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ONC chief speaks, may depart soon

When Karen DeSalvo, M.D., national coordinator for health IT, elaborated last week about the final stage 3 meaningful use rules that ONC and CMS had just released, one had to wonder if these would be among her last public pronouncements as the top ONC official.

After all, while it is not yet official, DeSalvo has been in effect confirmed as assistant secretary of the Department of Health and Human Services (HHS), the parent mega-agency of ONC and CMS.

DeSalvo, a former city health commissioner of New Orleans whose post-Hurricane Katrina work has been lauded in many quarters, has already received unanimous consent to her nomination by President Obama from the Senate Health, Education, Labor and Pensions Committee, despite the fact that her nomination hearing in August was canceled.

The committee’s chairman, Tennessee Republican Lamar Alexander, obtained the unanimous approval for DeSalvo and sent the matter to the full Senate, in which the nomination is expected to go through just as easily.

Alexander is a moderate, but he managed to secure every vote on the committee — even from the most partisan members — for DeSalvo. That means her approval by the full Senate (a hearing has not yet been scheduled) is all but guaranteed with such bipartisan backing for DeSalvo, who is well-liked on both sides of the political aisle.

Which brings us to the question of who, if anyone, will run ONC when and if DeSalvo departs for the full-time HHS job (she has been serving for a year now in  dual roles as ONC chief and HHS acting assistant secretary for health).

For a brief period last October, DeSalvo appeared to step down from the ONC after her appointment to the acting HHS job in the wake of the Ebola crisis, and ONC COO and Deputy Coordinator for National Operations Lisa Lewis was briefly at the ONC helm as acting national coordinator.

But DeSalvo quickly announced in a blog post that she would serve in both capacities.

By the time DeSalvo leaves again, the Obama administration, while not in official lame duck status, will be in that nether-period a year from the 2016 presidential election, during which top agency officials start quitting for other jobs.

Accordingly, we can probably expect even more turnover at ONC, which has already seen a host of departures of key officials over the past year.

In the context of all that, DeSalvo’s remarks during a media conference call last week about changes that relaxed rules for the EHR incentive program appeared, at least to me, to signal a sort of soft exit for meaningful use itself.

And DeSalvo, who has championed health IT interoperability during her tenure at ONC, seemed to deliver a mixed message about interoperability.

One of the notable changes (poorly received by patient advocates but applauded by many providers) was to lower the threshold for the so-called view, download and transmit measure to a single patient per provider being able to immediately see or receive his electronic health records. The rule used to be 5% of patients.

DeSalvo argued that despite the virtual gutting of one of the key interoperability measures, the new meaningful use regulations would ultimately lead to better access to records for all because of improved interoperability in other areas.

“As a part of that overall strategy to get to interoperability, we take advantage of some of the opportunities we have, and for the office of the national coordinator, our certification program and the certification of electronic health records helps us to move to a more interoperable health system,” DeSalvo said.