“Healthcare is influenced by where people live, learn, work and play, which has a huge influence on an individual’s overall health.” ~ Karen DeSalvo, MD, MPH, MSc
This year’s HIMSS Annual Conference and Exhibition saw Karen DeSalvo, the new National Coordinator for Health Information Technology, take the stage and it was clear we are entering a new era under her leadership. She recognizes that we are at a pivot point in the history of health IT and sees the need for everyone to take a breath and possibly find some better ways to reach some of our goals.
Speaking at a press event on Tuesday, one on one with me on Wednesday (video is below), during a Town Hall as well as a CCHIT led forum, then during her keynote on Thursday with CMS Administrator Marilyn Tavenner, and finally another press availability at the end of the conference, she laid out a broad vision of the current landscape and where we are heading as an industry.
On Tuesday DeSalvo explained some of her goals. One would be that every provider is using an EHR and health IT to capture, share and meaningfully use health information.
“That requires that there’s some floor that we set, that is raised, whether you’re a rural, small hospital, provider, payer, whatever you are,” she said. She also iterated a policy goal of using meaningful use as a driver to advance the healthcare marketplace. “It’s one thing to have an EHR,” she said. “We need to meaningfully use it, and push technology so that it is driving interoperability across the continuum and that it is improving outcomes.”
She also spoke of the critical importance of interoperability. “The reason I get excited about interoperability is because for it to work, for the doctor to show up in the ER and to know what medicine you’re allergic to, if you’re unconscious and need some help, there’s a lot of back work to see that everything comes together just at the right moment to save your life. That’s pretty exciting to me,” she said.
On Wednesday she joined former National Coordinators for a very interesting discussion on the birth and growth of the ONC. The only one missing was Dr. David Blumenthal, who headed the ONC during the passage of the HITECH Act and was instrumental in its creation.
“I’m sorry David Blumenthal isn’t here because he was advising (the Obama administration) but he was also advising Kerry when he ran against Bush,” said David Brailer, the first National Coordinator. “We spent the entire night trying to get two teams to back off of each other. We both agreed the next morning we made health IT bipartisan.”
The bipartisan nature of health IT was also important to Rob Kolodner during his tenure at ONC. “We didn’t want anyone to grab and control the core infrastructure. It was important to bring it in the room so that the solution didn’t favor one interest or the other.”
But Washington, DC, is often gridlocked, and even bipartisan efforts are difficult to get into law. It was only during a financial crisis and the trillion dollar stimulus that could really provide the funding to substantially move the needle on health IT adoption.
“It took an economic crash to create the opening for something that the groundwork had been laid for,” former National Coordinator Farzad Mostashari said. “The idea that we would get this opportunity was so unbelievable, literally unbelievable, and when the HITECH Act passed, it was a broad movement.”
Dr. DeSalvo, with only weeks in her current role, said, “I don’t have a low point yet.” She expressed optimism about her work saying that after her first HIT Policy meeting, “I got very excited about that because this is a community of vendors, purchases, providers, policy folks, who really want to get it right.”
The ONC has been focusing heavily on patient ID matching recently, including launching a collaborative initiative last fall.
During her keynote Thursday she emphasized interoperability and health data exchange saying, “We can do national healthcare exchange in three years.”
She also stressed the importance of meeting the challenge of patient matching to be sure that the right information about the right patient is being shared safely and securely. “This issue of patient matching and making sure that we get that right is very important,” she said. But she was very optimistic that we can get this done. “I know that this is possible. I have seen exchange in every part of our country.”
With regards to flexibility in stage 2 meaningful use and the challenges of many providers to meet the requirements in 2014, CMS Administrator Marilyn Tavenner announced that CMS will be “flexible” in granting providers “hardship exemptions on a case-by-case basis.”
“We have decided to permit flexibility in how hardship exemptions are granted in the 2014 reporting year,” Tavenner said.
Last December they announced they were extending Stage 2 of the HITECH Act EHR incentive program one year but that did not give any relief with providers who are struggling to meet the requirements in 2014, while simultaneously dealing with the ICD-10 conversion and a plethora of government mandates. Possible exemptions will be outlined in a forthcoming FAQ and will likely include vendors not being ready with their stage 2 technology.
The exemptions to deadlines will be granted for providers in situations where, “despite their best efforts, for reasons beyond their control, they can’t meet meaningful use Stage 2.” I predict there will be a LOT of providers that will need to take advantage of these hardship exemptions in order to avoid penalties.
Standing firm on the upcoming ICD-10 deadline, Tavenner said, “Now is not the time for us to start moving forward. Let’s face it, we’ve delayed this several times, and it’s time to move on.”
The switch from ICD-9 to ICD-10 means that the industry will have to change from about 14,000 codes to about 69,000 codes. I think the deadline for implementing the ICD-10 diagnostic coding set of October 1, 2014. is fairly well carved in stone. Since it had already been delayed one year, now it will not be delayed again.
At the press conference following the keynote, Dr. DeSalvo reiterated the hardship exemptions. Recognizing the call by a coalition of provider organizations to delay the timeline of the meaningful use incentive program and to offer providers more flexibility, she offered hope that these exemptions might stave off failure.
During my discussion with Dr. DeSalvo at HIMSS, she did a very good job of extemporaneously laying out the current landscape of health IT and a glimpse of the future. One of the things that I found compelling was the notion that we could eventually begin to pull in all those data that are outside of the traditional healthcare system that make up what are termed the “social determinants of health.”
She talked about the quantified self movement, patient-generated health information, and a move away from capturing data in the standard EHR to include all of these other data—including providers, patients, payers, and the entire healthcare ecosystem in the digital architecture. She paints an interesting picture of a future tech-enabled transformed health system.
Latest posts by Brian Ahier (see all)
- New ONC Leader Karen DeSalvo Discusses Priorities, Current Health IT Landscape at HIMSS14 - March 4, 2014
- Preparing for the Next Decade of Health IT at the ONC - February 10, 2014
- What’s in Store for Health IT in 2014? - January 23, 2014