Gora Datta, FHL7-Digital Health Standards Pioneer: A Behind the Scenes Look at Standards and Skills

Van Ton-Quinlivan: Welcome to WorkforceRx with Futuro Health, where future focused leaders in education, workforce development and health care explore new innovations and approaches. I’m your host, Van Ton-Quinlivan, CEO of Futuro Health. The growth of digital healthcare has accelerated significantly, and with the dramatic adoption of telehealth and telemedicine, thanks to the pandemic, that trend is sure to continue. There’s also the promise of more healthcare moving to the home, afforded by current digitization trends, and the growing impact of AI and machine learning on the healthcare sector. Our guest today is perfectly positioned to help us sort through the current and future implications of these trends and challenges.

Gora Datta is an internationally acknowledged subject matter expert on digital health, health informatics standards, and cyber health. He has consulted for major organizations and governments, including the State of California, the government of India, various departments and agencies in the U.S. government, and the World Bank and Asian Development Bank. Thanks so much for joining us today, Gora.

Gora Datta: Thank you, Van. Thank you very much. It is indeed my pleasure and honor to be part of this conversation with you.

Van: Gora, delighted to have you. Maybe we can start with some fundamentals. Why do standards bodies exist and what is their role and purpose? I know you’re involved with many of them.

Gora: Yes, you’re absolutely right, and this is a fascinating question. I would love to address this. I’m involved in multiple standards bodies. They’re called standards development organizations. To name a few: ISO international standards organization, IEEE Standards Association — and I will explain what that is — and then in the digital health sector, HL7 is another standards body.

But to answer your question, why do standards exist? Why do we need standards or standard bodies? I’ll go back in history and give you a few examples to drive home the point. Go back a little over 100 years. We had a massive, giant fire in the city of Baltimore in the year 1904. As a response to the fire, we had firefighters coming in from Washington, DC, from New York, Pennsylvania, neighboring states and neighboring cities. They all converged to help. Unfortunately, almost all of them were standing on the side as the fire raged through the city. Why? Because their fire hoses were incompatible with the fire hydrants and the water source within the city.

We have had similar examples of incompatibility over history.  9/11 is another classic example of when first responders converged and soon we found out that there was incompatibility of radio communication between the fire departments, the Port Authority Police Department, the local police department, and so forth. All the various first responders were unable to talk to each other and that led to some of the further downstream effects of the impact of the two planes. That’s another way we saw incompatibility, and therefore, the need to standardize. You get the trend.

I’ll give you three more quick examples, which are much closer to home. In the financial sector, if you go back before twenty years ago, those of us who traveled around the globe had to get local currency. Today, we whip out our ATM card, put it in an ATM and get the money in local currency. That wasn’t possible twenty years ago. Standards in the financial sector helped pave the way.

Two more quick ones. In the technology sector: laptops, toasters, cars, the list goes on. We couldn’t connect your laptop to somewhere else when you went to a different place, a different city or different country. Today we have Wi-Fi. What’s that? That’s an IEEE standard. And cell phones, the same thing. If you go to any country, your cell phone works. You’re off to your favorite social media.

I’ll give you one more example. In fact, I will ask you here: Go back 200 years to the early 1800s. There was one event which really changed world commerce, where countries came together. Before that everybody was on their own. What really enabled that? The answer is the railroad and the rail tracks. When a railway track from one country came to the border, it was quickly found out that the other countries’ railway tracks were of a different standard. It goes back hundreds of years.

Anyway, it shows that the need for standards is to enable commerce. It is to standardize the way we work, the way we play, the way we do our activities. Standards bodies are created to help bring together diverse experts, and most of these standards bodies are volunteer-driven organizations.

Van: Well, I certainly have a newfound appreciation for standards with those examples — from ATMs to laptops to toasters and railroad tracks! I think we can all relate to not having to worry whether or not they all work together as we travel. Gora, you mentioned HL7, which is a standard-setting body for technology in healthcare. What led to the formation of that body, and what do you hope to get done there?

Gora: Similar challenges to the examples I gave. In the healthcare sector over twenty-five, thirty years ago, hospitals and other entities started using computing and realized that you don’t just have one system. You have a need, a desire to connect your system with another system. Let’s say your patient comes up to the hospital and there you’re part of the health system within the hospital. But then you want to send the patient for a lab test, you want to prescribe some medication for them, you may want to send them for imaging — these are separate systems within the hospital. How do you interconnect? That’s why HL7 was formed over twenty-five years ago, with that initial goal of solving the problem within a hospital system. But soon, that expanded to inter-hospital in turn, and not only between the hospitals, but with other provider communities, other environments, with your local government.

