DeSalvo to HIMSS Press: Time for Health IT To Move Beyond the EHR

On the morning of April 14 at the Healthcare Information and Management Systems Society conference at the McCormick Place Convention Center in Chicago, DeSalvo and her team at the Office of the National Coordinator for Health Information Technology (ONC) gave brief statements and answered several questions from a few dozen members of the press, mostly regarding interoperability, meaningful use, patient engagement, and information blocking. 

DeSalvo officially announced the availability of $1 million in grant funds to support community projects for the Community Interoperability Health Information Exchange (HIE) Program. The funding will aim to help support and enable the flow of health information at the community level, leading to better care and better health, according to an ONC press release. The program will provide funds to up to 10 community organizations, state or local government agencies, or other community groups. "This will challenge the community to come up with new and innovative ideas, and advance ideas to think beyond EHRs and the traditional players," DeSalvo said at the briefing. 

What's more, under the new grant program, awardees will demonstrate the use of health IT to the wide range of health providers, including those that are not meaningful-use eligible, including long-term and post-acute care providers, and behavioral health providers. In fact, throughout much of her briefing, DeSalvo and her team pushed the notion of doing more to help these non-eligible care providers. Jodi Daniel, ONC's office of policy director, said that the agency has heard from these providers and have since separated some of the meaningful use-only requirements for those who aren't applicable for the program. 

DeSalvo additionally continued to push a more interoperable healthcare, saying this is the "year of execution." She said that ONC is "all hands on deck," and has been working with federal partners, states, private payers, and other organizations to standardize standards, and create the right environment to get data unlocked and moved. "The idea is to move data not only between EHRs, but between other repositories, and get to a place where you can leverage technology for better care delivery, and make care more convenient, accessible and patient-centered," DeSalvo said. She added, "the EHR is one of major drivers to advance care, but the world has evolved and advanced, and now the ecosystem is much broader than EHRs. To provide person-centered care, you need a model that's beyond episodic visits, and we need to make certain that we're allowing technology to evolve. EHRs only tell one part of story," she said. 

Regarding an ONC report that was released last week to Congress that detailed several examples of developers and health systems blocking health information sharing between each other, Daniel said that ONC has been hearing about it a lot, and has since looked at the evidence in the wake of complaints. "We do believe that information blocking is a problem and needs to be addressed," Daniel said. "It's one problem for interoperability, and we need to take action on it. The intent is to work with Congress to close the gaps," she said. DeSalvo added that it will take more than just the federal government to solve this problem. "It will take action on the part of the government, but also providers and developers will need to set expectations and contracts to have more transparency," she said. 

Another hot topic during the briefing was the recent feedback at HIMSS15 regarding CMS' proposed Stage 2 modifications to the view, download, transmit (VDT) patient engagement measure. Last week in its proposed meaningful use changes, CMS recommended dropping the number of patients required to VDT their health information from 5 percent to a single person.

At the briefing, a member of the press brought up that an ex-ONC National Coordinator for Health IT, Farzad Mostashari, has been very vocal at HIMSS, voicing his displeasure about the rollback. To that, DeSalvo somewhat sidestepped the question, saying that ONC's commitment to consumers having access to their health data has not wavered. "That control must be meaningful, and engaged, which means not just looking but having bi-directional engagement about the records," she said, adding that she hopes to foster dialogue with all stakeholders regarding the patient engagement requirements. "Let's everyone come to the table and figure out a path for it. We all want the same thing, so now we need to come up with solutions." She noted that the dialogue started by Mostashari has "advanced that conversation." 

Daniel provided a bit more clarity to the situation, noting that the requirement that says that providers need to provide patients with the ability to VDT has not changed. "All that has changed is the number of patients that actually do it," she said. "There are tools beyond the patient portal," DeSalvo added. "It's about much more than the technology, but it's about appreciation and understanding the real challenges in communities that we cant leave behind. You have rural communities and seniors that aren't so digitized. You need to focus on outcomes, but think about the tools and cultural  changes too." She added that the modification is "just a proposal and can be worked out." 

Finally, DeSalvo touched on the Sustainable Growth Rate (SGR) repeal bill, saying that "if the president is supportive of it, so are we," a comment that generated laughter from the audience. "It's an opportunity to move the dial away from the way we have been doing things, focusing less on volume-based primary care," she said. "We have been thinking about it, and we know there will be an opportunity to move to a new definition of meaningful use, potentially. The rules allow for some simplicity and clarity with meaningful use, rather than multiple stages. We are certainly thinking about how to be ready for it," she said.