The May 20 meeting of the Health IT Standards Committee (HITSC), one of the Office of the National Coordinator’s federal advisory committees, grew contentious after Jon White, M.D., acting deputy national coordinator, announced plans to replace the committee’s standing workgroup structure with targeted, time-limited task forces at the end of June. Several members responded to the announcement by expressing frustration with how ONC ties the tactical work of the committee to longer-term goals.
“It became clear to us in dealing with NPRMs (Notices of Proposed Rulemakings) that it is hard to figure out how to divide it up among existing work groups,” White told the full committee. “Hopefully, this new structure will be more efficient with your time as a committee as well as make it easier for the public to participate. We also heard that we needed better focus in terms of handoffs from the Policy Committee,” he said. The change was announced in a blog post on the ONC web site the same morning. The blog post also noted that 10 members of the committee would soon have to be replaced as part of the regular committee renewal cycle.
Steven Poznack, director of ONC’s Office of Standards and Technology, said, “the longer out a workgroup is looking, the less connected it is to the advice ONC will be seeking. Something a standards workgroup may put something on its roadmap for six to 12 months out, that doesn’t necessarily align with something ONC is going to be seeking advice on.”
Committee member Arien Malec of RelayHealth Clinical Solutions noted that a previous reorganization of the committee involved a process of soliciting the committee’s input. “I don’t feel it is respectful to announce a reorganization via a blog post,” he said. It would be more appropriate to have ONC say here are problems and here are suggestions for reorganization and then ask if committee members have feedback, Malec said. He added that both task forces and work groups can be successful, “but it is hard to believe we are going to have ad-hoc task forces build up the institutional knowledge about legislative and regulatory requirements and limitations with no attachment to the existing work group structure. I very much worry that the proposed structure gets us in a reactive, tactical mode.” If the work groups have not been functioning well, he added, perhaps ONC should reflect on how it could do a better job of long-term planning work.
Dixie Baker, a consultant with Martin, Blanck, and Associates who has headed up a security-focused workgroup for years and is one of the committee members whose term is expiring, noted that the subject matter experts in security tend to be subject specific, not task-specific. “I think it is a serious mistake to abandon the subject-matter focus for a task-force focus,” she said.
Stan Huff, M.D., chief medical informatics officer at Intermountain Healthcare, said he has experienced frustration that the work of the committee was narrowly focused on questions such as SNOMED vs. LOINC codes without a picture of what ONC would like the world to look like five years from now. “I have never seen a diagram of the way this is going to work,” he said. “What I am trying to say is that whether you use a workgroup or task focus, what is lacking is an opportunity for this brilliant group of people to lay out a vision of what should be. That is not addressed by the roadmaps we have seen. They were created by committee and do not give a coherent vision at the level of detail that would allow you to pursue a new architecture and information flow that would be enabling for the country.” He noted that issues appear “in semi-magical form on our agenda. We tackle each one in the best way we know how. But they are not attached to a vision of where we are trying to get to. That is what is lacking in these deliberations.”
John Halamka, M.D., the committee’s vice chair, said it would be useful for ONC to enumerate strategic barriers to interoperability it wants to streamline, whether they involve application programming interfaces, value-based purchasing, or provider directories, and then figure out the structures the committee should take. “Form follows function,” he said. “Sometimes that could be very tactical; other times more longitudinal.” For instance, he said, “security is not a project, it is a process.”
ONC's Jodi Daniel said ONC appreciates the committee members’ concerns, but asked for their patience and support. “If we are really missing something, we can always re-evaluate and stand up a work group,” she said.