National Coordinator for Health Information Technology Karen DeSalvo, M.D., admits there have been “growing pains” with health IT yet argues that the big picture remains that HIT can advance not only healthcare in this country but serve to improve health as a whole by tracking patients over time.

DeSalvo acknowledged that “rapid growth has created some growing pains” during a Nov. 19 keynote address at the annual American Medical Informatics Association symposium in Washington. Coming from a hospital background, she told the AMIA audience she has experienced those growing pains first-hand and knows “how hard” it can be for small healthcare organizations in particular.

According to DeSalvo, the main challenges facing health IT are:

*Usability of the systems—interfaces that are not present as in other industries.

*Reporting and click boxing that get in the way of a patient’s narrative. “Those digitized care experiences,” she said, “[do] not always tell the context.”

*Payment for the systems: There are questions about how to pay for the new systems moving forward, she said. While there were grants at the beginning, those are waning and everyone wants to make sure they are seeing a return on the investment. That ROI includes making sure data collected is put to its full value of reducing the burden of care on people’s lives.

“As we think about those challenges and many lessons we have begun to learn…we are thinking about where we are going in the next decade at ONC,” DeSalvo said, emphasizing that the agency is looking at how to best prepare the organization to meet the future of health IT.

This preparedness, she said, includes ensuring that ONC is staffed up properly to be a partner, how to work with federal partners, and “what is the future that we need to be prepared for to protect health data for people and make sure it moves.”

In the last few months, DeSalvo said ONC has taken steps to do that including a restructuring from being a granting organization to a true coordinator for health IT that thinks through the policy levers. “We are neutral,” she explained. “We don’t have a dog in the hunt; we are not making a product. We see things available to advance people’s healthcare and health.”

DeSalvo also announced that within the next two weeks a call for feedback on the draft Federal Health IT Strategic Plan will be released publicly for comment. The primary goal of the 2011-2015 Federal Health IT Strategic Plan was to accelerate the adoption of electronic health records and to facilitate information exchange to support meaningful use. However, the next iteration of the plan will set ONC’s priorities to advance technology beyond EHRs, she said.  

Part of the plan, DeSalvo said, is based on the understanding that the health eco-system is not only electronic documents but is broader and tells the picture of a person’s health. “That means we need to find a way to advance health IT going way beyond meaningful use,” she said. “It is a great program, but it is one of many tools in the toolbox that we have to…advance health IT and make sure we are being inclusive.”

In late October, it was announced that DeSalvo was leaving ONC immediately to become Acting Assistant Secretary for Health in the Department of Health and Human Services to help with the Obama administration’s Ebola response effort. In an effort to reassure the health IT community at large of her continued involvement in policymaking, DeSalvo has remained chair of the HIT Policy Committee and she continues to work on high-level policy issues at ONC.

Nonetheless, the College of Healthcare Information Management Executives and Healthcare Information and Management Systems Society sent a letter earlier this month to HHS Secretary Sylvia Mathews Burwell warning that their organizations only support DeSalvo’s appointment as the Assistant Secretary for Health if it is intended to be for a short duration with her quickly returning to full-time leadership of ONC. “If Dr. DeSalvo is going to remain as the Acting Assistant Secretary for Health with part-time duties in health IT, we emphasize the need to appoint new ONC leadership immediately that can lead the agency on the host of critical issues that must be addressed.”

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