Most doctors and hospitals now use electronic health records, but the data in them often doesn't flow from one to another. The new policy challenge is to liberate the data and help providers use it to improve health outcomes under value-based payment models. Dr. Karen DeSalvo has been the Obama administration's national coordinator of health information technology since late 2013. Last year, she was named acting assistant secretary for health at HHS, but she also remains the administration's point person on health IT. Modern Healthcare reporter Joseph Conn spoke with her last week at the Healthcare Information and Management Systems Society conference in Las Vegas. This is an edited transcript.
Modern Healthcare: You spent the better part of an hour not talking to but listening to folks in nursing informatics.
Dr. Karen DeSalvo: They have a great sensibility about shared care plans, team-based care, person-centered care—things that we talk a lot about in health IT—and I think we could learn a lot from them to make sure that we're implementing and building those kinds of future systems. And they have some other really good lessons to teach the rest of the health professional workforce in that they have a universal approach to teaching about informatics.
It's hard to improve your IT system if you don't have the vocabulary and know the questions to ask of your IT department, your vendor or others.
MH: What's the fate of the Stage 3 meaningful-use rules for the EHR incentive program?
DeSalvo: We put out a rule in the fall. It had an accompanying modification rule and then a certification rule that provided guidance for the vendors about the EHRs. We did ask for public comment on the MU3 rule, particularly because Congress had just given us an opportunity with the MACRA (Medicare Access and CHIP Reauthorization Act) legislation to devise a new way of incentivizing better care through using health IT.
We also want to make sure that we're building an MU3 that's as focused on interoperability as possible, because the data are being collected—now it needs to move. So, what are the ways we can make sure that we're incentivizing the right functionalities but also really focusing more on outcomes and care? We are now in that rulemaking process.
MH: Do you have an ETA?
DeSalvo: We have said that it will be sometime in the next few months. Some of this is related to expectations in the MACRA legislation. It's important for people to remember that that's the physician Medicare part. There's still hospital meaningful use.
MH: Do you see them coming out at separate times then?
DeSalvo: Right now we've been quite focused because of the legislative expectations in MACRA on the physician component of this. We have said all along that the lessons learned from our reshaping and rethinking MU3 for docs will help inform our thinking about other parts and have other ways we can address that if we decide we need to.
MH: How is the ONC changing the rules for certifying EHRs?
DeSalvo: In the last rule we put out for the 2015 edition, not only did we set expectations for core functional components of an electronic health record—about things like privacy and security and the need to expose public-facing APIs (application programming interfaces) so data could be more liquid—but we also did more with our certification program.
We heard so much feedback from doctors and hospitals that the marketplace where they buy the products isn't as transparent as they would want—that they don't have a way to make sure that the products work in the field, not just in the laboratory testing. So we did quite a lot of work with that program to step up the expectations on the certification process.
MH: What has ONC been doing to promote interoperability?
DeSalvo: In our (interoperability) road map ... we said from a policy standpoint the federal government had a major responsibility in advancing payment reform to see that there would be a business case for pushing and pulling data, and that we wanted to work on linking certified technology to payment models. We're doing the work that we need to with MACRA, and also with bundles and primary care and accountable care organizations as examples.
We're on our third iteration of the (interoperability) standards advisory because we believe one of the critical path issues is that those systems are all speaking a different language. That's an added cost and time issue, and so a form of unintended blocking. We have asked providers and the vendors to move to this shared set of interoperability standards. They're not only about the basic data, but also about privacy and security—not out of thin air in the federal space but with the private sector.
What's been great is the vendors, by and large, have bought on to it and said, “Yes, this is the direction we should go.” I think they have clearly seen that there's an opportunity for them to compete even if they're using the same standards—that the proprietary standards are getting in the way of them actually being as strong a partner to the health systems.
What's happened in the past few years increasingly is that big national companies are buying new hospitals or doctors' practices that have different EHRs, and instead of ripping and replacing, what they want is for those systems to be able to talk and the data to be more seamless.