Karen DeSalvo: 5 necessities to reach interoperability

The U.S. healthcare system isn't a catastrophe like Hurricane Katrina, but it's a slow boil, Karen DeSalvo, National Coordinator for Health IT, said Thursday during Health Care Innovation Day in Washington, D.C.

"The pain is greater and greater, breaking the bank for many Americans," DeSalvo (pictured) said to open the event, hosted by West Health Institute and the Office of the National Coordinator for Health IT.

Citing her experience as the City of New Orleans Health Commissioner in the wake of Hurricane Katrina, DeSalvo said she knows what it's like to build a system from the ground up. And health IT was at the foundation of all of the city's work.

"We began to plan. We needed to do better; it was about having information at hand for doctors," DeSalvo said. "We needed to understand population health."

DeSalvo stressed the importance of population health at January's Health IT Policy Committee meeting.

"That is the major next chapter that we must undertake as part of the President's major domestic policy initiative," DeSalvo said at the meeting. "[T]o see the promise of health information technology in the clinical interface for the health systems and the population and community at large to come to fruition." She added that she would like to see "real improvements" in health over time that could help with things like preparedness in the face of disasters. 

To DeSalvo, interoperability will inspire trust and confidence in the public and empower consumers to be more engaged in their care. Interoperability doesn't only need to adhere to the three-part aim of reducing costs, improving care and improving health--five more things, she said, are essential, including:

  • End-user adoption of electronic health records
  • Standards
  • Having the right incentives in place
  • Privacy and security
  • Proper governance and structure of health information exchange (HIE) balanced with equity in the system

DeSalvo said doctors, providers, the government and patients all need to broaden how they're thinking about the world. Patients live in many other places than in the doctor's office and hospital, and ideas about interoperability matter for aging in place, acute care and everyday wellness. Getting there is going to be a "complex and exciting endeavor," she said.

It's not just the basics, DeSalvo said, but also a matter of figuring out how to achieve interoperability with the never-ending onslaught of new medical devices. Creativity, innovation and coming to a consensus will be key.


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