Karen DeSalvo through the years: A look back at her ONC tenure
When Karen DeSalvo, MD, became the fifth National Coordinator for Health IT in January 2014, she took charge of ONC at a critical time for the industry, as four years of momentum spurred by meaningful use started to pay exciting dividends – but also sowed frustrations as many healthcare providers struggled with burdensome federal requirements.
She also had some big shoes to fill. Her two immediate predecessors, David Blumenthal, MD, and Farzad Mostashari, MD, had helped conceive and implement Stage 1 and Stage 2, respectively, of the transformative EHR incentive programs – setting the stage for widespread uptake of basic IT systems, then dramatically raising expectations about how hospitals and practices should put them to work.
But DeSalvo was the right person for the job, at the right time. Her public health bona fides – honed in her hometown of New Orleans, first in the wake of Hurricane Katrina as Vice Dean Community Affairs and Health Policy at Tulane University and later as New Orleans Health Commissioner – made her the ideal national coordinator for a period that saw the building blocks of basic EHRs mature into interoperable networks focused on improved population health.
As DeSalvo steps down from ONC to finally devote her full energies to the Assistant Secretary for Health role at HHS – the one she first took on during the Ebola crisis of 2014 – we look back at our coverage of her over the years.
Public health restored in New Orleans
Before she joined ONC, way back in February 2013 – as the health IT industry prepared to head to the Big Easy for HIMSS13 – we spoke to DeSalvo, then the city's health commissioner, about how technology infrastructure was a critical to the rebuilding process after Katrina.
"We say down here that New Orleans is a preeminent laboratory for innovation and change, and it has been since we lifted ourselves up after Hurricane Katrina," DeSalvo told Healthcare IT News nearly a year before she took the reins at ONC.
Specifically, she pointed to the advancements – HIE, patient engagement – enabled by the ONC-funded Crescent City Beacon Community. "We've been engaging with powerful work to change the way we deliver care and work with each other," said DeSalvo. "The Beacon Program is a national layer underneath that to make sure that we can advance the culture change and the data opportunities to improve the health of everybody."
(Incidentally, a citywide water crisis in New Orleans the next month meant DeSalvo had to cancel her presentation at HIMSS13 as she prioritized the public health emergency.)
HHS appoints new ONC chief
Then-HHS Secretary Kathleen Sebelius lauded DeSalvo's commitment to technology (her experience in rebuilding New Orleans' public health infrastructure post-Katrina) and population health (her leadership of the Louisiana Health Care Quality Forum) as she named DeSalvo the first woman to serve as ONC chief in December 2013.
"DeSalvo has advocated increasing the use of health information technology to improve access to care, the quality of care and overall population health outcomes – including efforts post-Katrina to redesign the health system with HIT as a foundational element," said Sebelius. "DeSalvo’s hands-on experience with health delivery system reform and HIT and its potential to improve healthcare and public health will be invaluable assets to the Office of the National Coordinator and the Department."
DeSalvo: Interoperability 'top priority'
In February 2014, soon after starting work at ONC, DeSalvo announced her plan to put technology to work effectuating better care for larger patient populations at lower cost. ONC would be focused on five goals as it kicked off its second decade, she said:
- Increase end user adoption of health IT
- Establish standards so the various technologies can speak to each other
- Provide the right incentives for the market to drive this advancement
- Make sure personal health information remains private and secure
- Provide governance and structure for health IT
ONC chiefs compare notes on past decade
At HIMSS14 in Orlando, DeSalvo joined her ONC predecessors onstage to discuss the high points and low points of a momentous 10 years.
"I don't have a low point yet," DeSalvo – just seven weeks on the job – said with a laugh. But she added that the high point happened at her first HIT Policy committee meeting. "I got very excited about that because this is a community of vendors, purchasers, providers, policy folks, who really want to get it right."
ONC restructures, charts a new course
About six months after taking office, DeSalvo unveiled her plan for a reshaped ONC, one more able to capitalize on the IT advancements made over the past decade. Key focus areas would be interoperability standards, care transformation, quality and safety, patient engagement and privacy and security.
