The recent announcement that National Coordinator Karen DeSalvo will serve as Acting Assistant Secretary of Health has left many industry folks scratching their heads and pondering what it all means for the ONC’s long-term viability and its ability to complete its Meaningful Use and interoperability goals. Here’s a few things we do know:
- HHS and the ONC did a poor job communicating details of the change. When the initial announcement was made October 23, it was unclear whether or not the move was permanent. HHS originally posted a bio for DeSalvo that noted she “previously held the role of National Coordinator for Health IT.” Five days later the ONC clarified the bio wording was a “mistake” and that DeSalvo would remain chair of the HIT Policy Committee, would continue to lead the development and finalization of the Interoperability Roadmap, and remain “involved” in MU policymaking. Meanwhile, Lisa Lewis will provide day-to-day leadership of the ONC.
- The same day HHS originally announced DeSalvo’s new role, the ONC’s Deputy National Coordinator Jacob Reider announced he would be leaving the agency at the end of November after three years of commuting between DC and his family in New York.
- The ONC has lost several other key leaders this year including Chief Scientist Doug Fridsma (to AMIA), Office of Clinical Quality and Safety Director Judy Murphy (to IBM), and Chief Privacy Officer Joy Pritts.
- CMS has been experiencing Stage 2 MU pushback in recent months from both providers and vendors who feel the timeline is too aggressive and/or the bar has been set too high for many of the objectives.
In other words, the ONC has been in a bit of a turmoil the last few months and critics are worried that apparent “brain drain” may create a leadership gap that jeopardizes the achievement of the agency’s goals.
In a recent HealthIT Buzz blog post, DeSalvo and Lewis attempted to quell these concerns, saying that that everyone in HHS is “committed to the work of ONC and ONC’s mission.” However, the situation reminds me a bit of a football team that replaces its starting line-up in the third quarter when the game’s outcome is too close to call.
I am not suggesting that the remaining ONC leaders are the “B” team players that aren’t up to the task at hand. Rather, I am questioning whether the “coaches” are truly committed to winning the game, now that the “easier” goals have been achieved. And by easier goals, I am suggesting that when the HITECH Act was passed in 2009, providers were relatively accepting of the need to purchase a certified EMR and fulfill the Stage 1 MU goals for incentive payments. The agency was flush with billions to fund various health IT-related efforts such as training through Regional Extension Centers and health IT/patient-centered care initiatives through the Beacon Community program.
Fast forward to 2014. While EMR adoption has grown tremendously, a few red flags have popped up:
- 53% of hospitals had adopted some sort of EMR through 2013, but 41% had not. Furthermore, less than 6% of hospitals had adopted EHRs that could meet all Stage 2 MU requirements.
- 78% of all office-based physicians had adopted an EHR through 2013, but only 37% of solo practitioners.
- Only 14% of physicians were able to share health information outside of their organization and only one-quarter of physicians routinely enabled patients to view, download, or transmit their health record.
- As of August 25, only 143 hospitals and 3,152 providers had attested to Stage 2 out of the more than 4,600 hospitals and 406,000 providers that have earned incentive payments since the program’s inception.
The toughest challenges are arguably in front of us. Stage 2 and Stage 3 remain big hurdles and we’re a long way from achieving goals for interoperability, standards, and health information exchange. If HHS leaders are truly committed to creating a national health IT infrastructure that supports electronic data exchange, they must work quickly to stabilize ONC personnel issues and ensure that forward progress is maintained.
In other words, now is not the time for HHS to lose sight of the ball.
Michelle Ronan Noteboom
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