Wednesday, October 29, 2014

The Changes at ONC and Next Steps

In 2014, there have been many changes at the Office of the National Coordinator.

Although I do not have access to an organizational chart, I believe the leadership of ONC and the changes in 2014 are as follows

National Coordinator: Karen DeSalvo (Named Acting Assistant Secretary of Health)
Deputy National Coordinator: Jacob Reider (Leaving in November)
Office of Care Transformation:  Kelly Cronin
Office of the Chief Privacy Officer:   Lucia Savage
Office of the Chief Operating Officer:   Lisa Lewis (Named Acting National Coordinator)
Office of the Chief Scientist:  Doug Fridsma, MD, PhD (Became CEO of AMIA)
Office of Clinical Quality and Safety:  Judy Murphy, RN (Joined IBM)
Office of Planning, Evaluation, and Analysis:  Seth Pazinski
Office of Policy:  Jodi Daniel
Office of Programs:  Kim Lynch (Leaving in November)
Office of Public Affairs and Communications:  Peter Ashkenaz
Office of Standards and Technology:  Steve Posnack
Interoperability Portfolio Manager: Erica Galvez

Although some have voiced concerns about loss of momentum, I believe that in change there is opportunity.

ONC has a served as a catalyst, accelerating the adoption of electronic health records by hospitals and eligible professionals.   Guided by the certification regulation, EHRs now include robust interoperability for public health reporting, transition of care exchange, lab result incorporation, patient/family engagement and quality data submission.

We’ve achieved a new baseline that did not exist 4 years ago.

Now it’s time for the private sector to step up and lead the charge on the next generation of interoperability - query/response based on FHIR, OAuth2/Open ID, and REST.   We need two implementation guides - one for document level exchange and one for data element exchange of the Meaningful Use Common Data Set (see the last page of this document)

A coalition of the willing - vendors, HL7, providers, program management, and champions from the private sector can keep the momentum going as we all drive to a new set of FHIR specifications in 2015 - a second Draft Standard for Trial Use based on lessons learned with the first draft standard.

Over the past few days, I’ve seen new energy and enthusiasm for accelerating interoperability, following the roadmap described by the Jason Task Force.

Rahm Emanuel said “You never let a serious crisis go to waste. And what I mean by that it's an opportunity to do things you think you could not do before.”

The combination of change at ONC, the Jason Task Force report, and new private sector urgency for interoperability is a perform storm for innovation

I think the weeks ahead will be filled with rich discussion about how all stakeholders can unify to accelerate the efforts already in progress.     It’s truly time for a new optimism 


Medical Quack said...

I don't know how you keep your sanity at times to write, and that's a compliment:) It's not the fault of the ONC with the way technology just rocketed the last couple of years and it's a challenge for them to keep up and I think technology again is dictating a change and fast and that's hard to keep up with. I would not want the stress myself either. I still think they might do better as their own entity at the FDA to collaborate with the device folks as technology is pushing in that direction anyway and then we would all win with 2 points of view in the same area versus back and forth. One of the folks at the ONC even liked that idea a while back and it makes for safer place when Congress goes over budgets too now that CCHIT is gone too:)

I keep looking at Zoeticx too and keep pushing it as it does interops "on the fly" if you will and has a couple APIs build and is on sale at the Allscripts store. It does the clinical side but with an open API there's room for more apps on their Clarity server that could be built for reporting, etc. An HIE can be used as a data source if desired along with direct interops and it has alerts and all the clinical whistles and bells along with the nice Ipad UI at both ends too. With the future of HIEs not really known and the fact that some have gone away, alternatives or back ups for interops might not be a bad idea. I think it was recently the ONC got a peak at Zoeticx along with some other folks in the industry and I look at it this way that we know Commonwell is building their platform too but they don't have to be the only fish in the sea out there either, although they might think differently:)

The EMRs already have their HL7 built in so on the interops why not go JSON to JSON on the fly it it works and is efficeint? Later when FHIR is done if it wants to become more elaborate it could be but the big deal is getting the clinical data shared and in front of the doctor's face and not require a constant live connection.

The World Privacy Forum put out some good videos too that explain to consumers what an HIE is and how you could or could not get your records from one and basically how they work.

I'm looking at the money to be saved with fewer HIEs as being a good thing.

Tom Mariner said...


As always, I agree with your sage leadership, which seems to be "Industry step up!" Yes, some amazing progress has come out of the past four years -- yes, some personnel changes at ONC has created some opportunities -- for great public servants to help us grow up with EHR, and for those of us who actually create these medically accessible snippets of data that hold the promise of even better, "affordable" healthcare.

It would appear the forces of the marketplace are helping us all follow our regulations and continue to work toward a neutral, effective, innovative future that lets us catch up to credit cards.

John has been accused / lauded as desiring a pause in our progress toward a digital health future at stage 2. I don't believe I got that from this post. Although the era of financial incentives is waning, I hope there is enough momentum to carry us into connected coordination with healthcare professionals and augment their talents with the means to help them make even better decisions.

Personal opinion not of any organization.