DeSalvo sees public health as an ONC priority

Dr. Karen DeSalvo is not the first head of the Office of the National Coordinator for Health Information Technology with a public health background. But she's sounding as though she may be the first to make public health an ONC priority.

She also revealed a personal stake in achieving another goal, completing work on a long-proposed nationwide system of interoperable health information records.

During her keynote speech at the Health Information and Management Systems Society convention in Orlando, Fla., last week, DeSalvo, the former health commissioner of New Orleans, noted that public health agencies are lagging in health IT infrastructure. Hunger in America, and its impact on health, is one issue she hopes to address.

Communities need to leverage their health information exchanges to include information about the total health of a patient, a breadth of vision that a public health perspective can bring to health information technology deployments, she explained.

Healthcare—that is, what doctors and hospitals do—affects only about 10% to 20% of our health, DeSalvo said. Choices we make as we live, work and play have far more of an impact—40% is dependent upon having access to fresh food, for example, she said.

“There are elderly people in this country who go to bed every day hungry,” she said. But as a physician, “I'm probably not going to ask questions whether they're enrolled in a feeding program.”

The goal of making electronic medical records available to all Americans within a decade was set by President George W. Bush in 2004. The vision of creating a national health information network by linking multiple regional health information organizations was laid out that same year by the first ONC chief, Dr. David Brailer.

While it won't happen this year, DeSalvo said achieving nationwide interoperability of healthcare information is possible in the next three years.

At a news conference after her speech, DeSalvo revealed how the lack of interoperability during Hurricane Katrina hit home for her.

She was in Alaska when the hurricane struck in August 2005. Her mother, since deceased, was at the time living in a group home that was evacuated. Communication was erratic.

“It was a scary time,” she said. For a while, “I didn't know where she was. By the time I found Jo, the woman who was taking care of her, she was having trouble breathing,” likely exacerbated by the anxiety of her forced relocation to unfamiliar surroundings, DeSalvo said. Her mother, who had dementia, had an advanced directive, which included her wish not to be hooked to a breathing machine. But due to the evacuation, the directive wasn't readily available, DeSalvo said.

Fortunately, “through magic and a fax machine,” a copy was made available to her caregivers, DeSalvo said.

“I would have hated to have had my mom intubated just because we didn't have the right information,” DeSalvo said, the anxiety and frustration of that episode still evident in her voice at its retelling.

Follow Joseph Conn on Twitter: @MHJConn