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IT Chief DeSalvo Outlines Approach to Interoperable Health System

By John Reichard, CQ HealthBeat Editor

July 17, 2014 -- Collaboration and planning are the early watchwords of Karen DeSalvo's recently launched tour of duty as the federal government's top health IT coordinator.

The goal is to lessen divisions that have developed among the different players in health care over a realistic schedule for moving to a truly "interoperable" health care system–one in which a growing volume of electronic medical data moves quickly and easily among patients, doctors, hospitals, labs, pharmacies and public health agencies.

But behind that methodical approach–one that risks criticism that DeSalvo isn't pushing interoperability hard enough – the new coordinator signaled impatience with vendors and health IT providers that drag things out too long.

"We're keenly interested in seeing that that data starts to flow," DeSalvo said, hinting that providers may be more capable of making that happen then they've been letting on.

In her first extended Washington, D.C., press briefing since becoming national coordinator for health information technology at the Department of Health and Human Services (HHS) six months ago, DeSalvo sketched out the activities of her office for the rest of the year, including "refreshing" the federal strategic plan for health IT.
"We've been trying to go really deep into interoperability really quickly," she said. "This is going to take everybody's input, and as much of everybody as we can include in the country."

"This is a thorny problem that we have yet to completely solve," she said.

In June, her office released a 10-year vision for achieving interoperability and invited public comment on developing a shared agenda in five areas: core technical standards allowing IT systems to talk to each other; certification of products as interoperable; privacy and security of medical data; "supportive" business, clinical and regulatory environments; and the development of governance structures.

The collaborative approach will establish three, six, and 10-year goals in each of the areas, she said.

Health IT systems have advanced to the point where medical data is "ready to be shared," she said. There also are "a series of bright spots around the country" that show it's possible to move data in a way that makes health care more convenient and easier to deliver, she said.

DeSalvo named a number of states that have created interoperability standards and attended to privacy and security concerns to allow information to flow. They include Maine, Massachusetts, Maryland, Minnesota, Tennessee, Kentucky and Colorado. She singled out communities such as Rochester, N.Y. for exemplary work.

DeSalvo said she plans meetings with advisory groups in the fall and wants to come out with a 10- year interoperability roadmap by January "that is specific enough that people will know what to do when."

DeSalvo has established a council in which the various agencies at HHS and also other federal agencies such as the Federal Trade Commission can work together to set priorities.

She'll also host listening sessions across the country in coming weeks to make sure that the federal government's health IT priorities "align with what the country thinks."

The revised federal health IT strategic plan will place a priority on "health" as distinct from improving "health care." The idea is to promote health "where you live, learn, work, and play," she said. "Wearables" are an important part of that.

"It's an opportunity to completely transform the delivery of health care and to give people an opportunity for things like dignified aging in the community," she said.
Wearables go well beyond products that count the steps one takes in a day to devices that monitor blood glucose and oxygen levels. Providers would be able to monitor a patient remotely, notice if the person might be having climbing steps and adjust medication accordingly.

Kids could have a GPS feature on asthma inhalers that would allow public health agencies to find out where they are having asthma attacks–say in a school that has a mold problem–and take action.

DeSalvo also touched on regulatory topics. Providers are supposed to attest by the end of the year that they have health technology that complies with "stage two meaningful use" requirements that determine whether they will receive higher Medicare payments. She said her office has data on the ability of hospitals to do so, and that 2014 edition health IT products needed to comply with stage two are now beginning to move into the marketplace.

DeSalvo also expressed impatience with proprietary systems that block the flow of medical data.

"We're keenly interested in seeing that that data starts to flow," she said.

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