What advice would you offer India’s National Health Authority that is implementing the Ayushman Bharat Digital Mission, which aims to create a seamless online platform that will enable interoperability within the digital healthcare ecosystem?

Shulkin: It is not easy to move in this direction or at least to be successful. First, you have to upfront have very precise standard data definitions, that as you’re bringing sources of data from disparate places, the biggest issue is how does that data come together. You need to be very clear on what that data definition is otherwise, you have an interoperable ‘pile of garbage’ – it’s meaningless.

The second part of that is that when you create a standard data set, it needs to be made available in the public domain. It cannot be a hidden, government secret. You need to put it out there and be fully transparent about what it is.

The third thing is you need some standards on interfaces, and this has been challenging. The Department of Veterans Affairs chose a specific interface called FIHR. I’m not advocating for that but doing an analysis of what interface will be most effective in your local environment, and then selecting that so that industry knows and understands what needs to happen is an important step forward.

The fourth thing is you have to properly, through government intervention, prevent what’s called information blocking. In the US, the electronic health record companies and even health systems themselves have actually worked against releasing this data to the patient. So preventing information blocking is an important part of having a fully functional, interoperable national health system.

Finally, the principle that I think is most important is that this data must belong to the patient. It doesn’t belong to the health system or the pharmaceutical company.

When you are talking about the patient’s data, they have full access to it and can move their data with them, get access to it. At the Department of Veterans Affairs, more than 10 years ago, we launched an initiative called the ‘Blue Button’ which did exactly that. It gave the veteran the right to be able to download their data onto a USB drive and take it with them wherever they want and so they owned them. Still most people in the US do not have that ability. Everybody, every citizen deserves to have that ability.

US Price Control, Outcomes-Based Contracting: Reflections Of Former VA Secretary Shulkin

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