As a former Obama administration official, Karen DeSalvo, M.D., has devoted much of her career to the dream of true interoperability.
If there's anything she learned, it's that the healthcare system won't be able to get there on its own.
"It’s a lot about technology, but where we need to get to as a country is truly putting the person first," said DeSalvo, who served as acting assistant secretary for health at the U.S. Department of Health and Human Services (HHS) in the Obama administration from 2014 to 2017. She also served as the National Coordinator for Health Information Technology from 2014 to 2016, where she set national strategy and policy on health IT.
"It’s their data and the business is built around supporting them; the data is not there for people to financially gain from," DeSalvo told FierceHealthcare. "I’m excited that we’re starting to get that idea. But we won’t really get there until the CFOs understand the importance of data sharing."
DeSalvo recently joined the Boston-based venture platform LRVHealth as an executive adviser where much of her focus has also expanded to investing in programs that address social determinants of health. "It’s not about building a better mousetrap for healthcare, but really advancing innovative ways to improve access to quality care to make it more affordable They are looking at business models and technology that can address a broader set of health inputs including the social drivers of health,” she said.
She also is a professor of medicine and population health at the University of Texas Dell Medical School in Austin, Texas. Her hometown continues to be New Orleans.
Here’s more of what DeSalvo had to say about the current administration’s push to drive interoperability across the industry and the importance of social determinants.
FierceHealthcare: What do you see as the biggest challenges in healthcare right now?
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Karen DeSalvo: I’m really excited about how we’re beginning to use data for better analytics models to predict who is going to get sick or who is going to have clinical problems like sepsis. We’re getting much better at using analytics of the data to get ahead of these challenges and be more preemptive in people’s health outcomes.
I think we’re just starting to think through how we can better use technology to make care more accessible and more affordable. Telehealth is the most common thing we think about as a tool for that, but we haven’t yet shown that it can make care more efficient, except in some populations like incarcerated populations. We’re seeing other technologies that are being used in the field like 3D printing and people experimenting with holograms and we’re starting to rethink how much does a human need to be in the room with another human.
All of this is creating a lot of dynamism in the field ... It’s going to be a big shift, and it’s going to change everything. It’s going to change brick-and-mortar expectations, it’s going to change training and medical licensure and also change access to medical and nonmedical drivers of health.
FH: How can the healthcare industry make some headway in addressing social determinants of health?
KD: What we’re learning more about in the last two years is how it affects healthcare cost and utilization and more concrete healthcare outcomes, things like readmissions to the hospital. That’s a great opportunity because it’s helping the healthcare system understand that it has equity in addressing the nonmedical determinants of health and we see them partnering up more with public health, and other sectors like housing and education.
As healthcare systems take on value-based models that have downside risk, we now have an opportunity where the people who are financially in charge realize that it's less expensive to address food insecurity, social isolation or even housing than it is to keep paying for hospitalizations.
There are some real pioneers that demonstrated this, like Jeff Brenner in the Camden Coalition, and Humana is doing some work around social isolation and food insecurity. The more this is getting into the peer-reviewed literature and talked about among health systems, we see that these pilots are starting to inform the debate about how we should be funding this, how much flexibility we should be giving to the healthcare systems, and how healthcare systems need to partner with other sectors.
FH: Looking back at your tenure at ONC, how did your health IT policy work set the stage for where the industry is today?
KD: When I was at HHS, I asked the team to reshape our thinking and take the electronic health records and Meaningful Use program out of the center of our work, put it aside and put the person at center and wrap data around them so it could inform efforts around advancing their health. That is reflected in our Health IT Strategic Plan that we did, which was a requirement from Congress.
A key part of that is that data sources are bigger than the EHR and bigger than what we were driving through the Meaningful Use program. We needed to think of a strategy that would put the person at the center and think about all the data that tells the story about their health and then finds ways to weave all that data together. That idea of a longitudinal health record led us to push this agenda around APIs (application programming interfaces) and having doorways to the data using a non-proprietary technology like FHIR. We wove that into the strategic plan, this idea that data needed to be shared and we were going to require it where we could.
I want to give a big shout out to the current administration for building on that work. In the nationwide interoperability road map that we created during my tenure, we signaled that one pathway to force data sharing would be making it a condition of participation in Medicare. So, I’m thrilled the administration is continuing to carry forward that general idea—putting the person at the center, making sure data is available to inform their care and aggregating that into a longitudinal health record. It’s absolutely where we need to go because, otherwise, we’re just working in one-off pieces of somebody’s health.
FH: What are your thoughts on the state of interoperability now?
KD: I’m excited about how nuanced the country has gotten about interoperability; it isn’t just about the exchange of data, but that the data also arrives in a machine-readable format and so it can be integrated into a record more seamlessly ... But the reality is, when you show up in the doctor’s office, they don’t have your information. It doesn’t feel real, and that still frustrates me as a doctor, as a person, and as a policymaker. I think it goes back to business decision-making.
When we have a disaster, like last year in North Carolina and the year before in Florida, when health information needs to be shared, either between hospitals or HIEs, we do it overnight. The technology allows for it. We do this all the time in the middle of a crisis which tells me that, technologically, it’s possible. But in the regular every day, the business interest of your data has value to my institution, usually a healthcare institution, or maybe an EHR company, or a health plan, so I’m not going to share it. This whole process of data liquidity and consumer-mediated exchange and the rules that ONC and CMS just put out, which push that issue that you can’t block, and if you want to be a part of Medicare you have to share data, these proposed rules are extremely important because they change the business model.
FH: So there needs to be a better business case for interoperability?
KD: CFOs understand the operating model and they are trying to keep people employed and keep the lights on. I have a lot of respect for them. We just need to build a business case that makes enough sense for them. That’s what we were working on, aligning interoperability with value-based payment models, that was our strategy at HHS. I’m excited that they are layering on additional expectations now with rulemaking. It would be great if the private sector would just do it, but they won’t. They are not caught up with the expectations, so we have to help them catch up.