for advancing the federal government’s health information technology efforts and catalyzing adoption of secure, interoperable health IT systems across the entire health ecosystem. In addition to his formal role running ONC, Secretary Becerra has tasked him with co-leading HHS’ efforts in artificial intelligence.  Prior to joining the ONC in January 2020 as our nation’s health IT czar, Micky spent twenty years in the private sector working on electronic health record implementation, interoperability, and data analytics.

In this episode, you will hear from the top technology leader in healthcare how our country is scaling innovations in AI, Interoperability, and HealthEquity. This interview is packed with valuable insights that can help you navigate the evolving landscape of Health IT and Value-Based Care.  Learn how “Interoperability isn’t the goal.  The goal is value-based care enabled by interoperability.”



01:30     Introduction to Micky Tripathi, Ph.D., M.P.P., the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.

03:30     Optimism at the ONC on the prospect of Artificial Intelligence in healthcare. (Read Micky’s blog: Leveraging Agency Expertise to Foster American AI Leadership and Innovation)

05:00     “We study natural stupidity instead of artificial intelligence.” (Reference from Michael Lewis’ book “The Undoing Project” on human mind research from  Amos Tversky and Daniel Kahneman)

05:30     Balancing AI optimism with risk mitigation.

06:00     How the HTI-1 Final Rule approaches the regulation of AI-enabled tools in healthcare.

07:30     Overcoming the “black box” of AI within EHR systems through dashboards that ensure algorithm transparency.

08:45     AI Model cards in EHRs that serve as a “nutrition label” to explain the context in which machine learning models intend to be used.

09:00     AI Risk Management Frameworks in EHR systems.

11:45     The new frontier of Generative AI and why the ONC is not distinguishing it from Non-Generative AI as it approaches regulatory actions.

13:00     Transparency with Generative AI training data sets for LLMs.

14:00     How does Generative AI fit into regulatory frameworks for medical devices?

15:00     Post-market surveillance of Generative AI tools.

16:00     TEFCA as is a critical 21st Century Cures Act requirement for establishing a nationwide, interoperable health information exchange infrastructure.

16:30     A major milestone for nationwide health data exchange through Qualified Health Information Networks (QHINs).

17:00     “Next-level interoperability is just as exciting (if not more exciting) than AI.”

17:45     Comparing lack of healthcare interoperability to mobile carriers (imagine a world if AT&T, Verizon, Sprint, and T-Mobile were not connected with each other!)

18:00     The poor consumer experience of healthcare is directly related to it acting as disparate singular networks.

19:00     Next step for health data exchange is private sector adoption from providers, payers, and public health agencies.

19:30     Common Agreement Version 2 as the next major evolution in TEFCA integration with QHINs.

20:00     The major idea of TEFCA is the Common Agreement that each network connects together (instead of having a big cloud-based repository or centralized infrastructure).

21:00     Common Agreement Version 2 supports FHIR-based exchange (open industry APIs).

21:30     The use case of FHIR APIs for meaningful information exchange in value-based care.

22:45     How FHIR APIs are moving payers in the direction of nationwide health data exchange with providers.

27:30     Striking the right balance between private sector innovation and government regulation to create an ecosystem of interoperability.

28:30     Ambiguity in regulation stifles private sector innovation and capital investment, and the role of ONC to provide clarity.

29:45     Aligned Regulation – how lack of coordination from both the government and market creates variations in FHIR APIs that limit automation potential.

32:30     A judicious approach to information exchange will support innovations in value-based care.

33:30     The recent draft of the 2024-2030 Federal Health IT Strategic Plan has been released by the ONC for public comment.

35:00     A coordinated Health IT strategy that places greater emphasis on health equity.

36:00     Moving from a foundation of mere EHR adoption towards a more mission-driven digital health strategy.

37:30     “Interoperability isn’t the goal.  The goal is value-based care enabled by interoperability.”

38:00     Updating the public health infrastructure with data modernization.

39:45     The CDC goal of having 75% of public health jurisdictions live on TEFCA within 5 years.

41:00     The ONC’s vision of health equity by design through the prioritization of data-driven approaches to create a more equitable health system.

42:00     “Health IT alone is going to resolve the systemic health inequities we have in society, but let’s make sure it isn’t making the problem worse by creating a digital divide.”

43:00     Strategies for creating an equity framework for Health IT.

46:00     30% of hospitals do not participate in TEFCA networks, and most of those are in rural and underserved communities.

47:00     The bias of AI algorithms in EHR systems can make outcomes worse for communities of color.

48:30     Validating training data for AI models to mitigate risk of algorithmic bias.

50:30     Information Blocking regulations in the 21st Century Cures Act and how the ONC is implementing policies to encourage information sharing.

53:30     Providers, health information networks, and certified technology developers are impacted by Information Blocking regulations. (What about payers?)

54:45     Penalties for Information Blocking ($1M per incident with providers facing “appropriate disincentives”)

57:00     The recent cyberattack on Change Healthcare, a data breach of the nation’s biggest healthcare payment system affecting a countless number of millions of people.

57:30     How the fragmentation healthcare system coupled with the need to share information creates a cybersecurity risk exposure.

59:00     The value of medical records in the black market.

59:30     Security threats from state-supported actors.

59:45     The HHS Cybersecurity Strategy to improve cyber resiliency and protect patient safety.

62:00     How the Change Healthcare cyberattack reinforced the overall need for system resilience.

64:00     Value-based care will mitigate system exposure to cybersecurity issues!

66:00     Thank you for listening to Enabling Health Value!  Learn more about value-based care enablement by visiting www.lumeris.com.