Dr. Karen DeSalvo stepped down last month as chief of the Office of the National Coordinator for Health Information Technology. She retains the title of acting assistant secretary of health, which she has held since the fall of 2014. The former health commissioner of New Orleans recently spoke with Modern Healthcare reporter Joseph Conn about her nearly three years leading the ONC, which made her the longest-serving person in that role. This is an edited transcript.
Modern Healthcare: Why are you leaving the ONC?
Dr. Karen DeSalvo: It really seems like the organization is in a great place. (Dr.) Vindell (Washington, her successor) is a great leader, and I trust him so much. He's had a few months in, and we've been able to work together. It is really clear to me that he's going to be able to take the mantle and carry forward the agenda that we've laid out.
MH: With a new administration coming in one way or the other in January, is your horizon right now the remainder of your term at HHS as assistant secretary?
DeSalvo: The political appointees are all expected to resign, and they start fresh.
MH: No expectations of staying longer?
DeSalvo: I don't. We're all trying to make sure that we are doing meaningful work in whatever role that has got a glide path that helps health and healthcare understand the future. I don't want it to seem that we're just working for the next few months. However, we have a lot of things that we want to get done at HHS in the next few months.
DeSalvo: The Office of the Assistant Secretary is very engaged in Zika through the Office of the Surgeon General and the Public Health Service Commissioned Corps. We have been leveraging the opportunities for the surgeon general to speak not only to the American people but to providers who were recently in Puerto Rico. My principal deputy has been serving in a coordinating function for the Zika Puerto Rico effort. We have work that we do in the area of blood safety, in reproductive health, as well as our Office of Minority Health, which has been providing support.
MH: Is that pretty much your agenda going forward for the rest of the year then?
DeSalvo: Those are the things that we're bringing to bear (to provide) support for Zika because those are obvious priority areas. On the other end of the spectrum is the beginning of the science in the first place. If you're going to message about good science and policy to act on, you have to develop good science. We have regulatory responsibilities and oversight. For example, the Office for Human Research Protections, or OHRP, is in the midst of working through the updating of the regulation around the common rule (for protecting human subjects of research). I want to make sure that we follow through on our regulatory commitment. I've got a strategic effort called Public Health 3.0, which has really been a hard look at the public health infrastructure at the local level. We've got a series of listening sessions around the country with the local public health leaders and public health systems … which we'll present in October. The importance of public health—obviously important to me for a long time—came to the consciousness of so many folks when the trouble in Flint came to light. Part of all the many challenges is a health department that has really struggled with less and less funding over the years, and that meant less and less bandwidth to take care of broader issues, including interfacing with the water system folks. It was a good reminder to all of us that public health as a governmental infrastructure is part of the core fabric of a strong infrastructure of a community.
MH: Is there an IT gap in reporting for public health purposes?
DeSalvo: In this Public Health 3.0 work, one of the focused streams of work is around data analytics and measurement. What we're seeing is a successful pioneering kind of approach for modernizing the public health department. They're leveraging big data, whether that's from electronic health records or HIEs (health information exchanges), or whether it's from more unusual sources like retail data or from social media. They are using that to help inform their work. The availability of data is giving local public health leaders new ways of thinking about not only health but also the social determinants of health.
MH: Is there a gap between the public-sector public health systems and the acute healthcare systems?
DeSalvo: One of the major challenges that we still have ahead of us is that the healthcare system needs to interface with the broader health system. This is not only increasingly a challenge for public health infrastructure that it needs more resources to stand up its IT infrastructure and its workforce, but it's also going to be increasingly true for other sectors like social and human services and behavioral health.
MH: Is there anything you know now that you wish you had known back two years and eight months ago?
DeSalvo: From the standpoint of ONC, what was most remarkable over the course of the last couple of years is that we've been evolving our own internal organizational structure to meet with the really dynamic external IT environment. We shifted focus away from the electronic health record and on to the data, which is the core actionable information about a person or a population that is going to continue to drive improvements in health and in science and get us to this learning health system. The work we did to unlock that data is going to create unlimited opportunities for entrepreneurs and for consumers to have access to information. I had the benefit also building upon what (former ONC heads) had done and was able to get focused more on standardization of the standards. I think one of the lessons that all the health IT world has learned in the last few years is that the flourishing of standards was important work to make sure we're speaking the same language.
MH: What advice did you give Vindell Washington?
DeSalvo: Being national coordinator is a joyful and delightful job. I would do it again in a heartbeat. You've got to have a true north and stay with it because you're going to get buffeted by a lot of opinions and agendas from people in organizations. Vindell has a true north that is about doing the right thing for people, for individuals, to see that they have an opportunity to be healthy. The last thing is to get out of the Beltway as much as you can. It's easy to get your head down and be thinking about that road in front of you or hearing from people who can come into Washington and meet with you. But the real world is out there, and every community is different in this country. I could go to rural Alabama or Nebraska, and the kinds of challenges that the providers and the communities are facing are different from what they are in Northern California. Our job, as national coordinator or as a leader at HHS, is to raise the floor. Always put the consumer and consumer protection out front and first.