In her keynote Thursday morning at HIMSS15, National Coordinator Karen DeSalvo, MD, said it's now time to "focus beyond adoption" of health IT and create an interoperable, learning health system "upon the strong foundation we all have built."

DeSalvo says she's participated in about two dozen listening sessions across the country this past year. After talking to the folks on the front lines "about what matters most to them," she said she's become "more and more optimistic" about the country's commitment to leverage health IT for improved outcomes.

She's also become more aware that it's important to "meet communities where they are," she said. This is a big and diverse country, and needs and capabilities with regard to technology can vary widely.

In Alabama, "they have challenges like lack of broadband access in rural communities," said DeSalvo. In New Jersey, close proximity to other states, and differing state privacy laws across state lines, are becoming increasingly challenging." In Silicon Valley, the entrepreneurial community has moved well past electronic health records and is already "thinking about the next phase," such as the Internet of Things.

At the same time, "communities move further when they work together," she said.

It's important to leverage that cooperation, as we move toward the next phase of digital health she said: enabling population health by "making sure health data is available for consumers, for our doctors, for everyone, when and where it matters the most."

We've come a long way, said DeSalvo. It's been "such an incredible accomplishment for just five years."

[See also: ONC calls for interoperability by 2017.]

But now it's time to push further.

"I do know it's hard work," she said. It requires "personal and organizational commitment." It demands "changes to workflow and changes to culture."

But the true benefits of health IT can only be realized when we're able to "digitize care experience across the care continuum," she said, calling for a nationwide healthcare ecosystem that thrives on "true interoperability, not just exchange."

DeSalvo said she's aiming strategically "beyond electronic health records," working to drive innovation "beyond meaningful use," spurred by a "vision of a learning health system" where data "is shared with appropriate consent to inform continuous improvement in healthcare and health, in real time."

"I'm optimistic that we have hit the mark with our interoperability plan," she said, referring to ONC's interoperability roadmap. The feedback she's received has convinced her that "this is the right path forward."

To get there "as quickly as possible," three big things must happen, she added.

First, we need to "standardize standards, including APIs."

Second, we need "clarity about the trust environment" around data security and privacy.

Third, it's critical to "incentivize, in a durable and sustainable way, interoperability and
the appropriate use of health information," said DeSalvo.

ONC projects such as the interoperability roadmap and its recent report to Congress on data blocking are part of it, she said. So is leveraging federal initiatives including meaningful use, other CMS payment rules and seismic changes such as the Department of Defense's upcoming EHR modernization project.

But the marketplace has a role to play too. Thankfully, "I am seeing collaboration like never before, especially in the private sector," said DeSalvo, pointing to industry collaboratives such as HL7's Argonaut project, and its FHIR standards framework.

All told, she said, despite all the work yet to be done, we're in a better spot than we've ever been before: "We are within reach of every American having access to their health information, when and where it matters to them most."

[See also: Interoperability in the cloud.]