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With Dr. DeSalvo Focused on Ebola, Did the Federal Government Get Its Priorities Wrong?

November 11, 2014
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Being an editor at Healthcare Informatics, I often have to multitask. We produce web stories every day, we have our print issue eight times a year, and then we have special projects that require considerable attention.  To best juggle these tasks, I have to prioritize the most important things over the not-as-important things. This might seem obvious, but the fact of the matter is some things deserve more time and effort than other things. I will make sure the number one thing on my to-do list gets done no matter what, even if it’s at the cost of lesser important tasks.

I bring this up because most people, regardless of job type, could relate to this aspect of my job—we all have to prioritize to some degree. This includes the Department of Health and Human Services (HHS) and within it, the Office of the National Coordinator for Health IT (ONC). So when Karen DeSalvo, M.D., was tapped by Sylvia Mathews Burwell, the Secretary of the Department of HHS to step away as National Coordinator for Health IT and serve as the Acting Assistant Secretary for Health as part of the Ebola response team, I couldn’t help but wonder what the main priority of Burwell and the federal government was. Was it Ebola response or was it health IT, particularly at a time when healthcare organizations need leadership and vision more than ever before?

The answer clearly seems to be the former, although ONC has seemed to do some “damage control” regarding its top-level changes recently, saying that DeSalvo will maintain leadership at ONC. During a Nov. 4 Policy Committee meeting, DeSalvo said, “Health IT and ONC remain a priority for this department and this country.” We might never know, but to me, it seems like the federal agency has been trying to appease health IT folks in the wake of this news, coupled with the announcements that Doug Fridsma, M.D., Ph.D, and Judy Murphy, R.N., have also departed ONC, with Jacob Reider, M.D., leaving at the end of November. Furthering this thought, a source at ONC told HCI that DeSalvo still expected to still work with ONC in her new role but will spend the majority of her time on other duties.

While HCI’s Editor-in-Chief Mark Hagland went into far more detail than I will about the inside happenings amidst the leadership changes at ONC in his recent excellent blog post, I do want to take this from him: according to Hagland’s sources, “[DeSalvo] has no intention of being more than technically in charge [at ONC], as her attentions are now divided between her HHS work around the high-profile Ebola crisis and a potential political career. That leaves her status as intensely ambiguous, at the very least.” 

First, let’s take a step back and look at the Ebola “crisis.” There is nothing to sugarcoat about the epidemic in West Africa; what’s happening there is just devastating, with death tolls reaching 5,000 according to recent CDC data. But in America, it’s a different story. In fact, when Dr. Craig Spencer, the New York City-based physician who contracted Ebola while treating patient in Guinea, was dismissed from Bellevue Hospital on the morning of Nov. 11, the U.S. went back on the list of countries without Ebola cases. What’s more, eight of the nine known Ebola cases in the U.S. have resulted in patient recoveries, with the one death occurring in what was (what now seems like) a pretty avoidable situation.

I’m not saying Ebola can’t be scary; it could, and the fact that it can spread exponentially is especially worrisome. But let’s face reality: the U.S., from what we know, is clear of the virus, and much of the hype surrounding Ebola in our country might have been media-driven. Even on the page of the HHS website that explains the position that DeSalvo has now taken, it says: “It is extraordinarily unlikely that Ebola would spread widely in the United States both because the disease requires direct contact with bodily fluid of someone who is infected with and has symptoms of Ebola.” The very agency that pulled DeSalvo from health IT for Ebola admits a spread is near impossible—go figure!

DeSalvo has unique experience when it comes to public health— she had previously served as New Orleans health commissioner, and after Hurricane Katrina hit, she was instrumental in building an award-winning model of neighborhood-based primary care and mental health services for low-income, uninsured and other vulnerable individuals with a sophisticated health IT infrastructure. That experience and knowledge should not be diminished in any way. But with the likelihood of Ebola spreading in the U.S. so small and the frenzy now dying, what exactly is so new and pressing that as a result, will take DeSalvo away from her role as National Coordinator for Health IT?