For example, in COVID, we saw the need, as a public, to exchange our vaccine information. How do we enable that? The recent expansion is really about patient engagement. That is, how do you and I share patients when they come into the health system? How do we exchange our information? I’m sure you don’t appreciate every time you go to a doctor filling out reams of papers with the same set of information. Why can’t I have that available? What is the standard for that? That’s HL7.

I also mentioned a couple of other standards bodies. I want to quickly talk about ISO — the International Standards Organization. This is a global, non-governmental independent standards body comprised of 160 member countries. If you want to be a member of ISO, you and I cannot be a member, it’s only the countries who are members. And you and I, any individual, becomes a member of that country’s delegation. I’m part of the US delegation to ISO in the health space. They are divided into different technical committees. My area of expertise is digital health. TC 215 is health informatics within the ISO space. There are other technical committees…hundreds. Then the other one I mentioned is the IEEE Standards Association. This is the world’s largest, and one of the oldest professional organization standards bodies, and I also am involved in that organization quite a bit.

Van:  Thank you, Gora, for representing the country. This does not sound like easy work at all, with so many stakeholders around the table. Thank you for what you do. There’s a major trend in healthcare where more complex care is being delivered in the home. What do you see around the corner with regards to the hospital and the home, or the intersection of mobility and care?

Gora: This is a question you wouldn’t have asked me two years before. It’s because of COVID. Suddenly, there’s a recognition that we need to take care of our patients at their home, where they are. I always remind people, unlike with other verticals — whether you’re talking about your logistics sector, your financial sector, commerce, you know, doesn’t matter — healthcare is over 1,000 years old. We have been taking care of patients as long as one remembers.

In modern times the way healthcare is delivered, you and I, as patients, we go to the hospital, we go to a provider, we go somewhere to take care of our health. Whereas when we are at home, we see the illness is still with us but who is taking care of us at home and what kind of environment can be provided for our care while we are at home? That’s the trend. COVID really put the spotlight on it saying you cannot travel, you cannot go anywhere, stay at home. But your disease never stopped. Your health challenges never went away. We still have to provide.

Two years ago, people said, “No, it’s not possible, you have to come to the care provider.” Whereas now, we expect the reverse. In fact, I’m expecting a major transformation in the healthcare industry. It is already on its way where, instead of the care receiver going to the care provider, it’s going to flip on its head where the care provider will come to the care receiver.

Van: Let’s go ahead and just jump right into that topic. I’m so curious. When would the provider come to the patient and what are companies that are at the leading edge of doing so?

Gora: I will give two or three examples, and you will immediately see where I’m going with that. Think what happened to the hospitality industry with Airbnb. Who was in control, you know? The traditional hospitality industry with the hotels and other sectors. You went there. Whereas with Airbnb and other such services coming into play, there was a complete turnaround on its head, where the consumer was in control in terms of where they wanted to go, what kind of flexibility they have.

Same thing we have seen in the Uber and transportation sector. Initially, if you wanted to get a taxi you had to go to a taxi stand, but now the taxi comes to you. You get what I’m saying with the “uberization” of the world we live in. COVID has shone the spotlight on our delivery of food and various services like Amazon’s, which are completely transforming how we deliver goods and services.

Same thing in healthcare, and what I’m proposing in healthcare was there 200 years ago. Think about it…it was a doctor who came home with his doctor’s bag. He paid home visits. What I’m really expanding on is the fact that in future, it will be the provider coming. It doesn’t have to always be a person. It can be a robot or a drone delivering medicine to you. Today, when you have to pick up medicine, you have to go to the pharmacy. Well, pharmacies have started home delivery, but the home delivery may take time. But what about drone delivery of the meds to your doorstep? Well, pizza delivery is happening, why not the medication? So, this is what I’m talking about with the transformation disruption which is going on in the healthcare sector.

Van: I’ve heard of concepts like the concierge doctor where, if you are part of that service, the doctor comes to you but he or she has a more limited number of patients, so you have to sort of pay a premium for that. But you’re talking about much more than that in this trend, right?

