Dr. Karen DeSalvo, National Coordinator for Health IT

( Music)

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli .

Margaret Flinter: A nd I am Margret Flinter .

Mark Masselli: Well Marg a ret , the fallout c ontinues from the investigation into the
problems at the Veterans Administration heath facilities around the country .
Secretary Eric Shinseki offered his resignation and the President accepted his
resignation . It’s become very clear that there were far more systemic issues
underway , not only a t the Phoenix facility that first garnere d the negative
attention, but perhaps at dozens of other VA facilities as well .

Margaret Flinter: Well the story on the Phoenix VA hospital is that the average
wait time was 115 days to get an appointment , and they report that perhaps 40
veterans may hav e died while waiting for treatment , so a full scale national
review now underway at all VA facilities .

Mark Masselli: According to report s, there are some 40 facilities that may have
similar issues to report . It speaks to some lar ger issues at play here Marg a ret
where in something of a perfect storm a n aging veterans ’ population , more
complex health problems and older conflicts like Vietnam and Korea , we have
hundreds of thousands of new veterans seeking treatment from more recent
conflicts and really a shortage a s we all know of primary care physicians .

Margaret Flinter: Regardless of his departure , I think that this effort will continue .
The work of getting trust restored to the veterans administrat ion, which ha s done
so much good in so many areas an d created so man y innovations , just has to go
on ; this has to get fixed .

Mark Masselli: And it’s also been confirmed that there were systemic cover - ups
of these wait time records at various hospitals . Those responsible are going to
be held accountable a s the President has promised .

Margaret Flinter: You know Mark , it ’ s ironic because the VA has been out in front
on so many issues when it comes to utilizing electronic health records , making
health information available to veterans through their very suc cessful Blue Button
Initiative . So , in some ways , they have enjoyed some modern conveniences or
innovations that really have made their care more seamless and better for
veterans .

Mark Masselli: And that ’s something our gues t today is quite passionate a bout .
Dr . Karen DeSalvo i s new National Coordinator at the Office of National
Coordinator for Health IT .

Margaret Flinter: She has unique insights into the complexities of meaningful
use and we are really looking forward to hearing from her .

Mark Masse lli: That we are . And we will also hear from Lori Robertson ,
Managing Editor of FactCheck.org .

Margaret Flinter: And no matter what the topic , you can hear all of our shows by
g oing to www.chcradio.com .
Mark Ma sselli: And as always , if you have comments , please email us at
www.chcradio.com
or find us on Facebook or Twitter because we love to hear
from you .
Margaret Flinter: We wi ll get to our interview with Dr . Karen D eSalvo in just a
moment .
Mark Masselli: But first , here is our producer , Marianne O'Hare with this week’s
Headline News.
(Music) Marianne O'Hare: I am Marianne O'Hare with these Health Care Headlines . The
investigation into the Veterans Health Admini stration hospital issues continues in
the wake of the resignation of Secretary Eric Shinseki after whistleblower
allegations that dozens of patients may have died at the Phoenix facility while waiting for months for an appointment that didn’t come in time . Evidence is
mounting , issues made public out of the Phoenix facility are systemic throughout
the VA , the White House vowing to get at the bottom of all the problem s denying
merit bonuses to anyone higher up the VA food chain , and punishing those
engaged in falsifying VA hospital records to appear to be compliant with required
patient wait times .
More th a n four years after enactment of the Health Care Law, 6 in 1 0 American s
say neither they nor their families have been affected by th e sweeping measure .
A mong those who say the law has impacted them , Republicans, much more
like ly to say their families have been hurt by the law , while Democrats are more
likely to say their families have been helped th a n hurt . Measles, mumps, rubella,
the standard first line of immunization defense f or babies being born in America
but the recent uptick in parents refusing immunization for their babies has produced a downside ; m easles rates are at their highest rate in 20 years . While
the numbers are n’t particularly high , the trend is untenable , according to the
Centers for Disease Control.
Getting that bronze glow artificially is going to be tougher for kids under 18 i f the
FDA has its way . New regulations banning tanning bed used for teens under 18 ,
studies show 57 % to 75% increased risks for m elanoma for those folks engaged

in regular tanning bed use . And young skin is much more vulnerable to long ter m
exposure . I am Marianne O'Hare with these Health Care Headlines .

