This interview with Dr. Helga Rippen, Chief Interoperability and Veteran Access Officer at the Department of Veterans Affairs, shares VA’s new definition of interoperability, the three pillars supporting its efforts, the next 12 to 18 months of the journey, and the interoperability principle few are talking about.
A New Definition of Interoperability
Interoperability has to be considered a team sport. From VA’s perspective, that team is the VA Interoperability Leadership Team (VAIL). Our goal is to facilitate interoperability across the VA to meet our mission of providing a seamless Veteran Experience. The VAIL establishes an ecosystem of partnerships, with senior leadership representation from across all ten VA organizations and VAIL members, and is open to anyone within the VA. These individuals come together as communities working to develop and implement an interoperability roadmap, identifying best practices and applying that knowledge to solving challenges.
In order to meet our goal in serving our Veterans, we’ve actually stepped back and taken a different view of interoperability. The traditional definition of interoperability is the meaningful exchange of information between two systems. The VAIL expands on this because it is also about the end-user experience. Interoperability, in our view, is about a confluence of conditions across business, data and systems that allow us to provide the right services and information at the right time, reliably and securely, to the right person in the right way so that they can make an informed decision and act on it.
Healthcare is one component, but then there are benefits, which include jobs, education, housing, loans, and the final resting place. It also include all of the support to maintain an operation like the VA, including human resources, management, logistics, acquisitions, and information technology. From our view, interoperability should support all of what VA does in order for it to be most effective.
Three Pillars of Interoperability
As with any structure, interoperability needs a solid foundation that starts with a definition, so everyone is in agreement about what we are talking about, what it all means.
Interoperability has three pillars at VA: The business pillar that has a lot of different elements such as usability, workflow, performance, even risk mitigation; the data component that includes quality and syntactic variation; and the systems and technology, which includes interfaces and architecture. We have definitions for each of the elements and a way to measure the maturity of each.
Our focus is not on identifying the next shiny object but on the end-user, so our interoperability maturity assessments focus on business use cases that touch on the Veterans’ moments that matter.
The three pillars are supported by foundational elements: interoperability principles, enterprise standards and guides; the 3Cs – compliance, conformance, and certification; and interoperability maturity assessments.
Embedded in the interoperability principles are the ethical principles for access and use of Veteran data. These principles allow us to all move in the right direction. We have enterprise standards and guides. For example, when we talk about workflow, what does that mean? What’s the best practice? What interface standards should be used? We need to understand the components we have and where they reside, so we are not constantly reinventing these.
The 3Cs as noted are compliance, conformance, and certification for the VA governance. Who’s making the decisions about directives? How are we making sure programs are accountable?
The last component of the foundation is the interoperability maturity assessment. With these measures, we are able to understand the interoperability posture of business use cases – providing us a baseline and a direction to improve.
Starting slow, defining, being able to measure something, and then identifying where there might be opportunities to build out is all part of a long-term journey based on evidence and on measures.
Business Use Cases
There is no VA-wide single score for success in interoperability because there are so many programs and systems and factors to consider. Focusing on business cases helps us identify our end users and by leveraging the Veterans’ moments that matter, offers a way to touch the major services the VA provides to Veterans. Interoperability is about more than technology. If we focus on what interoperability is supposed to do, we shift the conversation to the business, to how people experience something, what they allow or don’t. It’s about ensuring the data and its quality, ensuring we can use the data and that the systems in place support it.
Some of those business cases include biomedical images and reporting, which we know are not mature. Using HIEs and third-party sources, we will look to identify where we need to go over the next four to five years. The business cases include benefits adjudication where significant changes are being made in processes and systems to improve service to Veterans.
Recognizing that responsibility is important, we are developing self-assessment tools that can be shared with others to support their program’s journey. We expect to find out at the end of this calendar year how well people have been doing along the roadmap, looking at outcomes from a business perspective.
We view a lack of interoperability as a drag to the system. Our goal is to remove the drag so business processes can be more efficient. Ultimately, it’s the business doing the work; we’re just trying to pave the way for them to be successful.
The next 18 months are going to be critical. We’re going to be adding several more business use cases and will have touched all of the Veterans’ moments that matter, giving us a high-level snapshot of the interoperability posture of the VA. Using those results, we’ll do an assessment to find the enterprise opportunities with common impacts so we can focus there.
We’re driving towards more common standards and guides, efforts that will lift everyone, increase maturity across the board to improve the baseline which will support improvement across the enterprise.
Interoperability is partially about figuring out who really owns something and enabling them to own it in a better way. That is all part of the way forward.
Principles – including Composability
The eight interoperability principles are: missiondriven, ethically grounded, human-centered, trustworthy, transparent and collaborative, standards based, a culture of learning, and innovation and composable.
Interoperability is about building up foundations, measuring success, and a journey of continuous improvement. We want to ensure whatever processes we have in place support new programs, future changes and that means embedding best practices in ways that make sense, that are focused on doing the right thing. This isn’t about setting directives or creating documents, it is about ensuring we give people across the organization the tools – and that means from the development side, the data side and the business side – to succeed. It also isn’t about finding something new but changing and building out what we have when we can.
Composability is a key principle we don’t talk about enough. Composability allows us to move faster and more effectively because interoperability is written in, so it isn’t an after-thought, doesn’t even need to be thought about because it is part of the process.
Among the ethical principles for access and use of Veteran data there is one principle that is innovative, and little talked about, and that is the concept of reciprocity. Reciprocity elevates the responsibilities that we all have, that obligation we have, based on the benefits we receive, to give back to Veteran communities.
Innovation as the Competitive Factor
Industry can help by taking to heart the interoperability principles; to factor in composability; to focus on the exchange of information and the importance of a good interface. Industry is a partner in this, and if we can all move in the same direction, there are amazing opportunities ahead.
The competitive factor for industry is innovation, integrating what we have to support forward motion. We can expect this to be built into future solicitations, that view of how we do the right thing.
Infrastructure is critical, and it is hard. We look forward to continuing to move forward, to improve what we do and how we do it, and then sharing what we find so others can benefit.
About Dr. Helga E. Rippen
Dr. Helga E. Rippen joined the Office of Information and Technology for Veterans Affairs (VA) as the Deputy Director for the Interagency Program Office (IPO) in January 2018. With her experience in population and preventative medicine, analytics, health informatics, and policy, Dr. Rippen strives to improve peoples’ lives. She has worked with many types of audiences, such as lay-people, C-suite members of Fortune 100 organizations, and senior leaders of the Federal Government. These interactions have given her insight into the various drivers impacting health and health care delivery organizations. Dr. Rippen will use this knowledge at VA to help the Department fulfill its mission and embody its core values. She looks forward to supporting the needs of the soldier, the Veteran, and their families by working to ensure that their health information is available to clinicians to provide quality care whether they are seen at a DOD, VA or civilian Healthcare system.