Dr. Karen DeSalvo touts collaboration to achieve health IT goals
Karen B. DeSalvo, MD, MPH, MSc
Acting Assistant Secretary for Health
National Coordinator for Health Information Technology
US Department of Health and Human Services
Dr. Karen DeSalvo touts collaboration to achieve health IT goals
An individual walks into a clinic in a rural area. She goes up to a computer screen to sign in, and enters a few basic pieces of personal information in the language she's most comfortable with. She is called back to an examination room within a few moments, where a doctor specializing in her condition meets with her. The doctor has already accessed her medical records from the EHR (electronic health records) system, and together (with the help of a translator) they have a robust conversation about her recent diabetes diagnosis and her current concerns. The patient's visit concludes with an action plan for her current medical issue, printed in her native language. The notes from the visit, including the materials provided to the patient, are logged real-time in the EHR system. When the patient visits family out of state the following week, and goes to another clinic for a follow-up, the doctor in that new clinic sees all the notes and information from her previous visit, and uses that information as a jumping off point with the patient for a discussion about her diabetes.
This is a vision that Dr. Karen DeSalvo, the National Coordinator for Health Information Technology at the Department of Health and Human Services, is intent on delivering into reality. Broadly put, she is looking to identify and impact the social determinants of health, influenced by where people live, learn, work and play. She plans to use tools beyond the Federal meaningful use incentive program to stock the complete toolbox available to transform healthcare in the United States.
That's a tall, complex order. But it's exactly what Dr. DeSalvo has been preparing for. Dr. DeSalvo has focused her career on improving access to affordable, high quality care, and she knows firsthand the challenges facing underserved populations. She recently shared her experiences as a participant in the "Walking Gallery", a groundbreaking collection of personal stories, rendered in art by Regina Holliday and worn proudly on garments by gallery supporters. The symbolism of Holliday's artistic depiction of DeSalvo's experiences resonates with many- "Coming from a place where you can feel voiceless in a broader society, a place where those who need the most help are sometimes likely the least to get it – it's something I get up thinking about every day."
It's a sentiment she recalled in her keynote address on September 16th, 2014 at the first annual conference for the National Health IT Collaborative for the Underserved (NHIT Collaborative), where she spoke candidly about the challenge of reaching multicultural underserved populations: "I want to assure you that I wake up every day thinking of how we can best serve everyone in this country. Everyone. With a focus on those who need it the most and particularly those who often don't have a voice." She added "It is incumbent upon all of us to see that we are working collaboratively but most importantly, that we listen to the people we serve to understand how this powerful tool of health IT can advance care but more importantly advance their health."
Introducing Dr. DeSalvo at the conference, NHIT Collaborative CEO Luis Belen said: "The breadth in experiences and contributions of [Dr. DeSalvo] have been integral in setting the stage for the future of health IT for vulnerable populations."
But how does Dr. DeSalvo propose to serve everyone in this country? How far has the United States come since the HITECH Act in 2009, and what are the roadblocks that stand in the way of reaching her vision of using health information technology (health IT) to deliver affordable, quality care for everyone?
Those are questions she's intent on answering in the coming months.
Dr. DeSalvo and her team have undertaken a broad effort to review the entire care continuum, including addressing digital equity issues among providers in small practices, and more, in order to identify gaps, prioritize future initiatives and ultimately determine next steps. With plentiful data as HITECH funds sunset and meaningful use incentives for Stage 2 wrap up, the timing couldn't be better to identify and leverage learnings. The Office of the National Coordinator for Health Information Technology (ONC) has an aggressive list of new efforts planned to address the wide spectrum of learnings, strategy and planning that will illuminate the way forward:
- Report: HITECH Progress- Oct/Nov 2014
- Interoperability roadmap- January 2015
- National agenda for health IT- Spring 2015
To access previous ONC reports, visit healthit.gov.
For many groups, in particular the NHIT Collaborative, this focus on identifying gaps and leveraging learnings is welcome news. Multicultural communities comprise almost 40% of the nation's population today and are expected to be 54% of the US population by 2050 (according to US Census Bureau Projections, August 7th, 2008). The March 2015 report in particular promises to demonstrates how health IT initiatives have already made a difference in access and quality of care (while reducing prices and improving overall patient health), and also uncover areas of opportunity providers face including health literacy of patients, ongoing technical assistance for health workers using the new technology, and the ability to customize solutions to solve subtle barriers that may be population-specific.
Dr. DeSalvo already has insights into what's been learned and where the opportunities are. During her speech at the NHIT conference, she highlighted feedback from regional extension centers identifying a gap in adoption with small practice providers. Those smaller offices are frequently run by minority clinicians in minority communities. Their feedback - the HITECH Act incentives weren't for them. They clearly need tools and support including implementation, training, and language assistance to realize health IT's potential.
But leveraging learnings is not enough. Dr. DeSalvo spoke extensively about the role of collaboration as the fundamental element to achieving lasting change across the spectrum of health IT initiatives, stating: "If we are going to move ahead as a nation, this must happen collaboratively. The tent must be big, and we are committed to widening that tent so that we have as many voices and perspectives as possible…"
But why collaboration? With so many other crucial tools needed, why is collaboration first on Dr. DeSalvo's list?