"As we pivot to a new decade, these few strategic organizational changes allow us to better align the agency to meet the needs of the future," she said. "This functional realignment will improve the overall effectiveness and efficiency of ONC by combining similar functions, elevating critical priority functions, and providing a flatter and more accountable reporting structure."
Despite the promise of what was increasingly looking to be a pivotal moment for healthcare technology, there were big challenges in 2014. Meaningful use attestation numbers were starting to stall, as some providers buckled under onerous Stage 2 requirements. And ONC itself was having some challenges of its own. Some on Capitol Hill were starting to question the long-term mission of ONC, asking pointed questions about its regulatory powers for IT and medical devices. One proposed Senate budget cut its budget by 20 percent.
Meanwhile, the agency it was seeing the beginnings what would eventually become a significant brain drain, with the departures of Chief Privacy Officer Joy Pritts and Office of Consumer eHealth Director Lygeia Ricciardi. Soon, the stepping-down of Chief Scientist Doug Fridsma, MD; Deputy National Coordinator Jacob Reider, MD, and Chief Nursing Officer Judy Murphy, RN, would add to the sense that ONC was losing the prestige it enjoyed earlier in the decade.
However choppy the waters, DeSalvo stood at the helm of the ship.
DeSalvo drafted to tackle Ebola
But in October of that year, the national coordinator found her attention diverted, as DeSalvo was called upon by HHS Secretary Sylvia Mathews Burwell to bring her public health expertise to the fight against Ebola.
In being tapped as acting Assistant Secretary for Health, DeSalvo was charged with joining HHS Ebola response team and working directly with Burwell on "pressing public health issues," according to HHS.
Some private sector groups, such as the American Medical Association, worried that a "leadership gap" might slow interoperability and MU initiatives. But ONC Chief Operating Officer Lisa Lewis stepped up to serve as acting national coordinator while DeSalvo managed duties at both HHS and ONC, continuing to "work on high-level policy issues" related to health IT while the agency continued to follow her policy direction.
Obama nominates DeSalvo for HHS post
By May of 2015, DeSalvo was looking at an official promotion, formally nominated by President Obama to the post of Assistant Secretary for Health – a role requiring Senate confirmation.
That still hasn't happened (chalk it up to politics), but at least now she'll be able to devote her full energies to the task, rather than juggling her ONC duties, as she has now for nearly two years.
DeSalvo at HIMSS15: 'True interoperability, not just exchange'
In her keynote April 16 at HIMSS15 in Chicago, DeSalvo put out the call that the wider health industry must start to "focus beyond adoption" of health IT to create an interoperable, learning health system "upon the strong foundation we all have built."
Since meaningful use, we've come a long way, she said. It's been "such an incredible accomplishment for just five years."
But now it's time to push further: "I do know it's hard work," said DeSalvo. It requires "personal and organizational commitment." It demands "changes to workflow and changes to culture."
The true benefits of health IT can only be realized when we're able to "digitize care experience across the care continuum," she added, calling for a nationwide healthcare ecosystem that thrives on "true interoperability, not just exchange."
ONC releases final Federal Health IT Strategic Plan 2015-2020
Emblematic of the pivotal era in which she led ONC, one of the cornerstones of DeSalvo's tenure was this document, which sets the agency's goals for the rest of this decade.
It represents an "action plan for federal partners, as they work to expedite high-quality, accurate, secure, and relevant electronic health information for stakeholders across the nation," said DeSalvo. Drawing on recommendations from the Health IT Policy Committee, along with input from some 35 other federal partners and hundreds of public comments, it has four key goals:
- Advance person-centered health and self-management
- Transform healthcare delivery and community health
- Foster research, scientific knowledge and innovation
- Enhance the United States health IT infrastructure
ONC reveals final interoperability roadmap
As she said when she took office, nationwide interoperability was a "top priority" of DeSalvo's time at ONC. We're still not quite there. But this landmark document was one of her signature achievements, describing a path forward for this hugely complex and transformational task.
Its goals are big: giving consumers the ability to access and share their health data at will; stopping intentional or inadvertent information blocking by providers and vendors; adopting federally-recognized national interoperability standards. Moreover, it sets benchmarks to reach these goals, over the next three, six and 10 years.
"Data needs to be free," said DeSalvo. "If we're going to change the care model we need an information model to support it."