We had a delightful conversation with the eloquent and experienced Interop Hero Didi Davis, VP of Informatics, Conformance and Interoperability at The Sequoia Project. She shared all the amazing work her team and affiliates are doing to identify the specific, timely needs of interoperability, as well as educate a wide range of industry stakeholders on exciting innovations.

With more than 30 years under her belt, Didi has worn a ton of different hats, and supported a handful of companies and programs. These three decades have included time at a university hospital, 16 years with multiple vendors, and a partnership with Healthcare Information and Management Systems Society (HIMSS) — where she launched the first Interoperability Showcases in the U.S., Europe and Asia.

Didi wrapped up her time at HIMSS in 2009 and launched her own company, Serendipity Health, LLC. There, she filled lots of executive roles, including CEO. She also held the position of interim CEO for CareSpark, one of the first healthcare information exchanges in the U.S.

Additionally, Didi acted as chief technology officer (CTO) for the state of Tennessee, where she worked with five regional and state health information exchange organizations, among others.

One of Didi’s contracts was The Sequoia Project, so she started there as a contractor in 2013. Today, she’s thrilled to be the staff lead for the Data Usability Workgroup and industry stakeholders to help improve the quality and usability of data exchange.

In her role, Didi leads six testing programs for The Sequoia Project in partnership with organizations like the Radiological Society of North America (RSNA) and similar players.

Moving on, we learn a little more about The Sequoia Project and its mission. As a trusted, nonprofit advocate for nationwide health information exchange, its goal is to advance interoperability for the public good. Didi and her team work with the public and private sectors, as well as government stakeholders, to address health IT interoperability.

The company was established in 2012 as a home for the Nationwide Health Information Network. In 2014, they launched Carequality and worked with eHealth Exchange to put together a policy and technical framework to allow multiple networks to talk to each other.

Then, in 2018, the company went through a re-structure that resulted in eHealth Exchange and Carequality each becoming its own operating entities with its own governance and board of directors.

In that same year, the company re-branded itself as The Sequoia Project as a way to re-launch itself as the home for the Interoperability Matters forum, as well as other initiatives. And most recently in 2019, the Office of the National Coordinator for Health Information Technology (ONC) awarded The Sequoia Project a Cooperative Agreement as the Recognized Coordinating Entity (RCE) for the Trusted Exchange Framework and Common Agreement (TEFCA) to Support Advancing Nationwide Interoperability of Electronic Health Information. As part of that work, Didi and her team are putting together workgroups and feedback loops to help inform ONC and make TEFCA successful.

At DirectTrustTM, we love to see the collaboration among the community within health IT. After all, we’re supporting one another in the pursuit of advancing interoperability. We wanted to hear from Didi how she’s seen the same kind of collaboration show up in the work she’s part of.

As someone whose always felt a “kindred spirit to all the standards geeks out there,” Didi says she’s found many friends among her colleagues over the years. She’s amazed by the level of collaboration across the industry to help create a standards exchange space to form, what she calls, building blocks that pull together interoperability all over the world. Didi attributes the many standards she’s seen deployed as a direct result of all the collaboration in the last 20 years.

Most recently, she’s witnessed a community form around HL7® Fast Healthcare Interoperability Resources (FHIR) and explains how that’s brought a wider group of stakeholders together to innovate and modernize workflows in that space.

“I’m starting to see…the industry taking lessons learned from what we already have in place [and] figuring [out] ways to innovate and add on to those workflows to hopefully spur improvements and innovation as we move forward to…make it so we can engage the patients more. I’m seeing much more patient engagement.”

The HIMSS Interoperability Showcase Didi mentioned at the beginning of our conversation has been an industry mainstay, so we wanted to learn more about how she’s seen interoperability progress as it relates to that event. She summarizes beautifully the three major areas of advancements she’s observed: 360Xand push messaging, data quality, and imaging.

The first showcase premiered back in 2004 when Didi was a volunteer for HIMSS, and the event connected less than 20 organizations. Back then, the showcase focused on the vision for interoperability — nothing was tangible or put into practice at that time. Today, she’s proud of what it’s become. Didi describes the showcase as one of the largest draws for HIMSS. And, what they demonstrate at the showcase now is what’s actually happening today.

