Electronic Health Reporter

CHIME and HIMSS are in the news again, and this time you’ve got to love that they are — for sticking up for what they, as organizations, believe in. Their flexing of a little muscle is for telling ONC that its leadership and its current efforts just are not good enough; referring to the announcement that Dr. Karen DeSalvo, current national coordinator for health information technology, is splitting here duties between ONC and HHA, where she’s battling Ebola.

CHIME, especially, is known for its bravado, one of the reasons I find it such an intriguing organization to watch. Its messages are always loud and clear, and unadulterated; just what we need in an overly PC public where “the folks” are supposed to take what’s given to them.

CHIME and HIMSS’ letter is more about the overall leadership changes taking place at ONC and the organizations’ apparent difficulty keeping leadership in place; DeSalvo has led the organization for less than a year. “We are concerned with leadership transitions currently occurring within the Office of the National Coordinator for Health Information Technology (ONC); changes which could have a detrimental effect on ONC’s role in HHS’ charge to positively transform our nation’s health system,” CHIME and HIMSS’ letter to ONC states.

“Health IT is a dynamic field; to successfully address the needs of patients, providers and developers, ONC’s leadership team must be in place over the next two years. Such constancy will pay huge dividends in navigating all the changes that must occur for positive transformation.”

CHIME and HIMSS point out the obvious in their missive: That ONC faces a public that perceives its leadership as not wanting to be at the organization, much in the same vein as what’s going on at the White House amid reports that a disengaged Obama is counting down his last days as President.

As ONC’s leadership publically takes a willy-nilly approach, CHIME, HIMSS and others are done looking on wondering what’s up and are starting to demand some action. A half-hearted approach to leadership is not going to work, not now, not after so many of its programs that ONC lobbied for and put in place while practices and health systems looked on wondering how to deal with the swarm of new mandates and regulations.

It’s this nonchalance by Secretary Sylvia Burwell and DeSalvo – seemingly leaving the organization on auto pilot – that finally appears to be too much for many, including HIMMS and CHIME, to swallow.

So they write: “The combination of skills and focus is paramount; without it, we question whether our nation can successfully address the next challenging level of meaningful use and the delivery reforms required in the Affordable Care Act. We urge you to fill all ONC leadership positions as soon as possible with well-respected leaders who possess a combination of clinical training and practice, clinical and business informatics expertise, a clear vision for IT’s role in enabling healthcare transformation, and experience in public policy.

“If Dr. DeSalvo is going to remain as the Acting Assistant Secretary for Health with part-time duties in health IT, we emphasize the need to appoint new ONC leadership immediately that can lead the agency on the host of critical issues that must be addressed.”

Couldn’t have said it better myself.

For your reference, here’s the full text of the letter CHIME and HIMSS sent to ONC on Nov. 3, 2014:

The Healthcare Information and Management Systems Society (HIMSS) and the College of Healthcare Information Management Executives (CHIME) are writing to express both our ongoing commitment to health information technology (IT) as a tool for healthcare transformation, as well as our recommendations to address current developments within the Department of Health and Human Services (HHS).

Our vision remains clear – interoperable, secure, and widespread use of IT can improve patient safety, enhance care quality, increase access to care, contribute to population health, and reduce costs.

We are concerned with leadership transitions currently occurring within the Office of the National Coordinator for Health Information Technology (ONC); changes which could have a detrimental effect on ONC’s role in HHS’ charge to positively transform our nation’s health system.

We share the following recommendations in the spirit of supporting your efforts to ensure the incoming ONC leadership team possesses the optimal skills, experiences, and professional attributes. Moreover, our recommendations are congruent with critical issues we’ve raised with you regarding ONC’s and HHS’ health IT-related programmatic agenda.

Key Attributes for ONC Leadership

The foundational issues that ONC’s leaders must address in the near term require deep expertise and inspired leadership. Unfortunately, we are witnessing the exodus of most of ONC’s senior leadership. Most recently, Dr. Karen DeSalvo has been appointed as Acting Assistant Secretary of Health. Dr. Doug Fridsma and Judy Murphy departed ONC this month, and Dr. Jacob Reider is leaving at the end of November. Health IT is a dynamic field; to successfully address the needs of patients, providers, and developers, ONC’s leadership team must be in place over the next two years. Such constancy will pay huge dividends in navigating all the changes that must occur for positive transformation.

The combination of skills and focus is paramount; without it, we question whether our nation can successfully address the next challenging level of Meaningful Use and the delivery reforms required in the Affordable Care Act.

We urge you to fill all ONC leadership positions as soon as possible with well-respected leaders who possess a combination of clinical training and practice, clinical & business informatics expertise, a clear vision for IT’s role in enabling healthcare transformation, and experience in public policy.

In regards to Dr. DeSalvo, we have respect for, and applaud, your decision to utilize her unique skills to address the current Ebola threat.

As we understand it, you wish her to remain actively engaged with the Interoperability Roadmap, the Health IT Policy Committee, Meaningful Use policy, and emphasize health IT’s role in HHS effort to address healthcare delivery system reform.

In the very short term, such an arrangement emphasizes the important role health IT plays in public and population health, as well as important requirements for improving care coordination. If her appointment as the Assistant Secretary for Health is intended to be of a duration which would result in her quickly returning to full-time leadership of ONC, we welcome that approach.

A full-time National Coordinator must be in place in time for ONC’s review of all comments received from the public on the Interoperability Roadmap v1.0. If Dr. DeSalvo is going to remain as the Acting Assistant Secretary for Health with part-time duties in health IT, we emphasize the need to appoint new ONC leadership immediately that can lead the agency on the host of critical issues that must be addressed.

In addition, over the past several months, our organizations have individually and collectively been corresponding with you and other officials at HHS about several critical IT issues that need to be addressed promptly.

These issues include:

• Keeping the Interoperability Roadmap on its current trajectory, and actively involving all stakeholders in its development;
• The profound challenges associated with the transition to 2014 certified EHR technology and a full year Meaningful Use reporting period for 2015 as well as the future direction of the program;
• Ensuring HHS is strategic on the continued alignment between Centers for Medicare & Medicaid Services’ quality improvement and quality reporting programs and the Meaningful Use program;

• Employing a risk-based approach to appropriately mitigate patient safety risks; and,
• Supporting the development of health IT tools, including EHRs, personal health records, mobile technologies, and data infrastructure that are essential to empowering patients.

Overall, a strong and viable ONC must address the immediate and long-term requirements for healthcare transformation.

Interoperable IT leading to information exchange and support of care coordination is critical to the success of that transformation.

We look forward to working with HHS, ONC, and all the relevant agencies to ensure ONC has appropriate leadership to earn the confidence of the private sector and deliver on these critical issues.

We stand ready to assist in any way, and welcome the opportunity to meet with you to discuss your vision for health IT and ONC. Please feel free to have your team contact Thomas M. Leary, HIMSS vice president of Government Relations, at tleary@himss.org to arrange a meeting.

Paul Kleeberg, MD, FAAFP, FHIMSS

Chief Medical Informatics Officer

Stratis Health

HIMSS Board Chair

H. Stephen Lieber, CAE

President & CEO

HIMSS

Randy McCleese, M.B.A., M.S., FCHIME, LCHIME, CHCIO

Chair, CHIME Board of Trustees