Human-Centered Design's Role in Data Interoperability

Human-Centered Design's Role in Data Interoperability

VA is honing in on interoperability to serve as the foundation of key programs like EHR modernization.

The Department of Veterans Affairs is focusing on human-centered design (HCD) as it improves interoperability across key programs, Paul Tibbits, the agency’s Office of Technical Integration Executive Director explained during and ACT-IAC event.  

"[With] human-centered design, journey mapping, value stream analysis [we] begin to better understand ... ‘the why.’ Why do we want to do this stuff? With human-centered design, I think as a body of knowledge, brings to the table for us an institutionalized way to focus on real people who have real problems and use an approach ... [called] empathetic observation to look at real people, to look at real problems,” Tibbits said.  

By putting HCD at the center of its interoperability efforts, VA will be better able to identify discontinuities in both services and systems. Then, the agency will bridge those gaps with technology solutions like APIs or interfaces. The “top-down” focus, as Tibbits described, will provide greater understanding of internal operations, as well as deliver more effective services to veterans.  

“At the end of the day, we should wind up making the VA easier for the staff to operate, and we should make it easier for veterans to access the services of VA that they deserve," Tibbits said.  

VA recently created an internal group, the VA Interoperability Leadership Team (VAIL), comprised of senior executive service-level members who pick use cases and apply a measurement framework. The framework has three primary components: business, data and technical assistance. Each of those components has subcomponents, and it takes a maturity index approach, where there's a period A and period B measurement at two points in time. 

These measurements show the initial baseline. Then, following corrective actions to fix gaps and challenges, they show improvements. These use cases all revolve around the maturation of interoperability across key programs at VA. Tibbits said that VAIL has the initial results of these tests, and the agency plans to publish its results soon.  

“We'll be continuing to apply that framework across the department. The people who own that particular endeavor can use that information in various ways, [like] how they want to [and] where they want to focus their own change management,” Tibbits said. “That's the advantage of the business sponsor having these kinds of measurements. It’s ammunition to go ask for policy changes, additional resources, whatever it happens to be.” 

VA could also leverage these results to improve user experience by creating a feedback loop to continuously improve and iterate veteran solutions. 

"We're doing all these measurements, we're measuring all this impact, we got these maturity indexes here. Is it making a difference to the person who is on the frontline delivering service, or is it making a difference to the veteran who's trying to figure out their claim? Those two kinds of big areas,” Tibbits said. 

One of VA’s key programs, Electronic Health Record Modernization (EHRM), is modernizing its infrastructure with a focus on interoperability to improve access to patient data. Although health records are now digital, Tibbits said the agency needs to develop a way to categorize and organize the records to make data discovery easier for the end user.  

By applying HCD and gauging point of service, Tibbits said that VA will “cascade enablement” and drive greater information sharing and interoperability. Moving forward, Tibbits is working to assemble a “coalition of the willing,” or people that will share data to improve interoperability, to spark enterprise change across VA and its programs.  

“If we had applied human-centered design to this whole data management problem 10 years ago, we would have recognized that sending people an electronic version of an unindexed telephone book is just not going to work,” Tibbits said. “We [need to] get serious about that empathetic observation, understanding what is needed at the point of service. ... I would contend we do not know how to prioritize our efforts without that frontline empathetic observation.”