(Music)

Mark Masselli: We are speaking today with Dr . Karen DeSalvo , National
Coordinator at the Office of the National Coordinator for Health IT at the
Department of Health and Human Services. Before joining HHS Dr . DeSalvo
was the Health Commissioner of the City of New Orleans , where she oversaw
the tran sformation of the city’s public health system . An internist with the focus
on public health , Dr . DeSalvo taught at Tulane University School o f Medicine .
She also served as President of the Louisiana Health Care Quality Forum and
the National Association o f Chiefs of General Internal Medicine . She earned her
Medical Degree and Master’s in Public Health from Tulane University , and her
Master’s in Clinical Epidemiology from the Harvard School of Public Health . Dr .
DeSalvo, welcome to Conversations .

Dr. D eSalvo : Well Mark , thanks for having me .

Mark Masselli: You know , we have had the great opportunity of having a number
of national coordinators on , but you have shifted the focus of ONC beyond the
adoption of electronic health records t o meaning ful use and interoperability. So
first , could you share with us what the five main goals are in ONC’s mission for
Health IT and why is it a pivotal time to target our sights beyond implementation
to the next significant phase of meaningful use and interoperabilit y?

Dr. Karen DeSalvo : We have reached a tipping point . That give s us this
opportunity to start to think beyond the important role of adoption of certified
electronic health records technology in the clinical environment to looking forward
at a way to fr ee that data and see that it moves across the care continuum with
patients to save lives, to improve care, lower cost. We can beg i n to think beyond
health care as a key driver in improving health , which of course is important but
many know that almost 80% or more of people ’s health outcome is related to
where the y live , learn, work and play. So if we continue this progress in standard
data capture , collecting the health information to improve clinical care , we also
then have to build a good platform that allow s information from patients , from
the ir social environment to enter the health care and help information to not only
improve care but in public health , better patient engagement and empowerment .
And then that data can actually inform major public hea lth initiatives , do
surveillance work to improve the entire population’s health .

The agenda that we have is really dominated by the need to have an
in teroperable set of electronic health records but more importantly , a platform of
interoperability that al lows data to slow once captured in standard ized fashion . It
also means that we need to continue pay ing attention to creating the right floor
and see that there is not a digital divide but we are bringing the whole country

along and creating a solid, stron g, safe, secure platform that can support
innovation on top of it but also make sure that for everybody then to create a
system that is increasingly safe , that informs delivery , not only in the way of
payment reform but inform s delivery in the way of creat ing new model s that can
actually be much more patient s - centered .

Margaret Flinter: Well I think from a public perspective , entities like CMS , the
Office of the National Coordinator, CDC, Department Of Health a nd Human
Services might seem like very separa te institution s , everybody seems to be
singing fro m the same song book at this time about the need to focus on data
and the need to focus on the social determin ants of health along with the health
care that we deliver , and I think that’s going to serve us to great end . The third
would be from a public point of view , meaningful use of course , why would you
have anything other th a n meaningful use , but I don’t think outside of people who
are actually working on this, people really understand what that is. So maybe
just as a primer for our listeners , what are the core differences there and maybe
you can add on to that why have you chosen to delay the requirement for
implementation of Phase II to 2015 ?

Dr. Karen DeSalvo : Sure. It is such an important investm ent that our taxpayers
have made in modernizing the health care data infrastructure . And the HITECH
Act, which was part of the stimulus funding , provided an opportunity for the
country to make a financial investment that w ould offset the cost of adopting
certified electronic health records to create a structured way that physicians and
hospital s would first of all know that the product s they a re buying would be able
to perform the kinds of work that they wanted them to do . The funds would also
then help d irect the country to not only adopt but beg i n to engage and share
important quality improvement process es to help advance the nation ’s health
care , and then as we move into stage 3 , an opportunity for us to beg i n to think
about further advancing the intero perability of those system s that w e a re staring
to look at , not just the single visit of care and the care for the patient in front of us
but how that care can be rolled up across the continuum, understand where there
is redundancy or opportunities for us to improve people’s health care because of
the in teroperability and move towards outcome s. It also allows us to have better
shared standards like Legos or Lincoln logs that are the fundamental building
block s for this information about individual populati on s and the public health
overtime is going to really dramatically advance public health opportunities for
surveillance and care quality and safety and science .

