Health and Human Services rearranges its technology furniture

Technology moves fast, and sometimes agencies have to reorganize just to keep up. That’s the case at Health and Human Services, which last month reorganized to “streamline and bolster technology, cybersecurity, data, and artificial and policy functions.” Here on the Federal Drive with Tom Temin with what that actually means, the assistant secretary for technology policy, Micky Tripathi.

Interview transcript: 

Tom Temin  Technology moves fast, and sometimes agencies have to reorganize just to keep up. That’s the case at Health and Human Services, which, last month, reorganized to “streamline and bolster technology, cyber security, data and artificial intelligence and policy functions.” Here with what that all actually means, the assistant secretary for technology policy, Micky Tripathi. Mr. Tripathi, good to have you back.

Micky Tripathi  Thanks, Tom. Good to be here.

Tom Temin  And this whole office, the assistant secretary for technology policy and your title, that’s newly named as part of the reorganization, correct?

Micky Tripathi  It is, yep.

Tom Temin  Well, tell us more. What has happened here? There were three different offices handling all of these tech-related functions. Tell us what drove this idea to reorganize.

Micky Tripathi  Yeah, so, there’s a number of different things that, you know, kind of came together all at the same time. Is, as you know, we’ve been working very hard since, you know, since I came in in January of 2021, and under leadership of Secretary Becerra and Deputy Secretary Palm, we’ve been, you know, doing more and more at the department level related to technology and data strategy, things like the HHS data strategy, the HS cyber security strategy and AI, obviously, more recently. And what we’ve been seeing is that, you know, data, technology, policy and operations, have grown significantly both, you know, kind of at the department level, as well as within each of our operating and staff divisions, and increasingly, those are, you know, being recognized as kind of core functions of the department. They’re not just, you know, kind of an administrative thing that, you know, let’s maintain, let’s do this at lowest cost. We’re recognizing that these are more and more, you know, strategic things that we need to be thinking of as as real core functions that are critical to the mission of the department and all of our agencies. So, as we looked at that, your responsibility for these various elements have been distributed across my office ONC, ASA, the Assistant Secretary for Administration, and ASPR, the Administration for Strategic Preparedness and Response. And we looked at that and thought, you know, we really need to reorganize this to streamline and strengthen the department’s technology, cybersecurity, data, AI strategy and policy functions, and that will also, you know, enhance and consolidate our policy guidance, talents, delivery, capacity, all of that, so that we can, you know, really be in a better position to meet the urgent needs of the moment. Ensure that we’re positioned organizationally to keep pace with developments in the future. So, specifically, we’ve, you know, under the reorganization oversight over technology, data, AI, policy and strategy are moving from the Assistant Secretary for Administration the CIO’s office, and are being consolidated ONC in a chief technology officer, chief data officer and chief AI officer. That’s now called the assistant secretary for technology policy, and ONC is going to be duly titled ASTP, and the Office of the National Coordinator. And then another part of it, and I’ll stop in a second, another part of it was taking certain cybersecurity functions that were in the administrator, the Assistant Secretary for administration’s office and the CIOs office as well, and moving those over to ASPR to consolidate our cyber security, you know, resources and staff components. So, those are all under ASPR. So, now what you’ve got is cyber security under ASPR enterprise. IT functions under the CIO and strategic uses of technology and innovation and data and AI under the Assistant Secretary for Technology Policy.

Tom Temin  And given the former title of your Office of National Coordinator for Health Information Technology, it sounds like you’re making a distinction between the technology base to operate the department, personnel, finance, acquisition, all of those things that every agency does, and keep that somehow separate in focus from health information technology, because of the vast amounts of health data within the different components of HHS and the fast-moving way in which that’s being employed as technology moves on with AI. Is that fair way to put it?

Micky Tripathi  Yeah, I think so. Looking at what ONC has, you know, traditionally been doing over our 20 years, we were founded in 2004, it really was in the area, and continues to be. I mean, we’re not losing any of our core mission continues to be in the area of technology strategy and data strategy in the, you know, domain of health information technology. And that was true, you know, both in working with the sector. So, things that we do for data standards that are required to be supported by provider organizations and electronic health record systems, for example, certification of electronic health record systems, for example. And then also working with our federal agency partners to make sure that CMS Quality Measures, for example, are rooted in those same data standards, and CDC, public health reporting is based on those same data standards. So, we work, you know, both with the market and the sector and with our agency partners, but in health information technology. And what this represents is basically saying, well, we’ve already got that chassis built where we’ve got those deep collaborations with our agency partners. We’re very market facing. We work with the market and all of these areas. We ought to, you know, build on that chassis to say, well, maybe what as we thinking about technology strategy, more generally, not just in health IT. Let’s build on that chassis and start to add those things, because you’ve already got the capabilities, you know, combining technical, regulatory and policy expertise and experience here at at ASTP.

Tom Temin  We are speaking with Micky Tripathi. He is the assistant secretary for technology policy, a new title, at the Department of Health and Human Services. And if you look at the big, some of the big HHS components that are large repositories of data and AI application exploration, etc., in their own right, I’m thinking of CMS, NIH, the CDC and the FDA come to mind. But there’s others, too. But if you take those four, those are major planets of data in their own solar system, in some ways. What’s the relationship with them as they pursue whatever their missions are in using their data such that at the HHS level, there’s some cogency and assurance of standards?

