Trimmer ONC will have its work cut out for it

Midway through her first year as national coordinator for health IT, Karen DeSalvo, no doubt, has put her stamp on ONC.

In a pair of April meetings, DeSalvo, who started in January, outlined plans to streamline the agency's policy and standards committees, efforts that seemingly would create more cooperation and less siloes between the federal advisory groups.

Those discussions foreshadowed DeSalvo's latest move--the organizational realignment of the entire agency, announced on May 30. ONC--in consolidating and reorganizing--slashed its offices from 17 to 10, creating what DeSalvo called a "flatter and more accountable reporting structure" in a memo to ONC staffers.

The big question now: What can we expect of ONC going forward?

John Halmaka, CIO at Beth Israel Deaconess Medical Center in Boston and co-chair of ONC's Health IT Standards Committee, told FierceHealthIT that the move will enable the agency to focus on "high-value, low-complexity" priorities.

"I would much rather reduce Meaningful Use Stage 3 from 19 proposals to 10 and the S&I framework from 18 projects to five," Halamka said. "I'm hopeful that this new alignment will provide the enhanced management oversight and coordination to do that."

A good example of better alignment, he added, was making Steve Posnack responsible for certification.

"In the past, Steve wrote the regulation and was ONC's top interpreter of the final rules," Halamka said. "However, certification and testing were done by others, so there were often real flaws in the scripts/test procedures. Now, the person overseeing the regs is the person overseeing the scripts."

However, attorney Brad Thompson, of Epstein Becker Green, called the reorganization "generic" and told FierceHealthIT that it isn't clear what the agency's focus will be once the spotlight is off Meaningful Use.

"The federal government has paid a tremendous amount of money to encourage the Meaningful Use of health IT, and I have yet to see a clear vision for how that use will be further developed after the money is gone," Thompson said.

He added that while ONC, more than most other agencies, wants to figure out ways to work cooperatively with the healthcare industry, at large--pointing to the health IT safety center proposed in the FDASIA report as an example--there aren't a lot of concrete plans for how to accomplish that.

"As of right now, the agency is only releasing an extremely high-level vision without much detail," he said.

DeSalvo has talked about prioritizing interoperability and population health management in her tenure, and also has mentioned the importance of keeping privacy and security top of mind. However, she alluded to the loss of funding as one of the reasons for the reorganization.

"The HITECH Act's health IT infrastructure and program investments are ending and it is our responsibility to take this opportunity to reshape our agency to be as efficient and effective as possible," she told her staff.

It will be interesting to see how innovative the agency can be in achieving those goals, particularly as those federal dollars start to dry up. - Dan (@Dan_Bowman and @FierceHealthIT)