Gora: Much more, yes, absolutely. I’m not just talking about a physical person coming to you. It can be a driverless car or a vehicle coming in with a robot with sensors and other aspects which can take all your measurements, take all your vitals, and other things which the provider needs to have. I’m talking about introduction of AI virtual realities. You wear your headset, and there are sensors embedded in it which take your vitals and take your other information, sends it across the globe maybe where the doctor is. The point I’m making is not that doctors are getting redundant, but they are going up in the kind of services they provide, the value of services. The mundane activities can now be done by technology, and especially the emerging technologies which have come in the last ten to twenty years.

Van: We always ask ourselves the question on the workforce side: As these innovations come about, how will workflows and skillsets change as a result of care being more provisioned in the home, whether it’s through persons, robots or drones?

Gora:  We are already seeing that because of the advances in what I call emerging tech. It’s not one technology. There’s a bunch — fifteen or twenty within that basket.  AI, ML, drones, 3D printing, just to name a few quickly. These have already been marching on in other sectors of life, and in healthcare, they are now coming on number one. The second is we are already seeing the gap which this has created. On one hand, we have a tremendous demand for skilled workforce, and at the same time — you are aware of this very well –we have a lot of openings in the workforce.

This is not unique to healthcare. It’s across all verticals, all industries. What’s the figure…10 million jobs nationwide, and 7.7 million folks looking for jobs, and either side is not able to find the other side. Why? It is the skills gap which exists because we don’t have a workforce that is either newly skilled, upskilled side-skilled…whichever way you want to look at it. We have never retrained, and that’s the challenge we have today. How do we enable that?

Van: Gora, if I wanted personally to be better positioned for this trend of healthcare moving into the home, what advice would you have for me…or more aptly, my children or my nieces and nephews, for example?

Gora: There are a couple of things to it, right? One is that the current generation and the future generation are much more tech-enabled and wired than many of us who I lovingly refer to as the “gray hair” or the “no hair” folks. For example, you can take a two-year-old kid anywhere in the world — irrespective of the color of the skin, irrespective of the language they speak — and there’s one thing in common. The two-year-old child can barely speak his or her mother tongue, but at the same time, the child knows how to play with dad and mom’s cell phone. The other common thing is, every dad and mom is trying their best to stop that, and they fail spectacularly! The kid knows.

Technology has wired the current and future generations, whereas some of us are sort of playing catch up. We have two different challenges coming in. The new generation has certain expectations, whereas our current laws and regulations still need to catch up on that. And we have some gaps there. Healthcare is a classic example. In the U.S., the primary law which governs some of the flow of information and access of information is HIPAA. As I lovingly say, HIPAA is a state-of-the-art 1996 law still governing access in 2021.

Van: That must be quite a challenge for standard-setting bodies to play catch up with all these regulations…

Gora: Right. On one hand, they’re trying to do that. On the other hand, in the past the standards bodies would sort of wait for technology to mature, for the system to mature, before the standards would set in. Now they are much more agile and nimble, and they’re moving ahead. Within the healthcare sector we have emerging standards which are much more far-reaching, and not waiting for the technology to mature. Interestingly, even the governments around the globe, including the U.S., have caught on to that. We now have in regulations and in the law mentions of standards which are still not, let’s say, baked 100% ready to eat. They’re what we call “standards for trial use” versus when standards become completely baked, which is what we call “normative standards.”

In the past, the governments would only accept normative standards in regulation. But now they are also accepting and proposing standards of trial use, so that you don’t have to wait for the standards to mature. You don’t have to wait for technology to mature. You’re able to streamline and bring in the solution right from early on.

Van: What you mentioned sounds very similar to the world of higher education, where the curricular process has tended to want to take a while to wait for the curriculum to mature. But the cycle time of technology is so fast that if you wait, the curriculum is actually obsolete, especially for career programs. Which brings me to this point: it’s really tough for workers to keep up with the pace of change with technology evolving so quickly. Could standard-setting bodies establish skill standards so that higher education could actually peg their curricula even to these trial use standards before they become normative?

Gora: Absolutely. In fact, that is already happening with some of the standards bodies I mentioned where we are specifically looking at standardizing workforce skill sets, whether that’s HL7, or whether it is ISO. For example, I’m part of a group within the ISO TC 215 which is looking at public health emergency response and preparedness. COVID, just to remind everybody again, was an emergency we had two years ago and we are still dealing with it. How do we standardize? Part of that work is actually one chapter on workforce skills required, and there are other works which have already taken place.  But your point is very well taken. This is an area which needs to evolve and grow.

