Rapid Innovation: Using Healthcare Platforms and APIs to Bring a Digital Health Pass to Market

As vaccination rates increase, international travel reemerges, and the economy opens, I’ve found myself having conversations with friends, co-workers, colleagues, and other health and technology leaders about what it will take to truly feel safe and comfortable in a post-vaccinated world. One theme continued to emerge—how do we know that people around us are really vaccinated?

While the disruption to the healthcare system and our daily lives caused by the COVID-19 pandemic is undeniable, it has also propelled us into a promising era for advancements in technology. This gives me hope as we navigate our way through a new normal that prioritizes equity, inclusivity, safety, and security—elements that have recently been illustrated by the rise of a digital health pass.

As someone who spends a lot of time in my role thinking about how to drive digital transformation, I wanted to share the playbook we used at Change Healthcare to rapidly define and create a product that puts the power to access and securely share healthcare data into the hands of the healthcare consumer—you and me—and allows that data to be securely verified. This playbook provides a framework to develop interoperable, API-enabled, secure products that break down the barriers to data sharing across our ecosystem—a necessary component of any digital record.

Step One: Design with the end in mind

This is easy to say but hard to do, especially when there’s a pandemic and a pressing need for vaccine records. Taking this approach, we defined the long-term job to be done and then examined market forces and the state of current solutions. Healthcare consumers are increasingly demanding the same easy access to data and interactive experiences they have when dealing with other industries. However, not all Americans have access to broadband or a smartphone. These insights pushed us to create a product that was not just for COVID-19 but could serve as a portable, digital vaccination and testing record, accessible to anyone that could access a digital device— smartphone, feature phone, shared or owned computing device—and be verifiable using any appropriate standard.

Step Two: Envision the ideal user experience

As we continue to embrace the digital economy and digital-enabled experiences, a well-designed user experience becomes a critical aspect of any solution.

In a recent panel discussion with colleagues Rebecca Distler of ID 2020, Jeremy Springall of SITA AT BORDERS, and Terrell Jones of ON, Inc, I shared our thoughts as to what a practical user experience for a digital health pass or vaccination record might entail, for the consumer with the data and the verifier validating the data. While we all agreed that the use of the paper record might serve initially, it was clear that, over time, the process of obtaining and sharing this information would need to become faster, more automated, and interactive.

In my role at Change Healthcare, leading our digital transformation, platform strategy, and marketplace solutions, my job is to rethink the ways in which products are developed, user-centered platforms are created, and products are brought to market to achieve the desired user experience across healthcare’s stakeholders. A digital health pass is no different.

To ensure wide implementation and use, the health pass needs to be designed to meet the needs of multiple users across different endpoints. For example, as a traveler, I want my health pass to integrate into my self-service check-in experience at the airport. The airline may want to ensure the data provided by the passenger is transferrable to local government entities to approve travel status. The government entity may need ease of use if travel guidelines change and communication is required to expected travelers. Creating an ideal user experience for digital health passes, and across healthcare overall, will depend on setting interoperability standards to make the experience as seamless as possible and free of frustrating slowdowns.

Step Three: Establish the trust model

Any application or company that handles sensitive data is obligated to be a good steward of that data and its provision to the end user. This is even more important with healthcare data where inadvertent disclosure of healthcare data, cannot only result in injury to the healthcare consumer but also result in significant business risks in the form of fines or other legal action. When designing our product to handle healthcare data, we first established a trust framework—who would see, use, and interact with the data and what protections would be required.

In this product we established a three-segment trust model:

• A trusted source: Vaccine or test data needed to be traceable to the source of administration by a licensed entity (e.g., someone with a National Provider Identifier [NPI]).
• A trusted identity: A verifiable healthcare consumer identity, validated using data from the trusted source or by a trusted identity provider.
• A verifiable credential: A way to securely communicate status that can easily be verified to confirm the information provided is accurate.

By building security and trust into the model versus attempting to bolt it on later, we were not only able to identify key needs (e.g., the need to match and verify identities) but also establish a baseline for communicating and proving that trust to the customer.

