Federal health IT leaders are focusing on data, security, emerging technologies and human-centered design as some of their top priorities in the near term.
At AFCEA Bethesda’s CXO & HHS Health IT Day this week, CIOs from the departments of Veterans Affairs and Health and Human Services, Centers for Medicare and Medicaid Services, National Institutes of Health and Defense Health Agency, as well as other agency leaders, shared their best practices and technological areas of investment they see as helping meet their agencies’ missions.
Data is a huge boon for many agencies, especially HHS. CIO Perryn Ashmore highlighted that especially amid the COVID-19 pandemic, data has been the backbone of the understanding and decision-making around the public health response.
“We are hosting [HHS subagencies’] data and sharing it back with them and back with other components across the federal government, to our state and local partners, to the jurisdictions, whether that data is from the state with hospitalization and cases, and now of course with vaccinations,” Ashmore said.
Because of investments HHS had already made in building a robust data infrastructure, Ashmore said that he was able to turn platforms that enabled data-sharing about the pandemic in days and have continued to iterate on them throughout COVID-19. The pandemic had heightened need for and awareness of the importance of data, making further investments in data infrastructure and sharing capabilities a critical need for HHS.
HHS is also standing up its chief data officer office, indicating that the agency is complying with legislative requirements to create data leadership and governance. Acting CDO Kevin Duvall shared his experience standing up the office, signaling that HHS is committed to data maturity and development.
“What I’m focused on in the [CDO Office] is pretty practical things — let’s get a common internal data catalogue, let’s get some standards set up, let’s start thinking about how we can standardize and move toward a more common data-sharing agreement approach throughout the department,” Duvall said. “I’m learning how we did it in COVID-19 and how we were able to accelerate it there, and I’m trying to take those kinds of lessons and challenges and opportunities and incorporate it into standing up this new office.”
The other components of HHS are also looking at data to support their missions. At NIH, for instance, this has been impactful for genetic sequencing and imaging. NIH Center for IT Director Andrea Norris touted the low cost of generating data sets that have largely impactful effects on treating discuses and health issues.
“To be able to start to see how to treat diseases and issues of health and understand them in more precise ways than we could before when we just had small samples — isolated datasets, not of size or significance to even be statistically valid — we’re watching this happening,” Norris said.
Norris highlighted the role of data in bioinformatics and projects across NIH like the BRAIN Initiative, which looks to map the human brain and accelerate neuroscience research, in being able to advance understanding of conditions like mental health illnesses and Alzheimers. Data is also fueling the All of Us Program, which aims to study the health data of a million people. Investing in big data capabilities is allowing NIH to hold big datasets and large studies like these to carve out the future of medicine.
The Food and Drug Administration is also investing in the future of data by creating a flexible data environment and robust infrastructure to handle the data FDA creates, receives and shares. Amid FDA's recently released Data Modernization Action Plan this week, Cory Milam, FDA's director of the Office of Innovation, spoke about the criticality of data.
“We’ve really been able to continue modernizing in the face of a pandemic, which was the plan before the pandemic came out, with respect to our core infrastructure, our network and creating that data-flexible environment that is so pivotal to the work that FDA does, because FDA is a data agency or science-based agency,” Milam said.
Federal health agencies are stewards of American medical information and critical networks that have kept the federal response to the pandemic going, making HHS and other agencies vulnerable to cyberattacks. In light of these threats, and other recent attack revelations like the SolarWinds hack, agencies are prioritizing security as a top investment area, Ashmore said, especially with methods like zero trust.
CMS CIO Rajiv Uppal spoke about the security he’s building into the agency's systems amid heightened concerns around cybersecurity, as well as the importance of having a DevSecOps model.
“You have to make sure that your systems that you’re building are as secure as possible, so how do you enable that? Some of that is through automation, giving people hardened infrastructure, whether it’s the cloud infrastructure that’s hardened, also making sure they have DevSecOps pipelines available to them, with security already built in,” Uppal said. “We’ve also been investing in potential use of deception technologies on our network, so in case there is somebody, an adversary, in the network trying to move laterally, we can potentially detect that.”
Although all of HHS is facing security challenges amid COVID-19, Indian Health Service CISO Benjamin Koshy said IHS is looking to new technologies to broaden its horizons in securing new modalities of health care delivery, like telehealth.
“When in-person health care wasn’t available, and we had to switch to a telehealth model on a larger scale that was unprecedented for IHS, and utilizing technologies in the beginning that HHS had approved like FaceTime and things like that, was definitely a new way for the agency to move,” Koshy said. “The pandemic from a strictly security point of view is really broadening our horizons when it comes to embracing technologies because our priority is to make sure we can get the proper health care out to individuals any way we can.”
