The CCHIT Summit on Wednesday morning at HIMSS in Orlando brought four of the five people who have held the position of national coordinator of health IT together for a panel discussion. (David Blumenthal, M.D., who ushered in the meaningful use era, could not attend.) But Drs. David Brailer, Rob Kolodner, Farzad Mostashari and Karen DeSalvo engaged in a lively discussion. Although there was some disagreement about the proper role of the federal government in driving adoption, there was a refreshing degree of agreement about which goals to focus on.
Dr. Brailer expressed some concern about how prescriptive the meaningful use program has become. Once incentive money runs out, he asked, will the federal government continue to have a top-down “oppressive” effect on the industry or will it shift to a catalyst for a more bottom-up approach?
As an advocate for keeping providers’ “eyes on the prize” of improved outcomes, no one can match Dr. Mostashari and he was, as usual, quite eloquent in summing up how far the country has come so far and all the work still ahead. "Every year, we have progressed in digitizing healthcare as much as we had in the past 20 years combined. That is a phenomenal achievement by the community,” he said. But he added that just putting the technology in place isn’t enough. It has to be tied to changes in how we pay for care, and that work is happening with patient-centered medical homes, shared savings, and readmission adjustments.
“Without changing how you pay for care, you get what you pay for” regardless of the tools, he said.
One of Karen DeSalvo’s challenges as the new national coordinator, he added, is to make the connections between health IT, outcome improvements and payment reform tighter.
Although she has only been on the job for seven weeks, Dr. Karen DeSalvo more than held her own with her predecessors. She drew several rounds of applause from the audience for her comments about the work ahead. She noted that although the meaningful use program has done a good job of getting providers focused on implementation and improvement, targets just one part of the health continuum. Providers in behavioral health, long-term care, and other areas must be added to the mix. “That work still has to happen,” she said.
She also noted that the HITECH Act helped “prevent the digital divide from getting more exacerbated,” and expressed concern that as federal funding runs out, a digital divide in healthcare could re-emerge. She made several references to focusing on social determinates of health, noting that research suggest they account for 40 percent of outcomes.
DeSalvo seems to understand she is in a somewhat delicate position, coming into ONC as funding is drying up and as many providers are exhausted and a little cranky about regulations. She mentioned her job is to show the finesse to move the dial on regulation so it is still having a positive influence but not stifling innovation. Time will tell whether she can be successful, but she continues to impress audiences with her ability to articulate ONC’s mission in a way that connects with people’s basic healthcare needs.