DeSalvo's ONC Departure: The ImpactIf Confirmed for New HHS Role, How Will ONC Goals Be Affected?
If the Senate confirms' President Obama's nomination of Karen DeSalvo, M.D., as assistant secretary of the Department of Health and Human Services, the Office of the National Coordinator for Health IT would be losing a strong leader but potentially gaining more clout for its various programs, several security experts say. Those programs include proposals for electronic health record interoperability and secure national health information exchange.
Although she would be leaving her leadership role at ONC, DeSalvo could continue to help advance EHR interoperability goals, and other ONC efforts, through her higher profile role within the Obama administration and more frequent interaction with Congress.
DeSalvo was nominated to the new post because she is highly respected within the Obama administration, notes David Whitlinger, executive director of the New York eHealth Collaborative, which operates New York's statewide health information exchange. And with the clout she would gain in her new role, DeSalvo would continue to be a proponent for ONC's efforts, he says. Plus, she would likely be involved in HHS's potential discussions to consider "seeking regulatory 'sticks' to get EHR vendors to commit to making progress with interoperability" that can help facilitate secure data exchange, he adds.
If DeSalvo's appointment to the new role is confirmed by the Senate in the weeks ahead, "She'll work with stakeholders, including Congress, to suggest several short-term improvements to electronic health records programs while experts work on the longer term 10-year roadmap, [the EHR] interoperability plan and [HITECH Act] 'meaningful use' Stage 3," predicts John Halamka, CIO at Beth Israel Deaconess Medical Center in Boston.
The White House on May 6 issued a statement saying that Obama was nominating DeSalvo - who has led ONC since January 2014 - to the position of assistant secretary for HHS. In that role, DeSalvo would be responsible for overseeing 12 core public health offices, including the Office of the Surgeon General.
DeSalvo was named acting assistant secretary of HHS last October to help in dealing with the Ebola crisis. But HHS quickly clarified that DeSalvo would be holding on to her ONC role while taking on her new duties (see ONC's DeSalvo Stays On: Questions Arise).
In a statement, HHS tells Information Security Media Group that if DeSalvo's nomination for the new role at HHS is confirmed, she will, indeed, leave her ONC post this time around.
The Senate has yet to schedule DeSalvo's confirmation hearing. As for the timing of replacing DeSalvo at ONC, HHS notes: "The department will aggressively pursue additional people to join this team to ensure that we continue to deliver results, and we hope to make additional personnel announcements in the near future."
The timing of DeSalvo's departure in the coming months is better than if she had departed last fall, some security experts say. That's because ONC is between phases of rulemaking for the HITECH Act's meaningful use program that's providing billions of dollars in financial incentives for adoption of EHRs by hospitals and physicians, Whitlinger notes.
ONC, and its sister HHS agency, the Centers for Medicare and Medicaid Services, in March released two sets of proposed rules for Stage 3 of the HITECH Act "meaningful use" financial incentive program for electronic health records. Both HHS agencies are collecting public comment on those proposals (see Analysis: HITECH Stage 3 Security Rules).
In addition, ONC is still reviewing public comment to its January draft proposal for a 10-year roadmap for EHR interoperability and secure national health information exchange.
The goal of the 2009 HITECH Act was to improve treatment outcomes and patient safety, and reduce healthcare costs, by promoting widespread use of EHRs as well as the secure exchange of patient data. But hurdles, such as challenges in exchanging data between EHR systems, as well as lingering reluctance by some healthcare providers to share patient data, have resulted in spotty and disappointing progress toward nationwide health information exchange.
That's resulted in impatience by some members of Congress, who want to see a tangible return on the taxpayers' nearly $30 billion HITECH investment so far.
ONC laying out its 10-year interoperability roadmap earlier this year shows that the agency is seriously trying to address those concerns, Whitlinger says. "The lack of interoperability and frustration by healthcare stakeholders, Congress and probably even within the White House was at a riotous pitch" last fall, Whitlinger notes. "The problems haven't been solved, but there's been significant progress by ONC and CMS. A road is in front of us now, rather than a cliff." (See Senate Scrutinized EHR Interoperability).
In an email sent to HHS staff, which was shared with ISMG, HHS Secretary Sylvia Mathews Burwell says DeSalvo "led the development of an interoperability roadmap to increase communication between electronic health record systems, while at the same time providing patients more access to their health data while protecting their privacy. She has also sought to harness the power of electronic health records to improve the health care delivery system in the United States and has been an active leader on the Department's delivery system reform initiatives."
DeSalvo's nomination comes only about 15 months after she joined ONC, so any successor could also potentially decide to shift gears at ONC. However, that's probably not likely, considering that a new presidential administration - and likely another new ONC leader - will be taking over in January 2017, some observers say.
DeSalvo's successor at ONC will essentially be a lame duck as part of the Obama administration, Whitlinger says. "So now is the time for the administration to make its biggest accomplishments" with progress in EHR interoperability and secure health information exchange efforts, he suggests.
Security expert Tom Walsh, CEO of the consulting firm tw-Security, says the departure of DeSalvo will not be too disruptive to the agency's long-term vision.
"Ten-year interoperability for secure health information exchange - with the way technology changes, I have a hard time believing that a 10-year plan really means much," he says. "A three-year plan would be more realistic."
As for the direction that ONC has been going with privacy and security issues, "I am still concerned about data integrity," Walsh adds. "Interoperability is fine, but 'garbage in; garbage out' - interoperability just makes it faster to pass the 'garbage'." ONC should pay more attention to data integrity issues in its proposals for certification requirements of EHR software, he suggests.
ONC's interoperability and secure health data exchange proposals remain incomplete, says security expert Mac McMillan, CEO of the consulting firm CynergisTek. "Interoperability is one of the critical components of building trusted environments, but along with that you need standards for security and technology, and those have yet to be developed or presented as part of their strategy."
McMillan says DeSalvo's move shouldn't be viewed as a negative. "Since she is not leaving HHS totally; you would assume she would still be able to lend support to whoever her successor is," he notes. "Secondly, this is a 10-year program, so it's a marathon not a sprint, and none of the folks that are there today at the program's inception are likely to be there for its completion, especially when you consider that most are political appointees, meaning in a year and half many of them will be leaving anyway. So the success of interoperability is not hinged on DeSalvo; it hinges on the industry's adoption of it."
The Successor at ONC
As for suggestions for who should replace DeSalvo at ONC, McMillan says: "I would suggest that if interoperability is the new goal, then someone with a strong technical background or a chief medical informatics officer would not be a bad idea."
Charles Christian, who recently left his post as CIO at St. Francis Hospital in Columbus, Ga., to become vice president of technology and engagement at the Indiana Health Information Exchange, says he hopes DeSalvo's successor at ONC will have her knack for collaboration.
"It's my hope that the individual that follows her will have the same listening skills and a willingness to partner with the industry. The journey has only begun and I believe the work that we've accomplished, so far, is work worth doing," says Christian, who is also chair at the College of Healthcare Information Management Executives.