National health IT coordinator Karen DeSalvo, M.D. hails from New Orleans, where she served as health commissioner until late last year. She has seen the power of data respond to natural disasters as well as identify and more effectively help underserved patient populations.
We introduce readers to DeSalvo, now national health IT coordinator, in SearchHealthIT's first one-on-one, just days after the Office of the National Coordinator for Health IT proposed a rule offering new flexibility for eligible hospitals and eligible physicians in attesting for meaningful use. This interview took place hours before DeSalvo announced an ONC reorganization streamlining 17 offices and sub-offices into 10. Here is the second installment of excerpts, the first part is here.
On the difficulties public health agencies face implementing IT:
Karen DeSalvo:The thing about public health is that it saved our life today, and we didn't know it, and that's when it's doing its work. It's one of the quiet, behind-the-scenes infrastructure parts of our country that generally works extraordinarily well. Whether it's protecting food, biosurveillance or public preparedness, it's easily [overlooked]. Coming with that has been a long-standing problem that it's been underfunded at the local and sometimes the state level. When there are shortfalls in funding, things have to go. Over time, particularly in local public health, there's not been the chance to build up IT capacity to keep pace with health IT in general.
To the credit of the public health world -- professional societies, professional organizations, the CDC [the Centers for Disease Control and Prevention] and others -- they've been really leaning forward to see that public health is modernizing rapidly to be a part of this promise of health IT. It's something they're working on from workforce development to interfaces to understanding privacy and security opportunities and challenges that differ from the healthcare system, how deep data needs to be shared for contact tracing, etc. They've been really great partners, ready to build. But we have to be thoughtful and step-wise, just as they are, to build up their capacity.
How public health will eventually use clinical data physicians collect in EHR systems:
DeSalvo: [Working] in public health, what became so crystal clear was the power and opportunity from data being collected in EHRs in the clinical environment. When appropriately used, it can really help to support public health, and that's been part of the meaningful use program. It's important that public health [has] more timely data; it's one of the ways the adoption of EHRs is going to really transform public health in this country.
In the modern age of infectious disease and the contagions that reach the headlines like [Middle East Respiratory Syndrome coronavirus] MERS, the better connected clinical environment EHRs [are] to the public health system [the better they will] support biosurveillance. Early recognition of the potential spread of disease can allow public health to get ahead of it very quickly and do their work much more efficiently and effectively. That is an exciting promise and potential that is already underway. There are many other ways they're out trying to protect, but having them connected to the clinical environment in such a way that they can get real-time data will really advance and support their role in keeping us well.
On the promise of health data analytics for public health:
DeSalvo: I don't want to speak for the CDC, but I know CDC is thinking about how they support workforce development: the training of epidemiologists and public health fellows, considering how that training may be leveraged to provide a better infrastructure of public health informaticists. Public health professional societies are thinking through how to have their resources in local health departments and how they share services.
The analytics piece is one of the many places where public health can bring so much to bear as we work on how to manage big data increasingly accumulated by HIEs and other organizations. They have skills at understanding patterns of care and disease. Because of their training in epidemiology, they are certain they are appropriately using data and not finding significance where [it isn't].
They bring the perspective of prevention and social determinants to the analytics to help us think of more than healthcare as an improver of health but the whole environment where people live, learn, work and play. I get excited about the fact that in the world of health IT there's a meaningful and important space where public health and medicine can work together in concrete ways. We need to do that more and more to improve life expectancy and quality of life.