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Karen B. DeSalvo on the top tech changes health execs should watch


Karen B. DeSalvo, National Coordinator for Health Information Technology, gives the best courses of action for top technology challenges and opportunities facing healthcare executives.

In this Q&A with Managed Healthcare Executive (MHE), Karen B. DeSalvo, MD, MPH, MSc, discusses the top technology challenges and opportunities healthcare executives should be focusing on. DeSalvo is the national coordinator for health information technology and acting assistant secretary for health at HHS.

MHE:What do you think is the biggest health IT challenge the country currently faces?

DeSalvoDeSalvo: Now that the country has achieved great success in the digitization of health information through the adoption of health IT, we now have to begin making the most of that information. We also need to make sure that health information is accessible when and where it matters most to improve the health and well being of individuals and communities.

That is why we are devoting so much time and energy on transforming how we can help to improve and coordinate individuals’ health and care, pay for that care, and help to improve the health of communities, all in a patient-centric way. We call this effort “delivery system reform.”

MHE: What are some of the ONC’s top health IT priorities that you believe could have a significant impact on quality and cost of healthcare in the United States?

DeSalvo: There are three key areas that we think will have the biggest impact. First, we need to move health IT to common, federally recognized standards so different systems and tools can speak the same language.

Second, we need to change the culture around access to health information, including by combating information blocking, in order for all the digital health information to actually be accessible and useable by doctors, individuals, researchers, and scientists.

And third, we need to focus on the business case for the seamless and secure flow of information-because we cannot make the types of changes to quality and cost in the health system we all seek without an effective data foundation.

Next: What is the top health IT policy issue to watch?



MHE:What is the top health IT policy issue that you think our readers should be watching? 

DeSalvo: CMS recently issued the proposed rule implementing key provisions of the “doc fix,” otherwise known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA modernizes and streamlines how Medicare payments are tied to quality patient care for thousands of doctors and clinicians and creates powerful incentives to transition from payments based on volume to payments based on value and quality.

The proposal replaces a patchwork collection of quality programs with a single system where every Medicare physician and clinician has the opportunity to be rewarded for better care and investments that support patients.

ONC continues to work closely with CMS on using health IT to support better outcomes for patients and better tools for clinicians as part of the proposal.

MHE:In September 2015, the ONC, in collaboration with more than 35 federal partners, released the updated Federal Health IT Strategic Plan 2015–2020. What are some ways the agency has worked to advance the plan’s key objectives over the past few months?

DeSalvo: The team at ONC has been hard at work on activities that support the plan’s objectives. One major milestone was the publication of the Shared Interoperability Roadmap, a collaboration with the private sector, states, and federal partners, identifies the necessary near-term actions to advance an interoperable health system plan.

Building on that is our work to unite the private sector around three key commitments to make health data flow more seamlessly and securely. Earlier this year, we announced that companies that provide 90% of the electronic health records (EHRs) to U.S. hospitals, the top five largest private health systems, and more than a dozen professional associations and stakeholder groups made the pledge:

(1) Improve consumer access,

(2) No information blocking/ensuring transparency, and

(3) Implement federally-recognized, national standards so that health IT systems and tools can speak the same language. 

From a more technical perspective, we have produced the Interoperability Standards Advisory, a coordinated catalog of the best existing and emerging standards and implementation specifications to help guide developers’ efforts to create technology that shares information seamlessly.

And finally, we have worked closely with our colleagues from CMS on the proposed Quality Payment Program, which will reform the way we pay Medicare clinicians to reward more person-centric, practice-driven uses of health IT.

Next: What technologies will improve care and reduce costs?



MHE:What are some specific technologies that are evolving/arising that you think have great promise to improve care quality and reduce care costs?

DeSalvo: The use and implementation of Fast Healthcare Interoperability Resources (FHIR)-based Application Programming Interfaces (APIs) would be one example. This new technology has the potential to enable efficient information sharing among patients, families, providers, and researchers. 

The continued work around Prescription Drug Monitoring Programs is another significant investment being made at all levels of government in order to reduce opioid abuse. We are starting to see more integration and use of health IT, which will help inform providers at the point of care.

Real-time, accessible, knowledge about an individual’s opioid prescriptions can help providers determine the right course of treatment as well as help clinicians step in early if there appear to be signs of abuse.

MHE:If you could offer managed healthcare executives one piece of advice for ensuring their organizations are using technology to its full potential, what would it be?  

DeSalvo: The way we implement our technology systems and train our teams to use it is essential and often is not prioritized highly enough. I think it is critical that our nation’s healthcare organizations are working with their “boots on the ground” to ensure that technology is implemented in a manner that supports high-quality care, patient safety, and healthy people and communities. Engaging the entire spectrum of users is key in this process since they have the real-world experience and perspective that IT implementers may not.

Aubrey Westgate is executive editor of Managed Healthcare Executive.


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