In case anyone was still wondering about a leadership vacuum at the Office of the National Coordinator for Health Information Technology, Karen DeSalvo, MD, is still national coordinator – a fact that was in evidence Wednesday at the close of the American Medical Informatics Association's annual conference.

DeSalvo – who was named acting assistant secretary of health at the Department of Health and Human Services this past month, to lend her public health expertise to the response to the Ebola outbreak – spent her entire keynote address talking not about Ebola or epidemiology, but about ONC and health IT.

ONC Chief Operating Officer and acting national coordinator Lisa Lewis, picked to provide "day-to-day leadership" at ONC, according to HHS, while DeSalvo remains in charge of policy, did not take the podium.

ONC has been facing a lot of criticism of late, from questions about why so many top people have left the agency since the summer – Judy Murphy, RN; Joy Pritts; Lygeia Ricciardi; Doug Fridsma, MD; and, soon, Jacob Reider, MD – and why there has been such slow progress toward interoperability of health information despite strong EHR adoption rates.

The health IT industry in general also has been under fire from people who believe EHR vendors have not paid enough attention to usability.

DeSalvo addressed all of these issues – indirectly, by asserting her leadership, and directly, by discussing the work ONC has done over the past decade and is involved in heading into 2015.

Programs at ONC have "laid the foundation" for health information exchange by encouraging hospitals and physicians to switch from paper to electronic records, DeSalvo said. She specifically mentioned that the Regional Extension Center program has reached 150,000 people nationwide.

However, DeSalvo acknowledged that rapid growth of EHRs "has created some growing pains," she said, thanking Fridsma for that line.

Usability, she added, is "maybe not what we should expect."

DeSalvo also discussed ONC's 10-year interoperability vision paper, currently out in draft form. A proposed strategic plan, based on this vision and the first such plan since 2008, will be out in about two weeks, she said, then the office will take public comments for 60 days before finalizing the document.

"The world since (2008), when we wrote the last plan, has moved," DeSalvo said. Interoperability has become "thing on top of people's minds," neither healthcare organizations nor taxpayers will realize the full value of health IT or see a solid return on investment without that piece.

DeSalvo said groups like AMIA should step in and lead on interoperability.