Rulemaking in Washington takes a long time and that is one reason the Office of the National Coordinator for Health IT is relying on the private sector to partner with them to accelerate the process of implementing changes, ONC’s head said Wednesday at a policy conference in Washington.

Karen DeSalvo, M.D., said she frequently travels outside the Washington Beltway in response to an audience question about how anything can get done in the national’s capitol when there is the assumption that nothing gets done. On these listening tours, DeSalvo hears priorities, barriers and how the federal government is in the way or how it can help. Her next trip is to Oklahoma on Friday.

“I hear recurring themes quite a bit,” she said at the eHealth Initiative Annual Conference. “I’m doing my best to stay grounded.”

But she put in the caveat that the “truth is the arc of rulemaking and lawmaking is long and that is one of the reasons we are so strongly calling for the private sector to partner with us. … If we did this ourselves, it wouldn’t be as quick and nimble.”

ONC has points they would like the states to address, including harmonizing privacy, she said. Yet, there are other cases where the private sector is leading and ONC wants to see that continue. “Even if we got $92 million, that can only go so far,” she said referencing President Barack Obama’s proposed fiscal 2016 budget allocation to ONC. “We can’t do this alone. This has to outlive administrations. This is a community more broad than health IT.”

DeSalvo said people want something like an iPhone app that when you open it, it runs your store. As a doctor, she said she wants it to look how she wants it, not a vendor’s way. But to get there requires different technology than that is in use today. To do that, she said, advancement needs to work with what has taken place so far. “Everyone sees we want to move a new place, but we don’t want to throw out everything that we have,” she explained. “We need to be able to push data; we know that people want the ability to search.”


One major obstacle to implementing these reforms is cost. But DeSalvo said the business case is there that if people are spending additional dollars there has to be some interoperability. It is one thing to get the standards right, she said, another to get to the health system to use them, but a completely different question to think that data systems are not there for the health care systems to benefit people. “That’s where we want to push the envelope.”

For interoperability to be living and working system, it needs to be bidirectional, she said. That means patients can see not only what the doctor says to them but can contribute to their records in a “qualitative and quantitative way.”

By allowing consumers to be part of the conversation, it enables them to feel that health care is not a “mystery but something they have available to them,” she added. “Health information technology does not support decision or payment, it helps change care. When done right, technology makes care more accessible and convenient. That’s a place we all need to go.”

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