Advisory Panel: ONC’s Leadership Exodus

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: What is your reaction to ONC’s recent leadership exodus?

Back at the ranch, my team and I are implementing healthcare information technologies and give little thought to ONC’s entrances and exits. Cynically, I guess their departing leaders are chasing new money and will move to lobbying consulting.

From my perspective, I don’t see us in a post-MU world yet. Maybe that’s because we are so focused on still getting all the Stage 2 requirements to work, but I don’t think we’ve moved into a stable time yet.

I think it’s normal turnover when the top person leaves. That’s not to say that ONC is not undergoing an identity crisis. They need to re-invent themselves and I would think people at that level would enjoy that type of challenge. But they’re bureaucrats and I’m not, so I could be off. 

ONC is in free-fall. The confusing series of announcements about Karen  DeSalvo’s departure that isn’t a departure is symptomatic of a larger problem. There doesn’t seem to be a plan. Turnover in government agencies at this level is pretty normal, but there usually isn’t a shortage of people ready to fill the gaps. Not so this time.

My reaction is not of surprise at all. You have a very unpopular administration right now that is like a sinking ship. When non-politicals get involved, they don’t need to have their reputations tarnished by what is happening in Washington in general. The public may never get the truth behind the exodus, but it certainly looks like people that just want out of DC.

I am not surprised. CMS leadership (if we can use that term) lacks real-world understanding. When Ebola rose as an issue, it would have been a wonderful excuse to suspend programs like MU2 under the guise of a national emergency. Instead, they took Karen out of the leadership position at ONC and reversed themselves soon afterward when the heat got too hot from the IT and Informatics community, among others. Of course, she now has two jobs and won’t be able to do either as well as they need to be done. This is not normal turnover. I think folks are looking at MU and realizing that with the incentive money essentially gone, everything from here on out will be very difficult. Like all human beings, the ONC staff are doing the calculations – work hard for little reward or find something else to do.

I think this is a bit of “it’s harder to get all these (implementer) cats to cross the finish line then we wanted to believe” combined with the natural life-cycle of a run fast and free organization tied to stuffy CMS, and this has started to shut down the ask-for-forgiveness freedom that the recent leaders needed to stay interested.

Not surprised and neither (turnover or identify crisis). I think it’s indicative of our current state, both in healthcare and the world. Few make long-term commitments or have a vision that lasts longer than three years. We want to make changes to fix the perceived problem right now and pad our resume but we aren’t willing to live with the consequences of our choices. We’ve lost any ability to do anything other than complete a few tasks and then take off for the next organization with the hopes of increasing our paycheck and retirement portfolio. Jaded? Yes. But you asked.

I think these sort of non-career appointments have a high turnover rate. Most of the ONC heads have left after two years or so. I think this is a very difficult job. they have to be on their toes watching what they say 24×7. As for Karen D, I think she saw this as a perfect excuse to leave when the going is going to get very difficult, not that battling Ebola will be any easier. As for Jacob R, I think he was upset that he didn’t first get selected to be the National Coordinator before Karen D and then more recently get selected as at least the interim coordinator to replace her. I know I would have quit for that reason.

Not surprised – matter of time and I suspect the timing was perfect for her. I also think this is a symptom of a significant identity crisis and I think the overall program is in jeopardy. The ONC turnstile is likely indicative of what it’s like to try reconcile vision, policy, and politics with the realities of an immature technology market with providers trying to figure out how to be successful in an uncertain world. This might be a revised definition of insanity. In summary, I don’t blame her as the job has involved into something that cannot be achieved under the current construct (and I thought CIOs had it tough these days).

I think the changes occurring in ONC are higher than normal for government agencies. It could be the post-MU blues, but I think it is also the drain from pushing for HIT progress through tedious, laborious regulations which don’t always hit the mark.

Not surprised. Didn’t see any major strategic announcement following Dr. DeSalvo’s assignment except a change in the org chart, which didn’t amount to much. Her heart has always been in helping people with health issues and not working for an agency distanced from the patients.

This is an example of the government doing an about face and the government as well as ONC know they are doomed. They have no value to the healthcare system at this time with virtually zero leadership effect.

Looks pretty much akin to the death throws of a wounded skunk … it ain’t pretty and someone is bound to get sprayed.

As to Karen and Jacob’s departures, I was not surprise. Karen presented Grand Rounds here the week prior to her recent announcement and it was clear that she has much to offer this country. While the ONC role is an important one, many of us were so impressed with her candor, her transparency, her passion, and her commitment (in her own words) “to the poorest of the poor, and the sickest of the sick” that I believe she had to move into a more visible role. I’m not sure what’s next for her, but I genuinely believe we will see her move around, in a good way, for the years ahead. I hope she stays involved in ONC for a while (as the press releases seem to indicate). I hope HHS will work hard to seize this opportunity to reconsider some of the ways ONC could play are more collegial role, like the one Karen was creating,  promoting collaboration toward the ultimate roadmap that Karen was assembling.

Ugh. I hope the interoperability focus/Jason report doesn’t get lost (why did she?)

My feeling is that the personal movement shows that there is no plan. The government seems to be making it up as goes with no end game, which leads to staff unrest. The number of healthcare enterprises abandoning even trying to meet MU measures shows that the program should be reworked to focus on interoperability instead of focusing on the care delivery process.

They did what they thought would “revolutionize” healthcare and perhaps realized the root causes of our systemic issues are different than what they thought. We now have EHRs and MU measures but you could argue that’s made a ton of money for vendors but had little impact on quality of care. In government work, it’s not surprising when g-men and g-women go take private jobs at some of the same corporations they had dealings with.

I am concerned about the change in leadership. This new leader is the fourth in the last three years. That does not spell stability to regardless what CMS/ONC says about their stable team.