Mark Masselli: So you have got going on in Washington the Datapalooza 2014 .
What are the goa ls of this year’s gathering of health IT geeks , if you will, and
what kinds of innovation are looking most promising in addressing this new
health data infrastructure?

Dr. Karen DeSalvo : So it ha s gone in a few short years from being non - existent
to now 2500 people coming from around the glob e to participate in a mixture of

events that include Code - a - thon , international work between the UK and the US ,
and then a series of workshops about exciting work and effort s that are
happening such a s our Blue Button Program that we are partnering with Great
Britain on. So it’s a really broad mix of big thinking and concrete thinking about
how data improve s health care and health and to really get to the promise of
sharing data across the continu um whether about indi vidual s or rolling it up into a
macro level for big data . We have t o have system s that can talk to each other .
We have to come to agreement that what pressure will be measured as an
integer in three digit s in the electronic health records and buy (inaudi ble 10:58)
devices . As we get closer to having agreement on these things , we really can
enable patient s .

So with all the excitement , we are thinking of a couple of important areas , one ,
that big data needs to -- we are really paying a lot of attention to the privacy and
security issue s; we sometimes may forget to make space for the patient ’s voice ,
whether that ’s patient - reported outcomes or their own variables or the self -
generated data, and that is critically important , it really matters , so we should
m ake room in the big data for them is what I am saying as s ometimes they can
tell us more th a n a lot of analytics . And the final piece is we should be thoughtful
about having a prior ity hypothesis les t we prove that w ater is wet for something
that we alrea dy know , and really use this opportunity that we have as a country
w ith computing analytics to advance care and health and science in really
thoughtful way s .

Margaret Flinter: You served as Health Commissioner of the City of New
Orleans a while back, ent ering that position a few years after Hurricane Katrina .
And you have been credited with doing much to enhance the public health
system in the city , building a health information infrastructure and also supporting
the improvement and development of commun ity clinic s. What did you learn
from that experience that other entities might be able to learn from on t he
national lev el and what’s the impact been?

Dr. Karen DeSalvo : What happen ed to us in New Orleans was horrific , but it was
also a chance for us to hit the reset button and start over and do better for people
in our city . We ha d a history of high cost, poor outcome and a population with
very limited access to care , a public hospital system, that once you were in,
dedicated and caring people to take care of you but no frontline . So we came
together literally in the early days after Katrina . It grew into a structured process
at the state level to drive health care reform , and all along the way , we knew that
strong health IT infrastructure w as critica l to helping us appropriately care for
people individually but to plan for new population s that would return . And frankly,
because of the devastation and the loss of our legacy paper system , we we re
able to jump over some of the problems in work flow redes ign and start these new
clinics that had never existed , with electronic health records . So as we built the
infrastructure for our city , it was meant to widen the tent, get everyone in , change
the financial model and the payment structure to support primar y care in the

neighborhood with medical home s and then inform ed care help ed to plan using
health IT .

And part of this was really underscored and better defined when I moved into the
city health department to shape that agency in to one that could really su pport the
public health in our community ; i t was really struggling . I am taking with me , to
this job , some of those lessons and they include that having a set of values and
princip a l s that guide your work in every decision and help keep everyone focused
a nd at the table, that as a public health official , you have the accountability to
everyone in your community , you have to help as many as possible . I also
lea r ned about the power of collective impact approach es. So setting a share d
vision with everyone w ho can participate , should participate and feeding back the
data on how we are doing , how we are progressing . And the backbone of that ,
the infrastructure , e specially if you take IT as an example , ON C doesn’t make
EHR s. We don’t have , as we say in the so uth, a dog in the hunt. Our dog in the
hunt is to see that everything is working in concert and that we are moving
forward in the country in an inclusive fashion that allows a leading edge of
innovation but supports more a standard ization that can bring e veryone along .
It’s how I am approach this work at the federal level.

