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Providers and vendors react to Karen DeSalvo's resignation

Karen DeSalvo's resignation as ONC director left Connected Health Symposium attendees speculating where the agency and health IT are heading.

BOSTON -- The day after National Coordinator for Health IT Karen DeSalvo, M.D., left her post to become HHS acting assistant secretary for health with a focus on Ebola response, word spread quickly through the throng of attendees and speakers at Partners HealthCare's Connected Health Symposium.

The surprise resignation of the top federal health IT official rocked the world of healthcare providers and health IT vendors. But many were circumspect about the future of ONC and the meaningful use EHR incentive program. As the Obama administration moves into its final two years, Connected Health Symposium (CHS) attendees acknowledged that turnover at the agency was expected, though it might fuel uncertainty about future U.S. health IT policy and implementation.

With turnover comes opportunity, said Kevin Fickenscher, M.D., chief medical officer of the telemedicine vendor AMC Health. This year, of course, ONC has so far seen the departures of interoperability czar Doug Fridsma, M.D., consumer advocate Lygeia Ricciardi and chief privacy officer Joy Pritts, among others.

ONC needs a strong leader … someone who could go toe-to-toe with the vendors, maybe someone from the industry.
Kevin Fickenscherchief medical officer, AMC Health

"Now I think ONC needs a strong leader, and I anticipate the administration will reach out to come in during this two-year window to pick an individual to lead the effort," said Fickenscher, who previously served as president and CEO of the American Medical Informatics Association. "Maybe someone who's had a lot of experience in interoperability and could act as a lightning rod and someone who could go toe-to-toe with the vendors, maybe someone from the industry."

Beth Israel CIO: "No doom and gloom"

While DeSalvo's departure raises questions, there's no serious handwringing going on in health circles. DeSalvo helped rebuild infrastructure and led medical records digitizing efforts in post-Katrina New Orleans as the city's health commissioner. She's found her "sweet spot" in her new position at HHS, said John Halamka, M.D., Beth Israel Deaconess Medical Center CIO and vice chair of the federal Health IT Standards Committee.

"Every government program has its peaks and troughs," Halamka said. "ONC was an essential catalyst to move forward. Now maybe it's time for the private sector to step up more."

As for the future of national health IT efforts, Halamka was sanguine despite recent turnover at ONC. He's seen more progress toward health data interoperability over the past few months with DeSalvo at the ONC helm than he has in several years.

"In terms of ONC, there's been some key departures, and you would assume that they may lose a little momentum -- which is often the case with departures -- but I think that is not the case [in this situation]," he said.

One driver of this year's momentum behind health data interoperability is the newest data standard concept, Fast Healthcare Interoperability Resources (FHIR). FHIR may take off, he believes, because of the interest that EHR rivals Cerner Corp., Epic Systems Corp., Meditech, Inc., and athenahealth Inc. have shown toward implementing it.

"Heck of a challenge" awaits successor

CHS organizer Joseph Kvedar, M.D., said that because of the maturity of the meaningful use EHR incentive program, he believes DeSalvo's reassignment doesn't reflect any performance issues on her part. Yet he added that the next coordinator will have a "heck of a challenge" getting health IT data systems from competing vendors seamlessly sharing clinical data back and forth.

"I don't think it's about interoperability and standards; frankly it's about tech usability," said Kvedar, who is also the founder and director of the Partners Center for Connected Health. "The products are hard to use. ... It takes more than standards. More than interoperability, it takes ease of use."

Jonathan Bush, CEO of athenahealth, who delivered a CHS keynote, told SearchHealthIT that the meaningful use program will live on through risk-bearing healthcare entities, such as current accountable care organizations and the next generation they will evolve into.

While some health IT watchers may pin the ONC's future to the outcomes of elections this year and in 2016, Bush doesn't. "I think ONC will always be there. We haven't seen governments trim themselves back. I haven't seen any Republicans doing it, either."

Reider also leaving ONC

DeSalvo's exit wasn't the only surprise. Deputy National Coordinator Jacob Reider, M.D., also announced his resignation, effective in November. He served for three years in his position and was acting national coordinator when DeSalvo's predecessor, Farzad Mostashari, M.D., stepped down in the fall of 2013.

In a statement to ONC staffers, he described his time at ONC as the pinnacle of his two-decade career in health IT.

"It's been a thrilling experience, and I still pinch myself sometimes and marvel at the privilege that I have earned to play such an important role in shaping the health of a nation," Reider said. "It was a hard decision, and I will be very sad to leave my ONC family."

Let us know what you think about the story; email Shaun Sutner, news and features writer, or contact @SSutner on Twitter.

Additional reporting from Don Fluckinger.

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