Micky Tripathi  Yes, absolutely, they are major planets. And the department is, you know, kind of the big solar system or galaxy that you know that tries to, you know, sort of keep, have all of them have their individual mission focus, but keep them in the orbit, right? So, that’s the, you know, the ongoing, you know, kind of activities. So, really, the activities that we’ve been doing, ONC, from in health IT, have been working very directly and explicitly with our agency partners. So, we do a ton of work with CMS, CDC, FDA, NIH on advancing their uses of health information technology with respect to data, for example, with respect to leveraging things like TEFCA, which we talked about before nationwide network interoperability, fire APIs, which are modern Internet APIs. So, that’s work that we’ve already been doing. In a way, this is no different in terms of the types of relationship and the balancing of being able to help them with their individual mission focus and the innovative, you know, sort of, you know, flexibility that they need to be able to have, but the alignment at a department level with what all the other agencies are doing, and what we’re trying to accomplish with the, you know, as the department itself. So, yeah, all we’re really doing is saying that we ought to be thinking in that same way, as we think about AI, as we think about the strategic uses of data across, you know, across our agency partners, and in the innovative uses of other types of technologies, like identity management, things like that, as we, you know, as we move forward,

Tom Temin  And from a practical standpoint, reorganizations are easy to draw on graph paper, really hard to effect in terms of people’s hearts and minds. And I’m imagining some people have new reports. Managers have new people reporting to them. People might even be physically moving. How is this executed at the human level or at the personnel level?

Micky Tripathi  Yeah, I worked in federal government a long time ago, so in some ways, I’m coming at it fresh in my three years. And I will certainly say that doing a reorganization in a government agency is not for the timid or the faint of heart. It’s definitely a very engaged endeavor, you know, for good reasons, right? I mean, these are very important institutions, and we want to make sure that, you know, that we’ve got all the checks and balances that that are covering all of the bases and all of the, you know, different issues that could arise with that. So we did, you know, did a lot of work, you know, to and the Deputy Secretary’s office was instrumental in helping to lead this effort as we, you know, thought about the strategic need for what we need to be able to do, and how we need to be able to think about that and work with our agency partners, you know, in getting that accomplished. So there was a lot of work, you know, over the past 12 months, really, in setting the stage for this as a formal reorganization. But I will say that one of the things that I think really helped a lot was that we were already doing a whole bunch of these things. And I think that there was broad recognition across the department that we were already doing these things, and it was really much, much more ad hoc that, as we saw the need for these kinds of technology strategy things, you know, the secretary’s office, the Deputy Secretary’s Office and ONC were kind of rolling up our sleeves on an ad hoc basis, you know, putting together ad hoc teams to, you know, to scramble and meet the needs of the moment. And we were, you know, we were successful. We didn’t drop any balls. But that was when, you know, sort of the recognition was, we can’t keep doing this as an ad hoc activity. We need to, at this point, recognize this is, you know, this is the future, and so let’s dedicate those resources. So, there’s certainly a lot of work to make sure that the proper discussions we’re having had, you know, happening, that people weren’t surprised, that, you know, there was a good understanding of the motivation behind it. But as I said, a lot, you know, for many, many people, it was almost formalizing what we were already doing on the ground. So, that made it, you know, certainly a lot a lot easier as well.

Tom Temin  And just a final question, getting back to that galaxy of data question we were talking about a moment ago. Do you ever imagine that in all of that data that CMS, NIH, CDC, FDA, SAMHSA, there’s just so many, if it could somehow be aggregated, the answer to every question, medically and health wise, is already in there somewhere?

Micky Tripathi  That’s a really interesting question, you know. I think that we need to, you know, and the American people need to recognize that the federal government does not have a big, you know, even if you put all of those pots of data together, the federal government does not have and will never have, and does not want to have a big data of everyone’s identified medical record information, right? Full stop. That is not something that the federal government wants to do, nor do we believe that it would be in the in the public interest. That said, there is a lot of data that’s collected by federal agencies to serve their individual mission needs. If you think about adverse event reporting, for example, that FDA does, from a safety perspective, right, which I think we’d all agree that that’s really important for people to be reporting when they have adverse events to a vaccination or the medical device or with a drug, for example. So, that’s the kind of data that’s collected there. For public health reporting, for example, very little of the data that the CDC gets, if any, is actually identified at the patient level. It’s much more at the aggregate level for electronic case reporting. You know, how many of this kinds of diseases are we seeing in these kinds of jurisdictions, for example? And then the kind of information that NIH has, for example, from a research and discovery perspective, as we think about, you know, clinical trials information and information like that. All of that information has a lot of synergies across them. And so that’s the opportunity to be able to say, well, how do we match that data with, you know, across those organizations, to be able to get better perspective on it in a way that is privacy preserving, that uses modern approaches to say you don’t have to aggregate all that information in order to link it up, right? There are many ways of saying, we can link up data, but allow it to stay where it is in a privacy preserving way to the extent that there is, you know, private information in there. And then, of course, you know, CMS does have Medicare and Medicaid data, which is claims data for Medicaid and Medicaid members, and there are extra provisions and safeguards on the uses of that data, and, you know, protection of individual level information and that persists, right? None of that are things that we gloss over. Those are all things that we say we recognize those, but there’s still ways to make better use of that information, which will benefit the Medicaid, Medicare members as well.

Tom Temin  Yeah, I just like to know why my potassium is high so I could eat more bananas, but that’s one of the eternal mysteries of the universe.

Micky Tripathi  So, we should talk about TEFCA and fire APIs and all of the ways that you can access your own information from your provider organizations and from your health insurers.

Tom Temin  Well, that’s for another day. Micky Tripathi is the assistant secretary for technology policy at the Department of Health and Human Services. Thanks so much for joining me.

Micky Tripathi  Thank you, Tom. Really enjoyed it.

Tom Temin  We’ll post this interview along with a link to more information at federalnewsnetwork.com/federaldrive. Hear the Federal Drive on demand. Subscribe wherever you get your podcasts.

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