Mark Masselli: We are speaking today with Dr. Karen DeSalvo, National
Coordinator at the Office of the National Coordinator for Health IT in the
Department of Health and Human Service s. Now your office recently la u ded the
recommendation of a report A Robust Health Data Infrastructure produced by
JASON, an independent group of scientist s that advices the federal government s
on matter s of science and technology . And the report calls fo r building a
framework that support s ONC ’s vision for effective and efficient interoperable
heath IT system s. Why are the JASON recommendations so important and what
are some of the interoperability changes that l ie ahead for us?

Dr. Karen DeSalvo : What ’s exciting about it is that i t speak s to a future vision
that is a lighter super structure , a super highway on top of (inaudible 15:32 ) of
data , and it creates a platform if you will that allow s data to enter and exit from
sources that go beyond electroni c health records . And the traditional notion that
patient ’s health information resides only in electronic health record of course is a
traditional notion . It’s an important piece data in doctors’ offices but there is
much more that we want to and need to be able to integrate more into health
data bank or into the Cloud based world, and this JASON report speaks to a
world that allows for that. It accounts for the legacy system s that provides for
potential pa th forward to allow other sources of data to be included . And it does
this in a way that is problem solving around the technology and takes advantage
of some advances in technology that are somewha t new . It also speaks to the
importance of privacy and security of data and some ways that we might be ab le
to ensure the privacy and security but also allow for it to be used as big data and
patient s have much more access to own information to help with their own
decision making .

The JASONs are not HIT people by and large and so this is the smart scientists
who came together to solve a problem , and in some ways , are looking at it from
the l ens of a different industr y or background , and it’s so helpful to have t he eyes
of folks who are not entrenched in the traditional world that could take a fresh
look . We are in the process of working with ARC and others to get feedback
from te chnical folks , from policy folks, privacy and security partners and get a
round er picture , see where there are maybe gaps in the report that might need to
be flushed out. And there n eeds to be a business model that support s a
sustainable infrastructure that is accessible to everyone irrespective of ability to
pay , geography, etc. So there are some big unanswered questions they
deliberately did not address in th e report because it’s n ot part of their scope, so
we will be looking to get those address ed .

Margaret Flinter: So Dr . DeSalvo , I wanted just to take one brief moment of time
to get your thoughts on another forward focus issue , and that’s training the next
generation . We spend a lot of time addressing the issue of training the next
generation of health care delivery professionals but we know we need to train the
next generation of health IT professional s as well. Is there a role for government
in this? Are you engaged in prom oting that at universities, colleges, community
colleges around the county ?

Dr. Karen DeSalvo : This is part of the capacity building , not enough to put in the
computer in the electronic health record and flip the switch . So you are exactly
right . We ha ve to be certain that from the front desk to the back office that there
is some sort of universal understanding of the potential and promise and
challenges of HIT . There is a vocabulary associated with it that should be
integrated into not only health pro fessional training but probably even beyond
that for anyone moving into the health care environment . The nursing field has
le d the way in this and they have curriculum that touches all their students . I
think that the y are a model we should consider as w e go forward . We can all
decide h ow deep it should go at ONC .

Because of the funding given through the HITECH Act, we we re able to spur the
development of curricula across the country , but a heavy focus on community
college s because those are places wher e such a large and important part of the
workforce train whether that’s in nursing or laboratory or (inaudible 18:59 ) or
management . And so we have been able to kick start thinking and structure in
that area , but there is a lot of work still to be done . We work in partnership with
HERSA, and increasingly , with the Department of Labor to see what ways we
can all collaborate and think so that we can help advance the capacity in the
country . I don’t want to miss the opportunity though to say that it’s not j ust about
the health care environment , the public health informatics infrastructure is a
critically important piece of this , and they are working as a community to advance
the capacity in public health informatics system, think through ways that they can
e nsure that they are prepared for a future in which there is information exchange

increasingly and that there is big data that needs to be address ed and handle d to
improve the public health .