The answer was frank- the wider the tents, the more stakeholders included, the more ideas brought to the tables and the more voices heard, the more lasting the changes will be. Giving out grants isn't enough, and one person (no matter how well-qualified) isn't enough. An effort this big, this wide-reaching, needs to be embraced by as many individuals and organizations possible. It's a movement! And we're all called to contribute.
The NHIT Collaborative has been a proponent of collaboration as the vehicle to propel health IT solutions to reduce disparities in underserved populations since 2008. As a public/private/community partnership, they envision the full impact of 100% adoption of technology and its ability to provide affordable, quality care. When individuals engage in preventative care and conditions are addressed early, individuals are healthier. And when individuals are healthier, they cost their health plans less. And when health plans cost less, they are affordable so that everyone can have access to the care they need and deserve. It's a cycle the United States is forging inch by inch, with Dr. DeSalvo's help. And the biggest challenge is to make certain that multicultural underserved communities have access to HIT and the targeted services, such as language assistance, they need to benefit in full measure...
The focus on collaboration, at a conference sponsored by an organization that champions collaboration, could have been seen as lip service. But the fact that Dr. DeSalvo's already put the wheels in motion to make collaboration a key element of her plans, left no doubt in anyone's mind about her level of commitment.
She and her team have "set the table" for an advisory council with federal agencies including, but not only agencies within HHS, the VA, the DOD, the Social Security Administration, the FTC, NASA, and the FCC. As the largest payer for health care, the government has valuable information and connections to aid the cause, as long as it is safe and secure. She also highlighted the need to recruit a wide variety of talent in work groups and committees, to make sure the voices of all communities are heard.
But she's not stopping there. States have an array of powerful levers to contribute to the ecosystem and the conversation (including certificate of need, state grants, licensure of facilities, participation in Medicare, and more) and are able to filter down and get closer to the communities in need. To get that valuable perspective Dr. DeSalvo and her team are in the process of conducting listening sessions across the country to understand how people view health IT challenges, and how they view the role of the federal government in addressing those challenges. This qualitative data will help to identify gaps, prioritize initiatives, and make conscious tradeoffs as she and her team shape the roadmap and national agenda.
Dr. DeSalvo also commented on the opportunity to include behavioral health and post-acute care information in her health IT interoperability agenda. While these two areas were not included in the list of providers deemed eligible for meaningful use incentives in the HITECH Act, at the state level there is an opportunity to allocate resources to efforts to align data, potentially through a separate EHR system. Dr. DeSalvo acknowledged several states including Vermont, Kentucky and Michigan who have been leaders in the conversations around the use of this data, and whose insights and perspective are invaluable.
And finally, hinting at what will be released in January's roadmap, she touched on collective impact- a strategy of building a cross-functional team to solve complex problems. This approach requires strong leadership, a focus on ideas, and continuous proactive communication. While perhaps challenging to implement, the payoff is that with a shared vision and goals, everyone is part of the process and has an opportunity to be heard. This collaborative approach is Dr. DeSalvo's priority strategy for executing on the elements of the upcoming roadmap.
With Dr. DeSalvo's fundamental support for collaborative efforts to drive health IT solutions that eliminate health disparities for multicultural and other underserved populations, the NHIT Collaborative will be working on action plans in part based on the four areas of opportunity she identified as top-of-mind moving forward:
- Leveraging- Health IT can identify, address and decrease disparities, but new innovative ideas are needed. There are successful examples to draw from including the Health IT Fellows program, which works with front line clinicians and office staff to customize their systems to meet needs of the populations they serve, and create learning communities to share info across country.
- Partnership- The key to success lies in furthering the public/private partnership in place today. By engaging a broader set of stakeholders in the advisory committee, work groups, fellow programs and conversations, all people across country will have an opportunity to express their needs and wants.
- Adoption and tracking- The end goal is to help providers, regardless of the populations they serve, to have effective IT systems. While regional extension center programs are currently available, new ways to reach out and provide providers with the tools to adopt and adapt must be found.
- Care quality and quality measurement- There is more work to be done in creating certification policies, as well as examining how quality measurements and health IT functionality can aid in disparity reduction. There is also interest in understanding how to stratify populations to better identify disparities, with the intent to enable technology solutions that aid in collecting that information to help shape countries knowledge of how to help underserved populations.
DeSalvo's message at the NHIT Collaborative's conference was clear- there is much to do to reach the vision of using health IT to help drive equitable, affordable, quality healthcare for everyone in the United States. But she can't do it alone. It is everyone's responsibility, and the NHIT Collaborative will play a key part in the movement to attain optimal health care for all.
About NHIT Collaborative
Established in 2008, the NHIT Collaborative contributes to the elimination of health disparities and the attainment of optimal health in underserved communities. To achieve these goals, the NHIT Collaborative promotes the use of health information technology (HIT) by and for the underserved, with an emphasis on communities of color. The NHIT Collaborative works in partnership with organizations and individuals to assure that providers and consumers in these communities benefit equitably from HIT advances and resources, and supports the full engagement of multicultural populations with respect to HIT planning, adoption and use; education and outreach; workforce development/training; policy analysis finance/sustainability; and research and evaluation. To learn more, visit www.nhitunderserved.org. In the months leading up to National Minority Health Month in April 2015, the NHIT Collaborative will release additional articles addressing key topics and ideas to shape future health IT initiatives.