As acting assistant secretary for health at the Health and Human Services Department, Karen DeSalvo is heading up the near-Herculean task of transforming the way the nation's health care system handles information. DeSalvo, who is also national coordinator for health information technology, along with numerous federal and industry stakeholders, has helped craft HHS's Healthcare IT roadmap, a multi-year guideline to reshape health information systems, data-sharing and the seamless flow of patient medical records between systems, known as interoperability.

DeSalvo took some time to talk to Carten Cordell about the work of her team, in collaboration with agency partners and industry stakeholders, to remake the way the nation's health system can efficiently and secure share patient information. 

Can you talk about the Federal Health IT Strategic Plan and how this latest version developed?

When we started this process, we decided to pull together federal partners across the government. In the past, what we have done is written the strategic plan through straw men and then gone and talked to the various federal partners to get their feedback. We thought at this point that there was so much important conversation that needed to happen that we would pull together a Health IT council. We thought about who would have really important programmatic of policy considerations and who was involved in health IT.

The prior strategic plan had been more about a set of programs that evolved out of high tech, the meaningful use program and electronic health records. It made a lot of sense at the time that we did it because that is what we were really pushing to do, but it was so refreshing and exciting to know that we had this very quick consensus across the federal partners that this was about people and this was about seeing that the technology would enable not just our work, but our work to advance the health of this country. And we rolled out from there.

Did the VA-DoD project to share medical information across two, separate IT systems inform some of the challenges you thought you would face in terms of interoperability?

Oh yes, definitely. The Office of National Coordinator [for Health Information Technology] has another table that we sit at, that we coordinate with the VA, DoD and a host of other federal partners and it's pretty sticky, technical things that we work on with them. Drilling down to things like, what is a common clinical dataset and the domains and the standards, that is a place where we already had a good relationship.

That's a technology conversation, where we needed to lift up a little higher is where we needed to wrap that technology piece with some policy conversations and work on getting the right business environment for that data to move between the VA and DoD, as an example.

So in the Federal Health IT Council, some of those same technology folks participated, but we were able to bring in others from the VA and DoD who were thinking about purchasing care in the private sector and have a conversation about how there would be not just technology alignment, but policy alignment.

I'll just keep using consent and privacy as another example. I was just in Pennsylvania yesterday and the issue again coming up is that they have several health information exchanges, some market-developed and some private-sector developed and they all have a different privacy policy. The technology is not so much their issue for getting the data moving, it's really getting them all to come to the table around this sort of trust environment. So we have learned a lot from the VA and DoD and, I think, they from us as well. It's been a terrific partnership. Again, it's just a reminder that it's complex, not just from a technology standpoint because there are people involved. People have to make some really important decision to protect the data and protect the consumer.

What's next for you and what are you looking at down the road?

So we've taken this bigger idea of this strategic plan, and as you know my priority within it has been interoperability—which is data movement, and pulled out of all of that what we are calling our near-term health IT strategy.

It boils down to three streams of work: to see that usable data is readily available. That's much of our interoperability work, but I would highlight for you about health information blocking. It's increasingly clear to us that data that can move needs to move now. Sometimes it's being blocked for reasons that are annoying and unreasonable. Sometimes, it's reasonable. I hear this all over the country when I talk to folks. Blocking or impediments that are low-hanging fruit, things that we can move quickly, is going to be the focus and the usable data needs to be in a readily available space.

Secondly, it's about the usability of the products and the marketplace. Some of this relates to blocking. In the work that we have been doing with our partners, like the Federal Trade Commission and the inspector general, thinking about the ways we can make the marketplace work better. How can we push out data about transparency and give the buyers some kind of way to look at a scorecard and say, "This is what I bought and batteries were included." Basically, a lot of times, what happens is a [doctor] or a hospital buys a product and they think it included a set of interfaces and a way for them to extract their own data and it doesn't. That's a source of frustration and another kind of blocking. So in the space of making the product and system work better, we are going to be focusing a lot on our certification program, but also all of the other tools, both good and bad, that we have to advance the marketplace in the next few months. We have some work going on with the private sector also about usability. … There are some very exciting technological advances that may help make systems more user-friendly, particularly for clinicians, but for everybody in the system long term.

The third area is about reducing the documentation burden and regulations and harmonizing that so we are really clearer about linking the documentation piece to outcomes. This is something we were thinking about doing with CMS. Though again, across the federal partners, this is a conversation and work that is happening not just within HHS, but the Federal Employee Health Benefits program, the Department of Defense and the VA have a shared interest in seeing that we are all measuring the same quality indicators and having the same documentation expectations.

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