The ONC Reorganization

Many people have asked me to explain the recent reorganization at ONC, reducing 17 different offices to 10:

Office of Care Transformation:  Kelly Cronin
Office of the Chief Privacy Officer:   Joy Pritts
Office of the Chief Operating Officer:   Lisa Lewis
Office of the Chief Scientist:  Doug Fridsma, MD, PhD
Office of Clinical Quality and Safety:  Judy Murphy, RN
Office of Planning, Evaluation, and Analysis:  Seth Pazinski
Office of Policy:  Jodi Daniel
Office of Programs:  Kim Lynch
Office of Public Affairs and Communications:  Nora Super
Office of Standards and Technology:  Steve Posnack

In case you are looking for the Office of Consumer eHealth, it’s still there - in the Office of Programs.

Simply, the era of stimulus has ended and ONC no longer has the operating budget to do as many projects as fast as during the era of ARRA.

I believe that ONC will need to reduce the number of Standards and Interoperability framework (S&I) initiatives from 18 to a more manageable number - maybe 5.   This will be very challenging because many of the projects are priorities of other federal agencies.

Just as Apple has created an ecosystem for healthcare with HealthKit, I’m hopeful that a few good standards can accelerate the ecosystem.   For example, if content moves from CCDA to FHIR/JSON, transport moves from SMTP/SOAP to REST, and application program interfaces are available for home care devices/iPhone apps, then many S&I use cases currently requiring specialized standards become doable with the more generalizable approaches.   Remember, the web itself is basically HTML and HTTP.    If ONC focuses on fewer projects with greater depth, we’ll have the HTML (FHIR) and HTTP (REST) for healthcare.

Similarly, I’m hopeful that ONC will simplify Meaningful Use.  When you read articles like “Hitting the Wall on Meaningful Use”, you realize that Stage 2 tried to do too much, too fast, before the ecosystem was ready to support the change.    Stage 3 proposals should focus on outcomes and give providers/vendors the opportunity to achieve those outcomes without being overly prescriptive.    A more streamlined ONC, with better internal coordination can achieve that.   For example, in the new structure, the person responsible for regulation writing is now the person responsible for testing and certification - a perfect alignment of accountability.

I look forward to working on the HIT Standards Committee advising the new ONC.  I’m optimistic that the process will be more agile and responsive.

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