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Despite Dr. DeSalvo’s Departure, HIT Policy Experts Confident in ONCs Future

August 17, 2016
by Rajiv Leventhal
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The government’s expert agency on health IT has witnessed another shakeup at the top of its leadership, but policy folks don’t anticipate much change

Most of her peers will say that Karen DeSalvo, M.D., National Coordinator for Health IT for the last two-and-a-half years, accomplished a lot of good in a relatively short period of time when it came to advancing digital healthcare. Most recently, DeSalvo made clear that the Office of the National Coordinator for Health IT’s (ONC) priority moving forward would be to move away from focusing primarily on Meaningful Use and towards the creation of a healthcare system in which there would be a “person-centered path for improving health outcomes,” as Health and Human Services (HHS) Secretary Sylvia Burwell noted in her announcement of DeSalvo’s departure as ONC head last week.

However, DeSalvo’s journey as National Coordinator took an interesting turn in late 2014, when she took on a part-time role to lead HHS’ Ebola response team during the 2014 Ebola crisis. As such, rumors started swirling as to how long she would actually remain at her Acting Assistant Secretary for Health role while still overseeing ONC. But DeSalvo actually spent nearly two years juggling those two jobs, and for that many who have surrounded her during that time span have applauded both her work ethic and her multispecialty skillset. But it also meant that not many in the industry were in the least bit surprised when DeSalvo finally announced she should be stepping down from her role at ONC to be at HHS full time, giving way to Vindell Washington, M.D. It was not a question of if, but rather when.

Jeffrey Smith, vice president of public policy at the American Medical Informatics Association (AMIA), and formerly with the College of Healthcare Information Management Executives (CHIME) when DeSalvo started her ONC tenure, says that whenever there’s a shakeup at the top of ONC, there is an initial natural reaction to be concerned, but looking across federal agencies, one begins to realize that this is how business is done. “Look at the Departments of Energy and Transportation, and at HHS itself. You don’t see these executives and administrators stick around for more than a couple of years,” Smith says. “Those of us in health IT don’t have a 30-year history of working with the federal government. It’s a new area of policy, relatively. [The turnover] you see in ONC is actually consistent with how the executive branch is run.”

Jeffrey Smith

Arien Malec, vice president of data platform and acquisition tools for RelayHealth (an Alpharetta, Ga.-based McKesson business unit), and formerly of ONC, agrees that jobs of this ilk simply are not meant to last a lifetime, sharing an anecdote that shows how tough the job was. When Malec was working for the agency, the best time to get “instant emails” from ONC senior leadership would be at midnight on the East Coast, as they were still working at that time after putting their kids to sleep and before calling it a night themselves, he says. “It’s a hard job with a ton of political pressure and a tremendous amount of responsibility, and the average tenure of an ONC head over the course of the agency’s existence has been about two years. I think that tells you something about how hard that job is,” says Malec.

Indeed, neither Smith nor Malec were surprised in the least when hearing of DeSalvo’s departure last week, noting that that was always the eventual outcome when she took the Assistant Secretary position at HHS. In fact, Smith says that when Dr. Washington was brought on as a Principal Deputy in January, it was under the assumption that he would replace her and take over that head role when DeSalvo left.

Smith adds that what sticks to him most is how much listening and convening DeSalvo was advocating for and responsible for when it came to health IT policies and processes. “It’s not necessarily black and white when it comes to the differences between her and Farzad [Mostashari, M.D., former National Coordinator from 2011-2013] but I do think that she, as a function of coming into this conversation when she did, really did open up the doors of ONC and said ‘okay, let’s hear all the problems.’ And that was very helpful and fresh perspective when it came to trying to figure out what went right and wrong with Meaningful Use Stage 1 and Stage 2, and into Stage 3,” Smith says.

Taking a Look at Dr. Washington

In the announcement last week appointing Washington, who previously served as the president of the Baton Rouge, La.-based Franciscan Missionaries of Our Lady Health System (FMOLHS) Medical Group and as the health system’s CMIO, Burwell noted his involvement in key initiatives at ONC such as delivery system reform, the Precision Medicine Initiative, and the opioid crisis. “In his capacity as National Coordinator, Vindell will continue to lead the administration’s efforts to leverage health information technology to reform how we pay for and deliver care; transform health research and innovation to empower clinicians, individuals and communities to manage their health; and oversee implementation of the Federal Health IT Strategic Plan and the Nationwide Interoperability Roadmap to unlock digital health data and ensure it is widely accessible, usable, and transferable throughout the public and private sectors,” Burwell wrote.