DeSalvo: Interoperability crucial to patient safety

The former ONC chief thinks consumerism will play a major role in promoting data exchange.

Interoperability doesn’t just mean ensuring easy data exchange between two EHR systems anymore, Karen DeSalvo, MD, said on Tuesday. Patients have have an essential role to play, too.

DeSalvo, former assistant secretary for health and national coordinator for health IT, spoke at the Bipartisan Policy Center in a panel discussion with Andrew von Eschenbach, MD, former Commissioner of the U.S. Food and Drug Administration.

The discussion, moderated by former U.S. Senate Majority Leader Bill Frist, MD, was about “Patient Safety and Information Technology,” and it aimed to explore ways IT can still do better at enabling improvements to help prevent medical errors, which still cause the deaths of more than 200,000 Americans each year.

There are myriad ways health IT can help prevent adverse events, DeSalvo said, whether it’s the ability to check for drug interactions in an automated fashion rather than having to thumb through a hefty formulary with very thin pages, or advanced clinical decision support, which has shown that it can improve the safety of care.

We’ve come a long way since 2009, where the passage of the HITECH Act and subsequent federal investment of $36 billion laid the groundwork for a nationwide health information technology infrastructure, she said.

“The iPhone was barely on the market back then,” said DeSalvo. “We were barely thinking of IT in the way we do today.”

Flash forward eight years, and 90 percent of providers are up and running on EHRs.

“Many people have multiple electronic health records,” said DeSalvo. “We have a nice opportunity to leverage that data and make it more actionable.”

Culture change required for interoperability

But for all the progress the past decade, “IT is still in an adolescent phase,” she said. It can be clunky and there are challenges with usability, too. “There’s a lot of hunting and pecking still going on,” said DeSalvo, and plenty of work to do simplifying systems to reduce the signal-to-noise ratio for overburdened clinicians.

And interoperability, of course, remains a challenge.

“We’re increasingly using shared standards, but not quite there,” said DeSalvo. The flow of data is complicated too by “another suite of technologies that are unregulated because they’re about lifestyle and management,” and sometimes by providers’ misunderstanding of HIPAA, “which is meant to guide sharing, not prevent it,” she said.

One essential challenge to more widespread interoperability is cultural, said von Eschenbach. Physicians of his generation “grew up in a culture that was highly egocentric and individualistic.

“I was brought up to play golf, he said. “Today the game is basketball. We have to come together and work together in a more collaborative and interoperable way.”

DeSalvo agreed that quality improvement and value-based care depend on that collaboration.

“I don’t think you can get there without a team-based culture,” she said. “I still believe that moving to value-based payment is a driver to get more doctors to think about cooperation. Better data does change culture and behavior.”

But one key factor to changing attitudes about interoperability is often underappreciated, said DeSalvo: The role of the patient.

More widespread use of APIs has opened up opportunities for a lot of innovation, particularly with regard to consumer-mediated exchange, she said.

Giving patients more control over their health data “creates a completely different window to their health world,” said DeSalvo. “It doesn’t have to be two systems talking to each other.”

Increasingly, she sees data flowing toward places where consumers control, manage and share their data, enabled by trusted third parties and digital vaults.

“People have a willingness to free that data, so it can be put to good use,” said DeSalvo. “We are a team, and part of that team is the consumer.”

The model of healthcare is fast-evolving to make this more and more prevalent, as patients have more skin in the game with higher out-of-pocket costs, she said. They’ll have more agency to choose their providers based on the services they can provide, and “more and more they’re going to want to have access to their information.”