Karen DeSalvo, MD, has stepped into the role of national coordinator for healthcare information technology at a time when American healthcare is in a state of unprecedented change.
Her resume shows that DeSalvo has the right mix of skills to advance the healthcare system while helping the IT industry create better tools for providers and patients alike.
A practicing internist, she recently led a purchasing committee select a new EHR system. DeSalvo served as the New Orleans public health commissioner until recently, after working at Charity Hospital and Tulane University’s medical school.
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DeSalvo’s experience in New Orleans -- such as patients suffering end-stage diseases that could have been prevented or mitigated and the disaster of Hurricane Katrina -- combined with her upbringing, left her with concerns about inequality in access to healthcare and an insufficient medical communications infrastructure.
Growing up in Austin, Texas, with a single mother, “I experienced healthcare through the public system,” in “public clinics that were not as a consumer-friendly as we would like,” DeSalvo told the Health IT Policy Committee during her second day on the job.
Regardless of how friendly and coordinated the providers were, “my mother made sure we took care of ourselves,” she said. “That’s the foundation for how I think about healthcare.”
DeSalvo studied biology and policy science at Suffolk University in Boston, where she also worked in public health on HIV and AIDS, before returning to the South for medical school and a public health degree at Tulane.
As part of the National Health Service Corps in the late 1980s and early 1990s, she ended up working at the Charity Hospital, one the country’s first hospitals that served the New Orleans’ poor for more than two centuries before it closed after Hurricane Katrina in 2005. It “was mecca,” she said, and also where she met her husband, another resident.
“That was formative for me not only as training,” DeSalvo said. “I had a chance to see patients in that environment and realized that though it was a good learning opportunity, it was really not what we should see for any person on the planet, much less the richest country in the world… people should not walk into the emergency department with end-stage disease.”
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Patients were routinely treated for end-stage cancers, adults with undiagnosed congestive heart failure and syphilis. “This was between 1988 and 1996," she said. "Not in the 1950s."
As a fellow at Tulane she took over the resident training clinic, which “was a mess and had to be straightened up,” and as chair of Charity Hospital’s medical records committee, she and others considered installing a computer-based system.
For myriad reasons, the idea “didn’t stick,” she said.
Then in 2005, after DeSalvo left Charity hospital and worked as a professor and researcher at Tulane, Hurricane Katrina hit the city and forced the evacuation of Charity Hospital and other medical centers. “That changed my life and the lives of many,” she said.
The hurricane took the lives of more than 1,800 people, flooded the bayou city for a month and led many people with health conditions experiencing what soon may be considered “never-events” -- on the road, in other states, without access to their treatment or medical records.
“I use the word: it was terrifying as a doctor knowing that my team had patients who were on antiretroviral therapies or had communicable diseases or were on cancer regimens and had to have timely administration with quick follow-ups, and we did not know where they were,” DeSalvo told the panel. “Pieces of paper did not go with them.”
But all of that “led to an unexpected opportunity” to find ways to try to ensure the whole city’s population had a better system for healthcare. “Because all of our institutions were closed, we had a rich period of dialogue and collaboration that led us to a new framework for healthcare in Louisiana," she explained.
Unlike administrators considering an EHR at Charity Hospital in the early 1990s, city health leaders now found that “health information technology was central” to new models of care, especially as an infrastructure that would support focusing more resources on primary care and prevention.
Translating those ideas into policies, DeSalvo ended up leading Louisiana's state-designated health information exchange organization and helped launch patient-centered medical homes and community-based care programs in New Orleans that have garnered national accolades.
Now, DeSalvo is tasked with leading an agency trying to guide American healthcare through complex problems similar to what she worked on in New Orleans, and others — with most providers using EHRs, though not all of them happily,payment policies in upheaval, patients demanding better service, and millions of new Americans entering Medicare, Medicaid and private insurance plans.
“The next major chapter that we must undertake,” she said, “is to see the promise of health information technology in the clinical phase for health systems, the population and the community at large come to fruition.”