“I’m happy to see the collaboration of [ONC’s] 360X project, which DirectTrust helped launch…I know HL7® is helping lead some of the work, but I’m actually seeing the 360X standards baked into vendor workflows that leverage DirectTrust [and other standards] to support those push transactions.”

Didi goes on to say she’s seeing real innovation showing how Direct Secure Messaging can be used to transport any type of payload, including FHIR information.

“The scenarios that 360X covers are very near and dear, with referral management, acute care setting transfers to skilled nursing facilities [and] those kinds of things. So [it’s] really taking that discrete data, putting it in the right place at the right time for the right decision to be made by those clinicians…If I’m discharged from an organization, or if I’m needing to be referred to somebody, [clinicians] have that information to know what they need to do to take the best care of me.”

Another significant improvement Didi has seen is the quality of data being exchanged. For the last three years, she’s worked with the eHealth Exchange network to conduct a content testing program. As a result of that work, eHealth Exchange put a 2018 rule in place that network participants and eHealth Exchange vendors must pass content against Meaningful Use and meet specific content requirements. After all, the network is only as good as the data on it. Three years ago, nobody passed this test — and now she says 98% of organizations are passing as of end of year 2021.

And finally, Didi is especially excited to see the start of interoperability image exchange. Everywhere else in the world, imaging like X-rays and MRIs is commonly exchanged, but it was never prioritized here in the U.S. To help address this gap, she’s been partnering with RSNA and Carequality since 2016 to advance imaging, and she’s already starting to see some of that policy framework come to life.

With so many pioneering partnerships and projects Didi is involved in, we were eager to hear some of the things we can expect to see from The Sequoia Project in the future.

We learn that since the launch of the Interoperability Matters forum, three subgroups have formed to advance the future of interoperability issues, bring them to light, and collaborate on education and guidance to help improve areas where there are gaps or challenges.

One workgroup, called the Information Blocking Workgroup, focuses on practical implications of the proposed rule, as well as unintended consequences of new regulations. This group works to capture the many different perspectives around information blocking, inform groups and ONC on the process that’s needed, and help stakeholders understand new regulations so they’re prepared for them.

Another is the Data Usability Workgroup, which focuses on making sure data is exchanged in a usable format for clinicians, and to enable semantic interoperability for computers. The implementation guidance this workgroup is releasing will target the necessary improvements to enable that semantic interoperability for health information exchange. Plus, it will improve usability of data, so the end user has clear, correct codes in order to make the right decision based on that data.

The third is the Emergency Preparedness Workgroup. This group provides a platform to learn about health information technology innovations, regulations and key concepts that impact emergency preparedness. Right now, the group is focused on lessons learned from the response to Covid-19. That said, learnings from this workgroup can relate to any disaster response, like hurricanes or wildfires.

“[We’re] trying to create a community of practice where public health, the Medicaid agencies, state agencies [and] federal partners can all learn from the lessons, [and] also hopefully advance some of the innovations and remove those blockers to interoperability.”

To give a tangible example of one of those challenges, Didi references the scenario in which many public health departments were concerned about receiving a full Continuity of Care Document (CCD), because they’re only supposed to get the minimum required data, under the Health Insurance Portability and Accountability Act (HIPAA).

“With Direct [Secure Messaging], we continue working on figuring out innovations of all these evolving standards, including FHIR, on how we can take those highways that have already been built and use them to transport all kinds of different data as needed.”

We end our enlightening conversation with Didi’s final words of wisdom. She reminds us that interoperability is a journey. And while that journey may seem long, it starts with lots of baby steps that eventually lead to significant progress. We’ve seen lots of small steps taken thanks to the work of all our Interop Heroes, like Didi.

“It’ll take a village [for] all of us to get there. We need all of you…we need the industry and multiple champions, and the various avenues to support interoperability. And, continue [to be] passionate about it…we encourage all the stakeholders to contribute, not only to the standards, but also [to] speak up in their own organizations to say, ‘Hey, I don’t like the way this is happening. How can we improve it?’”

In order to push boundaries and innovate as best we can, the industry needs to think outside the box. And with a zestful spirit like Didi’s, it’s hard not to get excited about the possibilities that have yet to be discovered.

Thank you to Didi Davis at The Sequoia Project for sharing her incredible experience and perspective with us!

Learn more about the Interoperability Hero Initiative and check out our first class of Interoperability Heroes.

This post was contributed by Alyssa Foggia-Hamm.