Seek­ing a coali­tion of the will­ing on health IT safety

Modern Healthcare - - Q & A -

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 pub­licpri­vate 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?

“Our op­por­tu­nity to ex­change in­for­ma­tion is enor­mous. We’re mak­ing steps in the right di­rec­tion.”

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.

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