Van: Gora, what about the use of data? When you talk about providers going to the home, I can see the skill set for clinicians will continue to be relevant. I can see the persons who fix the robots and the drones. I can imagine that. What do you see as future uses of data, and what kind of careers can a data-oriented person have in the future of care?

Gora: The way the world is moving ahead, the key focus is in this whole area of an emerging area of data science called data usage. The data usage can be the primary use of the data for whichever sector you’re in, the secondary use of the data, and what we call the tertiary use of the data as well. We have different uses of the data…a primary purpose, or a secondary related purpose or a completely different purpose. Research is one example, where it is totally different than what the primary use may have been. But you need that data to do the research, to do some postulation, to do some modeling. This is becoming one of the key areas where data science is evolving very rapidly all over, not only in the health sector.

Van: So, it sounds like data science careers are growing.

Gora: Absolutely. It is a well-known fact in the industry that if you do a salary survey right now, data sciences is one which is growing very rapidly. There’s another area which is growing very rapidly that we haven’t touched upon — I want to plant the seed for you right now — which is the whole impact of cybersecurity in the digitally-connected world we live in. The bad guys, they are not going away. They are here and they are trying to make their best use of how to reach out to vulnerable citizens or organizations and create havoc.

Van: Alright, so careers in data science, careers in cybersecurity…these are all growing. You also have a background in the public health sector and how it uses data. I wonder, how has that transitioned from the past?

Gora: In a couple of ways. The public health sector within the larger healthcare sector has always been looked at as a separate area because the approach was, “Look, on personal health, I’m taking care of individuals.” I’m a patient, you’re a patient. How do we take care of that person? Whereas public health or population health is looking at a much larger macro level…the stepping back to the entire population whether it’s a city or a country or a particular jurisdiction, and the public health geared towards that. That’s a different perspective, and people thought maybe we need a different set of eyes, a different set of rules. But what we are recognizing — again, if you use COVID as an example — your individual health leads to public health, and your public health decision often leads to individual health. We are seeing the convergence.

There is another area which was also kept separately. It is separate even today within our laws and regulations. It is mental health and behavioral health. The way the laws were created over the last 150 years, mental health in the U.S. is completely an isolated, separate area. If you’re a patient with a mental health condition and you go to a mental health specialist to take care of your health challenges, and then if you go to your primary care physician to take care of other health challenges you can, by law, not have your mental health information be made available to the primary care physician. It is very fascinating how the laws have evolved. But as a patient, I’m having all these challenges. How do I get my health taken care of in a unified manner?

Van: I can see that in this future world, all of us will want to have ownership over our data and give permissions to those that we want to have a holistic picture.

Gora: Absolutely, and what has enabled this is this whole emergence of mobile technology. Before that, we had data in silos and there was a disconnect. There was no way to reach out and interconnect. Mobile technology is changing that completely for us. As a society, as a world, our expectation has changed overnight. We want that information now, no matter what that information is, and we don’t want to wait for it. What do we do first thing in the morning before our eyes open, we reach out for the cell phone?

Van: Guilty. (laughs)

Gora: The point is, this is where we are moving fairly rapidly, where our expectations have changed over the years, and mobile technology is one of the enablers. And therefore, yes, we want our data, plus we want to be in control of our data. How do we manage that? We are rapidly moving towards it.

Van: You’ve been doing quite a bit of work leading a federal grant with a set of partners and Futuro Health — just for full disclosure — is a part of that effort, where you are developing culturally-relevant public health IT workers and doing it through a health equity lens. You know, Gora, you are able to bring in not only Futuro Health, but the UC system, the Cal State system, the community college system, and many other employers and provider partners to tackle this shortage. Tell us more about this consortium and the effort that you are leading?

Gora: Thank you, Van, and I’m really glad that you’re part of the consortium. This was a fascinating journey we all began about a few months ago. In fact, this particular opportunity didn’t exist before June of this year. It was a grant opportunity which came around where the federal government was looking at how can we strengthen the nation’s public health informatics space and have a skilled workforce available, specifically from the minority population? But at the same time, can we not just create a skilled workforce but also fundamentally change the course curriculum of what is being taught in this particular space of public health informatics? Change the curriculum, recruit and train the students and the working professionals, and then place them on the job pathway.