Step Four: Design for interoperability and simplify data needs

In addition to the sheer volume of data that exists, it is also severely fragmented. This fragmentation creates additional barriers to achieve a private, secure, and interoperable exchange of health information that is required for a global digital health pass. We understand and must consider that:

• There is no single place where all vaccination and testing data are easily or readily accessible.
• Data belongs to and should be easily accessible by the healthcare consumer.
• There are both regulatory and personal sensitivities around sharing personal health data.

As we created the user experience and trust model for the product, we did so while embracing the idea that healthcare data interoperability had to be at the core of the product. Providing data to the greatest number of healthcare consumers will be a team sport, and we designed the product with enabling secure data interoperability in mind.

A standard misconception about a digital health pass is that patients will give up access to a myriad of hypersensitive information. This doesn’t have to be the case. To minimize the risk and sensitivity of sharing personal health data, we joined the Vaccine Credential Initiative, embracing the use of a standards-based credential to provide only the information that was needed to show vaccination (or test) status. By doing this, we not only reduced the surface area of risk but also made it easier to share status with others. There is no need for a health pass to share a consumer's comprehensive personal health history, just what is needed for a credential. Speaking of interoperability and credentials, this approach also allows us to support multiple standards, extending the idea of interoperability to the credentials themselves (whether from VCI, WHO, ISO, or others) making the product more valuable to the end user.

By minimizing our data needs, we also gained the benefit of simplicity and speed. Without the need to obtain data outside of the specific purpose of showing vaccination and testing data, we were able to speed our development time and security validations and, ultimately, free up time to optimize the product for customer needs and scalability.

Step Five: Make it scalable

What does it mean to scale? Starting with step one, we identified that scale would not only be vertical (do more transactions) but horizontal (extend to partners and the ecosystem). With that in mind, and engaging one very high-scale use case, international travel, my colleagues on the Plug And Play Tech Center panel discussed what the ideal user experience might look like for international travelers.

Travelers would need to first identify the rules and requirements prior to entering a country. Airlines should also have access to communicate this information. Because most governments will require a travel declaration, travelers will have to confirm they are compliant with government health standards. The government will assess risks based on a passenger’s information provided to the airline or travel entity. Ideally, this process would be similar to a visa application; and the government entity and travel organization will have standardized the data desired to come to a decision. The airlines will have access to the passenger’s most basic health status to support digital, self-service, rapid check-ins.

The adoption of digital health passes will require many entities inside and outside the healthcare ecosystem to work together to create a seamless user experience. To that end, we built our digital health pass as a platform-powered, API-first product, enabling us to easily work with entities across all three trust segments: data providers, identity providers, and verifiers. Taking this approach unlocked another key insight: scalability included the need to share the credential based on both push and pull models. Just as there will be no single data provider (versus a consortium), there is also no “universal wallet.” Thus, we developed API-based sharing mechanisms to allow:

• Immunization providers to easily create a vaccination credential.
• Healthcare consumers to share the credential with whom they choose in a way that makes sense for the situation—showing their credential or sharing it electronically.
• Verifiers to, with consent, securely verify the validity of the credential.

Implementing a health record interoperability system at a global scale is certainly challenging, but our current state of technology innovation makes a streamlined digital health pass an exciting reality. The proliferation of data, an expanding digital economy, and the nexus of tech forces that have emerged have formulated a pathway to break the silos that existed prior to the COVID-19 pandemic, which provides new opportunities for rethinking fragmented systems. The key will be to move away from creating solutions in a silo, where leaders begin to think and plan holistically to implement solutions that operate together, and a digital health pass is a promising way to start.

Change Healthcare's Vaccination Record is currently live and serving healthcare consumers in over 40 states. As we look forward to more international travel, the ability to go to concerts, and be out in the economy, we are actively partnering with data providers to create a consortium of data nodes that will make it easier for healthcare consumers to access their immunization and test data, with wallet companies to enable the mass distribution of credentials to as many healthcare consumers as possible, and with verifiers to help reopen our economy and return to our new normal.