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An End User's Perspective: How IDEA LAB is Changing Public Service at HHS

When IDEA Lab launched in 2013, it immediately served as an opportunity to advance meaningful change in a unique way.

Lee Stevens, Rachel Abbey and Kevin Horahan were selected for the first round of the HHS Ventures Fund for their Project - EMS to HIE Innovation.

Historically, as many of us in federal service know, getting innovative and proactive ideas for improvement noticed is challenging. Large-scale imperatives for the federal government take precedence to keep the country and its programs running efficiently. But that should not come at the expense of good ideas. The U.S. Department of Health and Human Services (HHS) IDEA Lab is the first, successful effort to give federal employees at HHS who want to make a difference an opportunity to do just that - with expert support.

It is often recognized across federal programs that coordination could be better, more effective and more valuable for the American taxpayer. However, gaining traction to actually coordinate has been a challenge and actually implementing long-term change has been nearly impossible. When IDEA Lab launched in 2013, it immediately served as an opportunity to advance meaningful change in a unique way.

In government we often see opportunities to use the "public good" to bring disparate stakeholders together, not just externally but even within HHS. IDEA Lab recently gave a team of us at the Office of the National Coordinator for Health Information Technology (ONC) and the Office of the Assistant Secretary for Preparedness and Response (ASPR) an opportunity to do that and to have our leadership engage directly.

Despite the best efforts of health systems and first responders during major disasters, it has been difficult to effectively contend with some of the extraordinary circumstances we have faced in the past two decades. Whether Hurricane Katrina's bullseye hit on a city below sea level or the unimaginable disaster on 9/11, we have learned that expecting the unexpected must be a part of planning. Considering the location and surrounding geography of population centers in California, a sizeable earthquake could prove devastating.

Recognizing that health information technology (health IT) typically gains attention following disasters, it was easy to see how a new effort that would link regional Health Information Exchange (HIE) entities together with new technologies could be palatable in a very complex environment. An HIE typically serves as an aggregator and broker of patient health information across disparate networks, frequently offering providers the ability to query patient health information. An at-risk state like California, with more than 40 HIEs, strong Emergency Medical Services (EMS) and health IT leadership was the perfect place to leverage existing health IT resources to prepare for a major catastrophic event. With recent reports citing over a 90% chance that California would suffer a sizeable earthquake in the next fifteen years, we needed to start work immediately. Unfortunately, we had limited resources to move forward and our ability to firmly partner across agencies was limited by busy schedules and other priorities. While our idea, at least conceptually, was agreed upon between a small group, there was no vehicle to drive us forward formally in an organized and recognized manner.

The IDEA Lab's Ventures Fund provided ONC and ASPR a platform and seed funding to think creatively about the ways we could "expect the unexpected" in California - and be prepared.We had little idea at the outset how much this opportunity would bring two agencies together as colleagues and friends, and lead to a larger concept that could one day improve nationwide health data exchange during disasters and offer day to day use to support EMS providers.

Through the formal application process, we were required to engage leadership in both ONC and ASPR. The visibility this created for our work, through recognition among leadership, was a game changer. The monthly reporting to IDEA Lab and the Chief Technology Officer (CTO) of HHS, made this effort a priority across both agencies. IDEA Lab allowed us to tap high-level expertise in a way that hasn't happened before. In fact, in our experience, it is the first cross-agency collaboration with equal buy in and input from both staff and leadership. That dynamic alone established a different type of coordination between ONC and ASPR like, we are "all hands on deck" to make a difference in an innovative way.

Our resulting IDEA Lab project, the California Patient Unified Lookup System for Emergencies (PULSE), allowed us to engage expert technical resources outside HHS. PULSE also provided the opportunity to engage state leadership in a way that helped craft the project to best meet the needs of Californians, while still being scalable across other states. Having the HHS CTO travel to Los Angeles for a meeting of state leadership and stakeholders, further underscored the commitment to this effort.

In the future, the PULSE project can serve as an interoperability broker across all participating HIEs in California. This means HIEs will have the ability to find and retrieve data on patients during disasters that may be outside their local medical services area. As we learned in Hurricane Katrina, patients frequently move great distances away from disaster areas but still need access to their medical histories. PULSE will also support the integration of EMS data into HIE platforms, a valuable service now only supported by one regional HIE, San Diego Health Connect.

While there is much work ahead to complete the effort, as of today we have more than 25 California stakeholder organizations signed on and committed to driving PULSE forward. Achieving this in one year would have been impossible had it not been for IDEA Lab. A simple idea by a group of career federal employees has now become a large-scale project recognized by the Department and agency leadership. The value of the IDEA Lab opportunity surpasses the most well-intentioned ingenuity that federal employees have the ability to raise in a very large and busy Department. For this reason alone, IDEA Lab fills a unique need and service to HHS that long went unrecognized.

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