During a discussion at HIMSS23 this past week in Chicago, officials with the U.S. Department of Health & Human Services and the Office of the National Coordinator for Health IT offered some updates on how the agencies are working together and with others to help shape a "digital healthcare system of the future" that works for everyone.

"The work that we do really needs to leverage the various parts of the department to put the people that we serve at the center of what we do," said Andrea Palm, deputy secretary, U.S. Department of Health and Human Services, who outlined the ways HHS is tailoring its approach to better serve consumers with increased cross-departmental and interdepartmental cooperation.

"We serve the same families in our Administration for Children and Families that we serve with Medicare and Medicaid, that we serve in our Substance Abuse and Mental Health Services Administration," said Palm. "We're all the same people who need CDC when we need them, etc.

"So how we think about the customer experience is an opportunity for us at HHS to lift up, to put people at the center, and to wrap service around them instead of requiring people to come to programs and interface with individual programs."

It's not easy work, she said, but the Biden Administration is "committed to enhancing the customer experience, to delivering services in a way that meets people where they are and meets its mission in a more customer friendly way."

And it's not just within HHS. "We as an administration are trying to lift up even more and say, if you are approaching retirement, that Medicare issue is also a Social Security issue. How are we thinking about the way Medicare and Social Security work together?" asked Palm.

"Or if you are a family who suffered a financial shock, a loss of a job, something along those lines, that's potentially DoL, that's us as USDA with the SNAP program – there are interfaces across government where we have made it less easy for customers to access what they need. This initiative is really designed to try to force us to think differently – better, smarter, and put people at the center of what we do."

HHS has a "big book of business" in its cross-government collaborations, she said, "because so much of what we do is about delivering services for people across the board. And so we're very focused at HHS. We have a number of cross-department teams who are taking these different use cases that we have agreed as a government kind of things we have to get after and do to work on. And we'll continue that work through the President's Management Agenda and some of the other efforts that we're doing to really put customer experience at the center of the kind of work that we're doing."

Equally important, said Palm, "and one of the things that I think we uniquely bring to the table in this conversation is the importance of states and local communities."

The pandemic was an object lesson in the importance of local public health, "in ways that we all now very clearly understand," she explained. "If you've seen one Medicaid program, you've seen one Medicaid program. States are very critical in how we think about putting customer experience at the center of this: When you're thinking about Medicaid eligibility and how we can and should be leveraging data that exists to make it easier for folks to become eligible for programs that they're eligible for."

Especially in the context of the sunsetting of the Public Health Emergency, said Palm, "there's a lot of work that's been going on around the ability of states to now reach terminal eligibility. How do we make sure we are bringing to bear the sources of data that we have to lessen the burden on customers, reduce the inaccurate eligibility exclusions and make sure that everybody who is eligible for Medicaid can remain?

"That's all part of how we think about serving customers and bringing to bear all of our resources to minimize the barriers that eligibility and the paperwork and those kinds of things put in the way of people accessing the benefits they need," she said.

Meanwhile, Palm nodded to the health IT space, where she applauded recent work at the National Coordinator for Health on agency alignment "so that we, as an HHS purchaser, are really trying to leverage our buying power to promote the work that ONC is doing, and [promote] the standards, and interoperability, and the kind of things we want to see in the marketplace more broadly."

HTI-1 in focus

Toward that point, Elisabeth Meyers, deputy director in ONC's Office of Policy, offered some updates on its own "close collaboration across departments," such as its work with CMS on the payer APIs.

"The Secretary's office really took a lean in deciding that, for now, let's think about API investments and think about the really drastic increase over the past several years – in part because of COVID, but also for other purposes – expanding public health services, expanding their healthcare support," she said.

She also noted the importance of HHS grants, cooperative agreements and contracts that will align to the policies that have been adopted by the ONC regulations, but on behalf of HHS.

"We've had some really interesting work from different parts of departments that maybe weren't as aware and now have tools that they need to think through what are the technology pieces that we could be including, or that we could be funding, to make sure that our programs are actually adequately supported, and we're not stealing program money to pay for technology after the fact," said Meyers.

"It's a really, I think, impactful policy that can set this foundational platform that when we think about initiatives, and when we think about programs, that they can be more effective."

Most recently, ONC has been educating stakeholders about its most recent notice of proposed rulemaking, which includes some updates to previous 21st Century Cures Act regulations on information blocking.

"One of the things that we're doing in information blocking is we're clarifying some definitions based on feedback from you all, to try and make a couple specific pieces of it a little more easy to understand and navigate for those who are setting compliance for it," said Palm.

"We're also modifying some of the exceptions, including to add an exception that reflects the work that's been done on another piece of the Cures Act, which is the Trusted Exchange Framework and Common Agreement, or TEFCA – trying to connect networks together, so the data in one network has the trust and detectable capabilities to move across from one network to the other.

"Specifically in this role, we put in an information blocking modification for an exception that allows for the emphasis to be on using that for those network participants that they can use that as part of their compliance, and really trust in that network as an opportunity for them to be in compliance with information blocking."

Explainable AI for clinicians

Avinash Shanbhag, executive director of ONC's Office of Technology, spoke about the new rules' focus on health equity and explainable AI.

"One is a predictive decision support intervention," he said. "This is our starting step of looking at all the AI machine learning models that are coming out. We are starting to take a step towards understanding how you could look at them and see biases in those machine learning models."

In the proposed rule, he said, "what we've done is we kind of put out proposals around transparency to build trust into those models. It's a balance between making sure that innovation is happening, but at the same time making sure that it's trustworthy. There is fairness and appropriate governance at the level at which we should start with. We think it's the right balance that we are striking, but certainly would be looking forward to your comments.

"As you know, with AI machine learning models, they are built on several data elements – data that gets trained – and it's very opaque. So some of the proposals in our model include identifying those source attributes. Those are the attributes that get used into those AI machine learning models to be made available to the users of those models – the providers."

The aim, he said, is to better equip providers to "start understanding what those models are. It's a small step, but we think that step is going to be in the right direction of making sure AI models, as they get built in the future, get really understood by this vast ecosystem that includes the developers, the providers and the government all taking part in the development and deployment of these models."

With the new proposed rule, ONC has widened its United States Core Data for Interoperability dataset to a newer version, version 3.

"It includes a lot of elements which are focused on social determinants of health and disability and behavioral health, and we think these are great advancements," said Shanbhag. "We feel that industry is ready to again capture, store and exchange those data elements and we think it's going to be beneficial to the industry to be able to leverage those data for doing great things to be able to do whole-person care that we really sincerely need in this country."
 

Mike Miliard is executive editor of Healthcare IT News
Email the writer: mike.miliard@himssmedia.com
Healthcare IT News is a HIMSS publication.