ONC chief Karen DeSalvo on EHRs, IT safety

Dr. Karen DeSalvo became HHS' fifth national coordinator for health information technology in January. She previously served as city health commissioner in New Orleans. DeSalvo, a former professor of medicine and vice dean of community affairs and health policy for Tulane University, led the effort to establish a network of primary-care medical homes as part of the city's post-Katrina rebuilding process. She also served as president of the Louisiana Health Care Quality Forum. A native of Austin, Texas, DeSalvo received her medical degree from Tulane and a master's degree in clinical epidemiology from Harvard. Modern Healthcare reporter Darius Tahir recently spoke with DeSalvo about progress toward meaningful use of electronic health records, the push for EHR interoperability and the proposed Health IT Safety Center. This is an edited transcript.

Modern Healthcare: What do you think of the latest figures on how many hospitals and physicians have attested for meaningful use of electronic health records?

DeSalvo: I think that it's too early to tell. We know from past experience with meaningful-use Stage 1 that people wait to attest until the 11th hour. I know there's work happening all across the country to meet attestation. It seems on track with where we expect it to be. We're listening to folks to understand how we can help share best practices and make sure that there are not any barriers that we can try to help move out of the way.

MH: Do you have any other plans to advance meaningful use?

DeSalvo: When it appeared that providers, through no fault of their own, wouldn't be able to upgrade to a 2014 product and meet the deadline set for Stage 2, we made certain people were aware there was a hardship exemption and clarified some of the qualifications around that. We didn't want people to be penalized because a product wasn't available. We're also working on finalizing a rule allowing providers to attest using the 2011 product.

MH: How do you respond to the criticism that some of the subsidies the government gave providers were used to buy clunker EHRs?

DeSalvo: Just like with any new technology, innovators, vendors and providers are working to find the product that's going to work best. We certify the products, and we have been continuously working to improve that process so the products are tested to make sure they work and give folks what they want. Sometimes providers just need more time to get to know all of the functionalities that their systems have, and that doesn't necessarily happen overnight. It may very well be that some providers decide that the product they started with isn't the one they want to stay with, which is true in any kind of technology marketplace.

On certification, right now we're focusing on reducing the time lag, administrative burden and complexity. We're trying to build better partnerships upfront with the vendors and clinicians. We want to create a feedback loop to find out how the products are working in the field and issues about usability that can help providers make choices for their next purchase.

MH: Tell us about your plans for the Health IT Safety Center.

DeSalvo: The safety center is a way that the health IT community can come together in a safe, quality- improvement space where it's not a name-blame- shame environment, it's a learning environment. The community can understand where there may have been IT systems involved in safety issues, which can then feed back into improvements in products. The safety center is thinking about problem-solving and not being punitive. That's not part of our certification process, it's really a public-private partnership.

The safety center requires congressional funding, and that's not something that we have. So we have laid some groundwork and are beginning to collect some baseline information in partnership with folks like the Joint Commission to understand if you were to have such a center, how could the data come into it? How would your partners work together to try to solve problems?

The timeline would depend on congressional action for funding, and we would have planning and consensus-building around the infrastructure. A part of that process would be to find the right host for the safety center. The policy committee recommended that we consider an existing organization to host a safety center. I'm very open to that because building on existing infrastructure and capacity would shorten the timeline and help us leverage other talent within a safety-type organization.

MH: Should we expect more patient-generated health data in Stage 3 of meaningful use?

DeSalvo: If you ask people a single question, “How would you rate your health?” the answer is incredibly predictive of their future health and healthcare needs. We need to find a way to make it a part of their health information. Similarly, we have to develop a policy framework that allows for patient-generated data coming from remote sensing devices like fitness trackers and other wearables. There are some very important questions we have to address like data provenance, clarity, privacy and security issues, and the signal versus noise situation. If every doctor started to get all this data streaming into them from all their patients, it would be overwhelming. These are all solvable issues, but they are complex.

MH: Some members of Congress are restless about the progress in EHR interoperability. How do you feel about the state of interoperability?

DeSalvo: I have made interoperability our top priority, not just because we think it's the right thing, but because there is a clear message from folks who are interested in improving access to quality affordable care that we've got to have interoperability. The payers, providers, vendors, consumers and Congress are ready. There are data to be shared. Our opportunity to exchange information is enormous. We're making steps in the right direction.

What we need to really push for is a more bidirectional opportunity for interoperability. I think the real future is going to be a more welcoming ecosystem for all the trading partners that want to share data in private and secure ways. That kind of interoperability approach isn't just about interfaces between vendor products. It's really about having a highway that's open to other folks and is governed appropriately and has the right privacy and security. There are communities like Indianapolis and states like Maine where interoperability works. There are other places like Alabama where they have some groundwork laid but they're not actively engaged.

MH: How are you going to make sure that providers and vendors find it worthwhile to participate in the Health IT Safety Center?

DeSalvo: In terms of building consensus and interest in the industry, that's going to be just like any process that is voluntary. The aviation industry is a great example of that. They started with the coalition of the willing, the forward-leaning vendors and providers who have safety as a high priority and a goal of no mistakes. We know a lot of those providers are ready, and they have vendors who have been working with them to improve safety and reduce errors. So there's a set of folks that I expect would be interested and willing to participate. Over time I expect everybody will want to be in.