Although the U.S. Department of Health and Human Services (HHS) has yet to make an official statement regarding the appointment of Donald Rucker, M.D., as the next National Coordinator for Health IT, industry experts and leaders have not made secret their praise for the reported next head of the Office of the National Coordinator for Health Information Technology (ONC).
On March 31, media reports confirmed that Dr. Rucker, who has worn many healthcare hats over the years, including that of Siemens Healthcare senior executive, ER doctor, health IT architect, and clinical informatics champion, had his name listed on an HHS employee directory with the job title ONC National Coordinator. Politico’s eHealth was the first to report this news, though it should be noted that his name is not currently in the agency’s employee directory. When asked, federal officials continue to tell Healthcare Informatics that they cannot comment on personnel at this time.
Update 4/11/17: According to a source close to Healthcare Informatics, Rucker has very recently started his job as National Coordinator, but the agency is waiting for things to settle down in D.C. before making an official statement.
But despite the non-confirmation from the government, it didn’t take long for health IT groups to praise the appointment of Rucker, currently an adjunct professor at Ohio State University’s college of medicine in the biomedical informatics department and emergency medicine, and probably best well-known for the 13 years he was an executive at Siemens. As Healthcare Informatics Associate Editor Heather Landi reported on March 31, the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) released a statement noting, "As we move into the next critical stages of assessing the Meaningful Use program, we are pleased to see the administration rounding out its health IT policy team. Rucker's appointment [assuming official confirmation] comes on the heels of news that John Fleming, a former U.S. representative, will serve as deputy assistant secretary for health technology.”
Indeed, in recent weeks, speculation began to fuel regarding the cloudy future of ONC, the health IT branch of the federal government within HHS. With the appointment of Dr. Fleming to HHS deputy assistant secretary for health technology, a new position was created in the federal agency, thus leading folks to ponder if this would signal a diminishing of ONC’s future responsibilities. Adding to this speculation was a Politico report that revealed Fleming thought he was interviewing for the National Coordinator position at ONC when he met with HHS Secretary Tom Price, M.D. a few weeks back.
But now, the hiring of Rucker, along with that of Fleming, creates a leadership core with a strong resume. As Farzad Mostashari, M.D., former ONC chief in the Obama administration, puts it, “The administration seems to taking [health IT] seriously and seems to be appointing someone serious with longstanding experience who is qualified to lead this next phase of the work of the office. And that’s a relief.” Arien Malec, vice president of data platform and acquisition tools for RelayHealth (an Alpharetta, Ga.-based McKesson business unit), and formerly an ONC staffer, adds, “In aggregate [with Fleming and Rucker], what you have in this administration is a solid health IT leadership team that covers the basis of understanding the needs of providers, the perspective of vendors, and also the needs of policymakers, both at the Centers for Medicare and Medicaid Services [CMS] and on the Hill. And in general, that’s a strong set of assets to bring to bear on this challenge.”
And, regarding the new position created for Fleming, and the report that he allegedly didn’t know what exactly he was interviewing for, Mostashari, who was National Coordinator for Health IT from 2011 to 2013 and thus has insider knowledge of policy nuances, notes that the assistant secretary for health technology, like ONC, is a function that crosses over between public health and healthcare. “We saw Karen DeSalvo wear both hats, so the idea that you would want health technology to be baked into how we think about both healthcare and public health, how they come together, and how they support each other, is an important issue.” And Malec even brings up Mostashari’s tenure, recalling that he was a “special advisor” when he was first brought on to ONC. Malec says, “There is an art to how you title people’s jobs in the interim. Some of this might be explained by this administration pulling together the right people, putting them in the right seats and then clarifying titles roles and responsibilities later.”
Farzad Mostashari, M.D.
So, what are the biggest challenges that lie ahead for Rucker, his ONC team, and Fleming? Both Mostashari and Malec say that enacting the health IT tasks involved with the 21st Century Cures Act, the certification of electronic health records (EHRs) and other health IT products, and linking health technology to value-based care are the biggest points of emphasis moving forward.
Mostashari notes that one of the big areas where folks will look for leadership from ONC will first and foremost be making use of the infrastructure that’s been built over the last eight years to solve real-world problems. One of these is around quality measurement, he says. “We can’t keep doing what we have been doing on quality measurement, and one of the real disappointments so far of HITECH [the Health Information Technology for Economic and Clinical Health Act], has been the idea that we would automatically be able to report on quality based on data in the EHR has not happened yet or come true. So [Rucker] would be sympathetic to that burden physicians feel, and understand it. We can work together to solve that problem, and in the world of value-based payment, it becomes imperative to reduce the burden and increase the meaning of those quality measures.”
Malec adds that making health IT easier for providers is a continuity of the mission in the Obama administration that started and adjusted the path of health IT based on lessons learned in the field. “I don’t expect a radical change in the mission of ONC, but rather I expect continued continuity and a continued evolution towards making the health IT adoption approach more flexible and amendable to physicians, and better aligned with the needs of delivery system reform,” Malec says.
What’s more, Malec notes that there is “no question” that health IT products fraudulently claim to be certified but in reality they aren’t meeting the certification requirements in practice. So in this sense he think that ONC does need to have some level of oversight in order to correct and mediate. “I think ONC has better clarified the mission of oversight to be more of a force to help people work through that process and only using the heavy guns in the worst of circumstances,” he says.
Nonetheless, Malec continues, “We need to also think about the role of certification and the flexibility that we have relative to certification in a broader context. Why do many certified EHRs not meet doctors’ needs in practice? I would observe that there’s a lot of checklist-oriented certification where EHRs meet the certification rule but that certification rule might not be sufficient to meet interoperability in the real world.” He points to better success models in the form of public-private certification models, noting CommonWell, DirectTrust, and the Argonaut Project, in which there are organizations, vendors, and providers who are doing the work to make sure that products are interoperable in practices. Malec says, “That process is iterative, requires learning from the field and updating how you certify technology. That’s a poor fit for the regulatory framework. I have been an advocate for ONC delegating some of its authority to these public-private networks that may well do a better job in driving certification in practice.”
Regarding advice for Rucker as he settles into his new role in the coming days and weeks, Malec recalls a Health IT Policy Committee meeting years ago in which then-committee leaders put forth a timeline for the meaningful use program, moving all the way from technology adoption to a learning health system in four years. Malec says new policy leaders must learn from that as there needs to be a recognition that the U.S healthcare system “is a massive, safety-critical sector of the economy, so it doesn’t move as quickly as we want it to or expect it to. Defining clarity of where we’re going, aligning that with value-based payment, and tempering and driving reasonable expectations relative to the timelines to get there is critical,” he says.
And Mostashari, perhaps as good a person as anyone to give Rucker advice, simply says that he must play to his strengths. “ His strengths will be the ability to be go deep into the subject matter and to really understand and lead through confidence and knowledge. “He knows the issues more closely, more intimately and better than anyone else [who is] in a policymaking position, and that [will be] the influence around the debate,” Mostashari says. “That’s what I did and I think it will serve him well.”