VA Assistant Secretary of Information & Technology and Acting CIO Dominic Cussatt spoke about the balance of security and accessibility. His focus in security is not just on building confidentiality into his security models, but also in availability and integrity.
“We need to make sure the availability piece is really critical for health care,” Cussatt said. “The data needs to get to the clinicians. When they need it, they can’t wait. Sometimes it’s life-or-death situations. The same is true for warfighters when they’re treating patients or getting data to warfighters who are in conflict with the same integrity. They could get the data fast, it could be confidential, but it lost its integrity as it traveled to that clinicians, and it’s not the data that they were expecting or the data in the context that it was when it left the storage facility. So it’s about risk management and managing risk across those three elements and across your business and mission objectives.”
Technologies on the rise like artificial intelligence and wearables are areas of investment for HHS and VA. Amid the data-driven initiatives that HHS is taking on, especially in terms of science and research, AI is a critical tool.
“The science and research questions we’re solving are really, really hard, and I think that’s where AI comes in,” Duvall said. “Self-driving cars have to have AI because of the complexity of making decisions on a second-by-second basis about what to do. That technology, applied to the mission space within NIH, I think it’s the future of health for the world.”
Among otherr applications, Upall said AI will play a significant role in claims fraud detection and prevention and in helping CMS process comments for the rules it releases publicly. Meanwhile, Cussatt at the VA is looking to use AI to predictively support veterans and do a better job with its data management.
FDA is also interested in standing up its AI capabilities, currently trying to build out its infrastructure supportive solutions and discovery to have optimal AI, Milam said. Milam is partnering with industry to stand up a cloud environment, as well as high-performance computing and advancing computing research analytics activities to enable better AI and emerging tech tools.
Wearables and "internet of things" devices are other up-and-coming areas. IHS is partnering with its biomedical engineering group to better implement standards and better practices around IOT devices across its medical facilities, for instance, while ensuring that those devices are secure.
“We are looking at basically trying to standardize some of those IOT devices across different hospitals and facilities at IHS,” Koshy said. "We are looking to start a project down the road to start addressing those IOT devices right now in conjunction with our biomedical engineering group.”
Wearables and IOT have potential impacts for veterans. Now that VA has expanded its telehealth to a great degree and is working on improving its data repositories and management, Cussatt said combining those efforts with wearable data can fuel the future of medicine at VA.
“If we could combine that with leveraging patient-generated data that is mined through the use of wearables — things like FitBits, Apple Watches, digital scales, blood pressure monitors, diabetes managements — and if we could get that data, sort of feeding into our health care system, real time, that really ups the game for practitioners to not only have point-in-time care and encounters, but also monitor that health and really look for trouble signs or really look for continuity of care,” Cussatt added.
Workforce and Human-Centered Design
Soft skills with people are underlying key areas that federal health officials are focused on, including human-centered design, investing in the IT workforce and collaborations.
Uppal, a long advocate of human-centered design, spoke about the need to not only develop and introduce new IT tools, but also to spend time training employees in using them.
“What we’re trying to do is when somebody goes through, let’s say, human-centered design, when they come out of it, can we pair them up with a project so they can have some hands-on learning experience?" Uppal said. "Trying to connect the training that people get, followed by experiential learning so that the concept they learn would stick better — that’s the kind of program we are actually working on right now."
Stacie Alboum, NIH CIT's deputy director, echoed Uppal’s comments. It’s one thing to have the technologies in place, but embracing and knowing how to use them is another matter, she said. CIT has increased IT support training for NIH staff, making sure that they were able to take advantage of technology tools, especially amid pandemic-induced telework, to transition into remote work successfully.
CIT is also investing in the quality of its recruitment and retainment of IT staff to keep her organization robust.
“The key to success in this entire experience has been the people factor,” Alboum said. “We’ve been very focused on recruiting and retaining diverse top talent. People really are our greatest asset, and it’s really been to the credit of our talented and dedicated IT workforce that we have succeeded an unimaginable pace of work since this all began.”
Other areas across HHS and federal health agencies are looking to support people, with collaborations being a key part of that. Ashmore, for instance, said the progress and efforts done through the Federal CIO Council will be key for him, while Norris at NIH is looking for high-performing partnerships across industry and academia.
“The biggest enabler of our mission is going to continue to be, I think, sound partnerships and our … research ecosystem,” Norris said. “We work in a national, in some cases international, ecosystem with universities, with medical centers, increasingly with technology partners, with pharma.”
All of the participants stressed the importance of collaborating across their own organizations, as well as external partners in getting to the future of their work and agency mission. Those partnerships, as well as the training and human-centered design approaches, can ensure smooth technology adoption well into the future.