Who Will Guide the Ship at ONC?

The news that David Blumenthal, M.D., plans to step down as national coordinator for health information technology this spring to return to Harvard University has forced the health IT community to evaluate his tenure and begin speculating about who might take the reins at ONC.

Perhaps the most obvious candidate is Deputy National Coordinator for Programs and Policy Farzad Mostashari, M.D., who came to ONC after drawing national attention for leading New York City’s Primary Care Information Project, where he facilitated the adoption of prevention-oriented health information technology by more than 1,500 providers in underserved communities. Dr. Mostashari also led the NYC Center of Excellence in Public Health Informatics.

“I would expect that Farzad is well placed to take the wheel and guide the ship through the next phase of our redesign efforts, and I hope he is asked and accepts,” said Jonah Frohlich, who recently left his position as deputy secretary for health information technology in the California Health & Human Services Agency. “It's hard for me to imagine anyone else stepping in and doing a better job. It will be challenging to gather consensus and raise the bar in Stage 2 and 3; I suspect there will be much resistance to raising the bar too high,” added Frohlich, who is now managing director of Manatt Health Solutions in San Francisco.

“But we must move forward, and we especially need robust privacy and security policy and a genuine interoperability framework that includes rigorous standards backed by good policy. I hope that will be the focus of the next coordinator; it certainly needs to be,” he added.

Looking back over the Blumenthal era at ONC, health IT analysts and executives offered mostly praise for his leadership skills during a tumultuous period.

Dan Rode, vice president of policy and government relations for the American Health Information Management Association (AHIMA), noted that Blumenthal’s exit had been expected and that his leaving has more to do with Harvard’s requirements of faculty than any desire to divest himself of HITECH and other projects facing ONC. (Harvard’s policy, as stated on its Web site, is that leaves of absence cannot be extended beyond two years.)

Rode said Blumenthal should be congratulated on a terrific job of moving the HITECH project along with almost impossible deadlines set by the ARRA-HITECH legislation. “I am sure he and the industry would have liked a bit slower pace,” Rode added, “but that was not what the legislation dictated, and he, the ONC staff, and the volunteer leaders and members of the HIT committees have spurred the industry along quicker than anyone would have imagined just two years ago.”

Pamela McNutt, senior vice president and CIO of Methodist Health System in Dallas, said it had not been widely known that Blumenthal would leave his post this spring.

McNutt, who chairs the College of Healthcare Information Management Executives (CHIME)’s Policy Steering Committee, praised him for helping propagate a huge number of regulations in a short period of time. “He also built a tremendous staff,” she said. “That talent base, which has done a lot of heavy lifting the last couple of years, has done a great job of outreach, and I don’t expect that to change going forward.”

Catherine Bruno, CIO of Eastern Maine Healthcare Systems and executive sponsor of the Bangor Beacon Community Grant, also pointed out Blumenthal’s talent for gathering great leadership. “I believe he put in place a very strong team,” she said. “We’ve worked closely with the Office of the National Coordinator, and Aaron McKethan, who leads the Beacon program, and Dr. Farzad Mostashari are both very strong leaders.Using that as an example, I’m thinking that he has been busy lining up people for a smooth transition.”

“He brought a passion using electronic health records to improve health, and he also brought experience with him of successful use with [EHRs] from the Boston area,” Bruno added. “He put in place a group of folks that could begin implementing that in a nationwide way.”

Robert Tennant, senior policy advisor to the Medical Group Management Association, called Blumenthal an “articulate and passionate advocate for physician practice adoption of HIT.” He will leave his post as national coordinator having been an important catalyst for the transformation of the nation's health care delivery system, Tennant said, adding, “We are hopeful that Dr. Blumenthal's successor will retain his policy of direct outreach to the physician practice community and develop and implement the policies and programs necessary to facilitate the continued adoption of HIT in these care settings.”

Jeffrey Bauer, Ph.D., a Chicago-based independent health IT consultant who has been critical of the HITECH law, said he was not surprised that Blumenthal would leave. From Bauer’s perspective, HITECH actually slowed down health IT adoption as the industry paused for two years while the meaningful use regulations were drawn up. “I think very highly of Dr. Blumenthal. He is very accomplished in health IT, and I think he went into this idealistically, but he stepped into an impossible situation,” he said. “You can’t make a silk purse out of a sow’s ear.”