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Mass ONC Departures: Are the Lights On With Nobody Home? Five Critical MU Questions Federal Health Officials Must Answer

November 4, 2014
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Mass departures among the top leadership at ONC have left the industry shaken and in search of answers

In recent weeks, an atmosphere of concern among healthcare IT leaders nationwide has turned to one of increasing alarm, as virtually all the senior officials at the Office of the National Coordinator for Health IT (ONC) have either departed or shifted focus, at a moment when issues around Stage 2, and the upcoming Stage 3, of meaningful use, have been piling up one after another. So much is happening now that one needs a scorecard simply to keep track of who’s left and what’s happening. So here’s a quick summary:

  • On Sep. 22, ONC announced that Doug Fridsma, M.D., Ph.D., the agency’s chief science officer, was leaving to become president and CEO of the American Medical Informatics Association (AMIA).

  • On Oct. 3, ONC announced that Judy Murphy R.N., the agency’s chief nursing officer (CNO) and director of its Office of Clinical Quality and Safety, was leaving to become CNO at IBM Healthcare Global Business Services.

  • On Oct. 23, Sylvia Mathews Burwell, the Secretary of Health and Human Services (HHS), announced that Karen DeSalvo, M.D., National Coordinator for Health IT had been tapped to serve as Acting Assistant Secretary for Health, in order to support the Obama administration’s Ebola response, and was “stepping away” from her duties as National Coordinator, while technically retaining the title.

  • On Oct. 24, ONC confirmed that Jacob Reider, M.D., Deputy National Coordinator for Health IT, was leaving the agency. The announcement of Reider’s departure occurred exactly 17 days after Reider had denied publicly to me at the iHT2 Health IT Summit in Washington, D.C. that there was any pattern in the ONC departures up to that point, stating for the record that “no hemorrhaging” was taking place at the agency. When Reider made that comment on Oct. 7, Fridsma and Murphy had already left ONC, as had Joy Pritts, the agency’s chief privacy officer (June 12), and Lygeia Ricciardi, head of its Office of Consumer eHealth (June 26); but DeSalvo had not yet “stepped away,” and of course, he himself had yet to make his announcement.

  • On Oct. 29, following widespread expressions of dismay and confusion in the industry regarding the DeSalvo Ebola management announcement, ONC published a blog in which the agency stated that “Dr DeSalvo will serve as Acting ASH while maintaining her leadership of ONC. Importantly, she will continue to work on high level policy issues at ONC, and ONC will follow the policy direction that she has set.” Just days earlier, Jeff Smith, vice president of public policy at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) had written in his Washington Debrief on this website, “Health IT leaders were shocked last week to learn the top two health IT officials from the Obama administration are leaving their posts,” referring to the DeSalvo and Reider announcements.

“DeSalvo is leaving the office at t a critical time, with MU attestation numbers below historic levels, and big policy priorities related to interoperability and Stage 3 yet to be finalized.” DeSalvo had gone so far as to announce in a committee meeting that she would no longer attend any committee meetings; but HHS and CMS (Centers for Medicare and Medicaid Services) officials quickly walked back that statement, reassuring healthcare leaders that DeSalvo would remain active in her ONC work while also dedicating her efforts to her Ebola preparedness work.

In his Oct. 27 Washington Debrief, CHIME’s Smith noted that fewer than 10 percent of hospitals scheduled to meet the Stage 2 requirements of meaningful use had done so as of that date, and fewer than 2 percent of eligible physicians had attested to Stage 2 at that time. Meanwhile, the development of an interoperability and patient safety roadmap was at that point (and still is, a week later) in its very early stages.

Why It Matters

The departures (including the “stepping away” of DeSalvo as National Coordinator) are not only alarming in and of themselves, but have two additional elements to them that are causing industry observers and healthcare IT leaders to become increasingly nervous, with some calling for drastic federal action of a variety of types.