DeSalvo debuts at HIMSS14

On her mind, interoperability, data, policy - and so much more

Newly minted ONC chief Karen DeSalvo, MD, made her debut at HIMSS14 with the ONC Town Hall, a video interview with HIMSS14 TV, a sit-down interview with Bloomberg BNA reporter Alex Ruoff, a panel with three of the four national coordinators who preceded her, the ONC Town Hall, and a keynote with CMS Administrator Marilyn Tavenner on the last day of the conference.

There was more. But these give the flavor of her initiation as national coordinator for health information technology, not to discount the ONC Annual Meeting, Jan. 23-24 in the nation’s capital. One might say that HIMSS14 was trial by fire.

As she put it when meeting on Wednesday, Feb. 26, with the former coordinators, who talked about their high and low moments on the job, “I don’t have a low point yet,” DeSalvo said. But she did offer up a high point. At her first Health IT Policy Committee meeting she was greeted with a whole host of opinions. "I got very excited about that because this is a community of vendors, purchasers, providers, policy folks, who really … want to get it right,” she said.

At the meetings and interviews, DeSalvo highlighted the promise of interoperability.

"The reason I get excited about interoperability is because for it to work, for the doctor to show up in the ER and to know what medicine you’re allergic to, if you're unconscious and need some help, that takes an awful lot of back work to see that everything comes together just at that right moment to save your life,” she said to Bloomberg. “That’s a pretty exciting thing for me."

“It is happening in the country,” she added. “There are places where it happens like that, and I want every American to have that experience.”

“I’m going to tell you back what I’m hearing from stakeholders,” DeSalvo told Healthcare IT News in an interview in early February, when asked why interoperability was taking so long. “What I’m hearing is that there are some technical aspects to it that are real and important. There have to be some standards to allow for that interoperability to occur. There are some business issues that relate to not just the business model, but to the marketplace itself – and providers, which are themselves right now undergoing a lot of evolution and change because of quality and payment reform.”

“It’s a dynamic place,” she added. “I think from a business case standpoint, there’s been work to do to get some of that appreciation.”

It was at HIMSS14 that she hinted some relief would be coming via flexibility around the hardship exemption to penalties associated with meaningful use. CMS announced on March 11 it would give exemptions to providers whose EHRs could not be certified to 2014 standards in time for the 2014 reporting year.

“My goal is that every provider is using an electronic health record and technology to capture and then share health information. Everyone,” DeSalvo said at HIMSS14.

"That requires that there’s some floor that we set, that is raised, whether you’re a rural, small hospital, critical access provider, FQHC, whatever you are," she said.

Another policy goal, she said, is to use meaningful use as a driver to advance the market.

“It's one thing to have an EHR," she said. "We need to meaningfully use it, and push technology so that it is driving interoperability across the care continuum and that it is improving outcomes."

When asked how she views herself, a doctor, as the head of ONC amid the Doug Fridsmas and Steve Posnaks, who live and breathe federal policy and technology – Fridsma is chief science officer and director of the Office of Science and Technology at ONC, and Posnack is ONC’s director of federal policy.

DeSalvo, who headed efforts to rebuild the public health infrastructure in New Orleans following Hurricane Katrina, served as president of the Louisiana Health Care Quality Forum and as a member of the Steering Committee for the Crescent City Beacon Community grant, and who is the first woman to head the ONC, responded:

“My background is pretty varied,” noting that she’d been a doctor, a teacher, an administrator, a public health professional and a researcher. “I’ve worn a lot of hats in my career. When they asked me to take on the role, it was because of my experience in the field, with implementation, with using health information technology and delivery system reform and improvement. It’s because I come from the field, and I actually understand what it’s like to be on the frontline and have to learn how to use an EHR or encourage others to implement a new EHR, or make those pricing and purchasing decisions, change the workflows around a new EHR, do the training of the staff because they’ve never seen that before.

“I really understand all that at a granular level, but I also understand policy, and I also believe a lot that this country could do better if we all focused ourselves and moved in the same direction.”

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