Mark Masselli: We have been speaking today with Dr . Karen DeSalv o , National
Coordinator for Health Information Technology at the Department of Health and
Human Services . You can learn more about their work by going to HealthIT.gov
and you can follow her on Twitter by going to @KBDeSalvo. Dr . DeSalvo , thank
you so muc h for joining us on Conversations on Health Care .

Dr. Karen DeSalvo : Thank you all for having me .

( Music)

Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care reform and policy.
Lori Robertson is an award - winning journalist and managing editor of
FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in US politics. Lori, what have you got for us this
week?

Lor i Robertson : Well we have seen many candidates attacked for their support
of the Affordable Care Act , and now in the 2014 midterm races , we are seeing
candidates who opposed the law still be ing attacked for supporting it . The
attacks of course are false . For instance , in the Republican Primary of the
Mississippi Senate race , a tea party group is airing an ad that claims long time
Senator Thad Cochran “says he opposes Obamacare but he accepts a special
exemption for himself and his staff”. Cochran does m ore than say he opposed
the law, he voted against it and he voted to repeal it . As for the special
exemption , that’s not true either . Cochran and his staff went into the Washington
DC Insurance Exchange, as required of Congress by the law . The federal
g overnment picks up 72% of federal employees ’ premium s on average , just as it
did before the Health Care Law.

In the Arkansas governor’s race, Republican Asa Hutchinson accuses his
Democratic opponent Mike Ross of “ supporting t he bill that led to Obamacare ”.
Actually, Ross was one of only 34 House Democrats who voted against the
Affordable Care Act, and he was one of only three Democrats who voted to
repeal it in 2011 . Hutchinson ’s ad refers to a committee vote that Ross agreed to
only after securing cert ain concessions . And that’s my fact check for this week. I
am Lori Robertson, Managing Editor of FactCheck.org .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political players and is a project of the Annenber g Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradio.com . We will have FactCheck.org ’s Lori
Robertson check it out for you here on Conv ersations on Health Care.

(Music)

Margaret Flinter: Each week, Conversations highlights a bright idea about how
to make wellness a part of our communities and everyday lives. During the
school year, some 21 million American children receive free or red uced price
lunches through their schools, often the healthiest meal these children eat during
the school day. Yet, once school is out, only 10% of these children participate in
the free meal programs during the summertime, and studies have shown that
many of these kids tend to gain a significant amount of weight over the summer
as a result. A group of researchers at the University of South Carolina sought to
tackle that issue with a program they developed called the Healthy Lunchbox
Challenge. They deplo yed the program at a number of large community - based
summer day camps, and lead researcher Dr. Michael Beets says they relied on a
simple known fact about kids, they love competition.

Dr. Michael Beets: Staffers would then count the number of kids that b rought
those items and assign them points. You would get a point for a fruit, a point for
vegetable, a point for bringing in water. And then during the course of the week,
everybody’s group points are tallied, and so there is this competitive process.

M argaret Flinter: Dr. Beets says the simple competition and group rewards
system created a dramatic shift in the average camper’s lunch box from chips,
cookies and sugary drinks to more fruits, vegetables and bottled waters.

Dr. Michael Beets : But then o n the backend, we also saw that they also reduced
the things that we didn’t want them to bring in, without even saying “Please
reduce these things ” . And so kids are not just bringing additional fruits,
vegetables and water, they are substituting these hea lthier items for the less
helpful items.

Margaret Flinter: The study published in the Journal of Nutrition Education and
Behavior , they see this as a model for summer day camps across the country,
which serve some 14 million children per year often in un derserved areas. The
next phase of their study will look at the actual weight and body mass index of
kids in the next round of campers to calculate the impact on lowered weight gain.
The Healthy Lunchbox Challenge, a simple competitive challenge and rewa rds
system designed to get kids to switch out high fat, high sugar, high calorie foods
from their diets in favor of healthier snacks and beverages, now that’s a bright
idea.

(Music)

Margaret Flinter: This is Conversations on Health Care. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org and brought to you by
the C ommunity Health Center.