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National Coordinator for Health IT Karen DeSalvo: Focusing on Listening to Provider Concerns

February 5, 2014
by Mark Hagland
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Karen DeSalvo, M.D. shares her perspectives on a broad range of topics with HCI

On January 13, Karen DeSalvo, M.D., formerly City of New Orleans Health Commissioner and Senior Health Policy Advisor to Mayor Mitch Landrieu, joined the Office of the National Coordinator for Health IT (ONC) as the National Coordinator for Health IT, in the most important public policy role in healthcare IT in the United States. Now that she is in the National Coordinator position, how does the landscape look to her? Dr. DeSalvo sat down on Feb. 5 for a phone interview with HCI Editor-in-Chief Mark Hagland, to discuss meaningful use Stages 2 and 3, physician struggles, vendor capabilities, and the role of the trade press, among other topics. Below are excerpts from that interview.

I know that you’re facing a welter of immediate priorities, but could you name the top three priorities, from your own perspective, right now, in the first six months  to year of your tenure?

Not necessarily in order, there are several. They include some organizational assessments, to make sure that our form and structure as an agency meet the needs and fit the funding, and as we begin to focus more on the coordination function at ONC, and our role on facilitating, implementing and leveraging goals. It’s the meaningful use, lower-case sense, of health information technology that I’m speaking about there. What do we have in place that is leveraging the needs we have in the country to improve the delivery of care, in such a way that we improve care and lower costs? Also, we’re  looking at how we can do a much better job of enabling health information exchange, both as a noun and a verb, so what needs to happen to get to the goal of true inoperability. And I might need to do some restructuring of the agency in order to make sure that that happens.

But also, there are so many technical components that go into interoperability—into not only standards, but also governance and business issues. Those need to be looked at. And also, we have two major regulatory obligations—meaningful use Stage 2 and meaningful use Stage 3, and always, in that context, thinking about how that [process] advances the health of the nation. We had a discussion in our policy committee of the latest elements of MU3. So it’s an immediate need, to make sure we’re addressing meaningful use Stages 2 and 3 appropriately, to get to the [broader] goals.

We’re hearing considerable concern in the industry among physicians. Hospitals may be struggling with meaningful use, but physicians are struggling even more, as a group. Are you also hearing about physicians falling behind hospitals in the meaningful use process, and if so, what are your thoughts on what might be done in that regard?

We have definitely heard from physicians that not all eligible providers will be able to achieve Stage 2. Certainly, some are well underway; but we’re hearing that there may be some challenges, so we’re listening to that. And there may be some lessons learned as we move towards Stage 3—not only the broader goals, but also the quality measures. I have heard that. And also, we’re hearing from physicians that there are needs beyond the technical elements, having to do with the usability and friendliness of [information] systems. And that matters because if you really want health information technology to enhance safety, the electronic health record [EHR] needs to be “usable” in such a way so that when that doc opens that record, the information needed comes right at them, right? And there’s some opportunity to really enhance that at the point of care, in the clinical environment.

Also, what we all want to see is to have systems that are usable in that clinical environment, so that docs and patients are interacting with each other. There’s some real opportunity there; the vendors are interested in that, the doctors are interested in that. And sometimes, clinicians still have to pull out the information instead of getting it pushed. And to me, that’s related to health information exchange needs, too. We’ve already had a lot of listening sessions in those areas. And in terms of the lower-case m, lower-case u, the meaningful use of all this, doctors do want to be a part of integrated system, and we need to try to help them get there.

Another big concern we’ve been hearing across the industry is regarding the usability, functionality, and interoperability, of vendor products right now, particularly EHRs. What is your response to provider concerns over vendor products?

It gets back to what the role of is, of the Office of the National Coordinator for Health IT—and that is as a coordinator for health information technology. This is a role that requires us, as an agency, and me as National Coordinator, to do a bit of what you’re describing, honestly, which is to listen to the concerns [of providers], and to look for opportunities to use whatever authority we have to try to help make the electronic health record more of an enabling tool. And that means we need to make sure to do an internal look to see what we’re doing as an agency to enable innovation. I’ve heard what you’re sharing, and I’ve asked the team to think about that, because what we really want to do is to be a force for advancing the field.