At HIMSS 2014, National Coordinator for Health IT Karen DeSalvo, M.D., spent an hour with a small gathering of reporters to answer any question we'd throw at her, something of a coming-out party just two months after stepping into former coordinator Farzad Mostashari, M.D.'s, shoes.
I was listening for clues on how the coordinator's previous experience as New Orleans health commissioner would inform her outlook and for early ideas on the directions in which she might lead policy. While there were many, a few in particular jumped out.
On health data integrity: "[Patient matching] is a lot about patient safety as much as privacy and security. You want to know that you're using the right data when you're taking care of that person in front of you."
On meaningful use stage 3 and how rigorous or complex its measures might end up: "Our workgroup has been doing a very thoughtful job of reflecting on the burden of meaningful use stage 2 on providers and being thoughtful about how to balance their expectations, hopes and goals around meaningful use stage 3 with the realities of the marketplace. It is important we continue to push and we don't lose momentum. But we also want to see that we do it in such a way that we don't overstretch and not [reach] the goal where we're collecting data that's meaningfully shared."
On what possessed her to leave the New Orleans post and join the federal government in a very contentious Capital: "I am inspired by the work that's happening in the country and by the work that's happening at HHS ... I had a chance to work with some of those folks when I was in New Orleans and thought that being a part of the team would be a great change to make a difference not only in my own community but on a bigger scale.
When you take away the rules of payment and expected structures of the traditional healthcare environment in the U.S., and you let it grow organically, the medical home is what grows in the wild.
Karen DeSalvo, M.D.,
National Coordinator for Health IT
"I also think the time is really ripe to think about how we apply all this HIT [health IT] success and infrastructure into the delivery environment so we can iterate and improve care people are getting all the time. [We also need to] think about new kinds of care people haven't been getting but they should because we haven't been thinking properly about technology as a tool to help innovate: Not just to bring data back but to actually change the way care is delivered.
"I'm really happy with my choice. I loved my job, I love my city. It was a wonderful journey but this is a brand new one and it's been great."
On EHR usability, after telling the story of her mother's post-Katrina ER visit and the difficult tracking via fax of her advance directives, which included a no-ventilator clause: "Even if [the advance directives] had been in the EHR, and even if it had moved perfectly through the system, if you couldn't find it because the user interface didn't allow for it, it wouldn't help her. Those are the kinds of things that are on top of my mind for making the system really work better."
On patient-centered medical homes, a concept that some research studies show may not yet be ready for prime time: "Health system delivery reform is complicated. In my experience, to do it right you have to get into the guts of the environment, whether it's primary care or a health system, and make changes to the workflows. That requires a lot of processes [and] involves everyone across the team, and has some quality improvement focus on quality improvement not in a light way, but a serious way.
"When you take away the rules of payment and expected structures of the traditional healthcare environment in the U.S., and you let it grow organically, literally on the streets in a place like New Orleans after Katrina, the medical home is what grows in the wild. It is what happened to us in our city. We didn't have a checklist to follow. It naturally occurs. If you want to keep the patients where they are, if you want to put them first, you need to work in teams and you have to look at that population as you're planning what to order, what hours to be open, who's going to be on the team, how you're going to do handoffs. You can't just think about that one patient who shows up in front of you; your responsibility is for the whole practice.
"The opportunity for IT is not to do that for your practice, but as we begin to expand on that data, you can begin to think about the community you're serving. Not just the population that might be enrolled, but everybody within the area. That's where the fun is, and I mean that seriously."