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October 24, 2014 12:00 AM

DeSalvo, other departures signal brain drain at ONC

Joseph Conn
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    DeSalvo

    (This item has been updated with a correction.)

    The appointment Thursday of Dr. Karen DeSalvo as acting assistant secretary of health leaves the Office of the National Coordinator for Health Information Technology—already hit hard by key staff departures—further depleted. DeSalvo headed the office for the past 10 months. The ONC is the leader of the federal government's health IT promotional effort.

    Also leaving is the agency’s No. 2, Deputy National Coordinator Dr. Jacob Reider, a three-year veteran at the ONC, who said in his own message to ONC staff that he had coordinated his announcement with DeSalvo. Reider said he won’t be leaving until late November.

    Lisa Lewis, who previously served as the ONC's chief operating officer, was named as acting national coordinator. Lewis, a lawyer, has been with the ONC since March 2010, and becomes the first non-doctor to oversee the office. She served five months as acting principal deputy national coordinator earlier this year. During her first three years at the ONC, she was chief grants management officer, according to her biography on the ONC website.

    Related Content

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    Besides Reider, there are only two other physicians in leadership roles on the ONC staff, both relative newcomers. Physician informaticist Dr. Jon White is on part-time detail from the Agency for Healthcare Research and Quality at HHS, serving as interim head of the ONC’s Office of Clinical Quality and Safety and acting ONC chief medical officer. Dr. Andrew Gettinger, former chief medical information officer at Dartmouth Hitchcock Medical Center in Lebanon, N.H., is running the ONC’s patient-safety portfolio on a full-time but interim basis. Both appointments were made this month.

    To say there’s been turmoil and turnover at the ONC this year would be an understatement. It’s not only dealt with a change of leadership, but also its own changing role now that grants and electronic health-record incentive payments under the American Recovery and Reinvestment Act have either been exhausted or are running out. In March, Mat Kendall, ONC’s director of the Office of Provider Adoption Support, who headed its program for health information technology extension centers, stepped down. In May, DeSalvo realigned the agency, consolidating 17 offices into 10.

    In September, Dr. Doug Fridsma, ONC’s chief science officer, who headed the agency’s multiple projects on standards and interoperability, left to become CEO of the American Medical Informatics Association.

    Earlier this month, Judy Murphy, a registered nurse who served as ONC’s director of the Office of Clinical Quality and Safety, stepped down to become chief nursing officer at IBM Healthcare Global Business Services.

    The personnel shifts come as ONC and its partner in the electronic health record incentive payment program, the CMS, are feeling industry pushback on the timing of Stage 2 meaningful use of that program and the criteria now under development for Stage 3, expected to go into effect in 2017.

    The health IT community is also in the midst of preparations for the planned Oct. 1, 2015 shift to the more complex ICD-10 diagnostic and procedural codes. Many providers and some plans are already falling behind schedule.

    ONC advisers have recently proposed a paradigm shift in the national health information exchange infrastructure, with a goal to model it more closely on Internet principles, to promote EHR interoperability.

    Despite the many changes, “ONC’s policy work is not stopping,” said Peter Ashkenaz, an

    ONC spokesman. “The policy set by Dr. DeSalvo is unchanged. Lisa Lewis will implement the strategic direction that has been set. Dr. DeSalvo remains engaged in key initiatives like interoperability and other major policies.”

    DeSalvo was the New Orleans health commissioner prior to joining the ONC in January. Her 10 months leading the federal effort on health IT is the shortest tenure of any of the five ONC leaders since the position was created in 2004 by President George W. Bush.

    Follow Joseph Conn on Twitter: @MHJConn

    (This article has been updated to indicate that besides Reider, there are only two other physicians in leadership roles on the ONC staff, rather than only two physicians on the ONC staff.)

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