This is the work opportunity which came around. The team we put together is a perfect example of what I call a public-private partnership where industry, academia, and government came together. Our consortium has members from each one of these sectors, plus the trade unions, the service union associations as well. We all have come together to solve the common problem, which is to change the curriculum across the state of California so that it applies uniformly. Let us make sure we are teaching not only our future students, but we are also teaching and upskilling our current workforce in these new emerging areas. At the same time, we are also bringing a minority population into the mainstream to make sure that when such challenges come in the future, we are much more prepared than we were in the past.

Van: Gora, in the field of health informatics, I wonder if you can give some examples of what that means, or what’s in that box of health informatics?

Gora: Sure. Health informatics and public health informatics are two overlapping, intersecting circles. When we talk about traditional health informatics, we’re talking about individual health. As I was mentioning earlier on…me as a patient or somebody else as a provider dealing with the patient. But public health informatics is looking at a much more macro population level. But again, some of the fundamentals are still the same from a technology perspective. What we are working on with this particular grant we just spoke about, is we are looking into defining the public health informatics and technology requirements so that we can train our workforce appropriately.

I’ll give one example to illustrate that point. As COVID was spreading, we’ve had to get ourselves tested to see whether you have a disease, right? Where do you go for the test? What kind of tests do we need to take? How do we get that information? Not only us — as an individual who’s getting tested — but how does the government at the city level, state level, or national level get that information very quickly? Because of mobile technology and the digital world we live in, we wanted that information. We want to know how many cases. That’s one example of where health informatics plays a big role, and making sure that information goes up the chain very quickly.

Think of it. You go to the lab today to get tested for something, right? Doesn’t have to be COVID. Can be anything. You want to make sure that information reaches not only your city level, it goes to the county level, the state level and then, finally, at the federal level. All these take time. But we want that information now. Can we do that? That’s where technology comes in, that’s where standardization comes in, and that’s where the informatics role comes in. It’s not only on the testing side. This entire flow of information back and forth, up and down, needs to be standardized, needs to be defined in such a way that we have a seamless flow of information. That’s where the role of informatics and standards come into play.

Van: So, if I were encouraging family members to think about careers, certainly it sounds like everything that has to do with data, and the data infrastructure would be growing in terms of needs in the future?

Gora: Absolutely. In fact, if we just do a quick search in California — which is where we both are based — the number one job is actually not, contrary to popular belief, in the logistics sector because of the supply chain challenges we are having. That is number two. Number one is in the healthcare sector, and it’s all across.

Van: What a good call to action, Gora. Let me close by asking you, I know that in some other countries, their mobile infrastructure is actually better than the infrastructure in the U.S. Are there any approaches to public health overseas or health informatics overseas that you think the U.S. can learn from?

Gora: Absolutely, and the U.S. is also working in close collaboration with many other countries, not only at the ISO international standards organizational level, but also direct collaboration. But in short, yes, there are other countries who have moved ahead. In fact, the U.S. really started this paper-to-digital transformation in the health sector, I would say, only in 2010 or so. Earlier than 2010, the only penetration — and I’m generalizing here — but the only penetration in the healthcare sector was on the accounting and the billing side. But on the clinical care side, we were completely paper-based. Remember the clipboards? When we went to the doctor’s office, the doctor entered the room with a clipboard and a paper. Well, you see less of that. Now they have a laptop, they have some kind of computer available to them while they see the patient.

So, this transformation from paper to digital started in 2010. But other countries have been at it longer than us, so there are lessons to learn. Two quick examples: There’s a very fascinating project going on in the European Union right now called Mobile Health Hub, which is looking into the deployment of mobile technology in the health sector across the 27 member countries. It is looking at unified access standardized across the member countries. Later tonight, I’m in fact speaking at a health forum in South Korea where the government is very interested in hearing about what are the challenges and opportunities in the mobile health app space…the world we are so moving into. Have an app? Yep, we have an app on the phone. There are a lot of examples of these.Van: Well, it sounds like we can expect clinical care to transform greatly, and hence the skill sets of those workforces as well. Anyone and everyone should be encouraging their loved ones to play with technology and mobile devices and learn data skills because they all seem very relevant in this this world that you’re describing.

Well, Gora, I learned a great deal from you today doing this interview. I am so appreciative that you were able to join us on this podcast. Thank you for spending time with us today.

Gora: Thank you very much, Van. It has been absolutely a pleasure and I enjoyed the conversation. I’d love to come back to you and have further conversations. This was fantastic. Thank you very much for having me.

Van: Thank you. I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you will join us again as we continue to explore how to create a future-focused workforce in America.