The Office of the National Coordinator for Health Information Technology (ONC) has suffered the departures of numerous high-level personnel over the last year, including recent changes at the top of the agency.

Last week, Dr. Karen DeSalvo, the National Coordinator for the past ten months, joined the Administration’s Ebola response team as Acting Assistant Secretary for Health at HHS.  Lisa Lewis, formerly ONC’s Chief Operating Officer, has been named Acting National Coordinator.  In an October 28 blog post, DeSalvo and Lewis said that DeSalvo would “maintain[] her leadership of ONC” and would “continue to work on high level policy issues at ONC . . . .”  In particular, DeSalvo will remain chair of the Health IT Policy Committee, will continue to “lead on the development and finalization of the Interoperability Roadmap,” and will “remain involved in meaningful use policymaking.”

ONC also announced last week that Deputy National Coordinator Dr. Jacob Reider would leave the Office in late November to move back to Albany, New York.  Within the last year, at least six other high-level staffers have left ONC, including:  Chief Science Officer Dr. Doug Fridsma; Chief Nursing Officer and Director of the Office of Clinical Quality and Safety Judy Murphy; the head of consumer e-health initiatives, Lygeia Ricciardi; Chief Privacy Officer Joy Pritts; Mat Kendall, the director of ONC’s Office of Provider Adoption Support; and Carol Bean, ONC’s HIT certification director.

With the raft of departures have also come new appointments, with four announced in October 2014 alone.  In addition to Lisa Lewis’s appointment as Acting National Coordinator, Lucia Savage became Chief Privacy Officer, after serving as Senior Associate General Counsel at United Healthcare.  ONC also announced the temporary appointment of physician informaticist, Dr. Jon White, on part-time detail from the Agency for Healthcare Research and Quality.  Dr. White is serving as interim head of the Office of Clinical Quality and Safety and as Acting ONC Chief Medical Officer.  Finally, Dr. Andrew Gettinger, former Chief Medical Information Officer at Dartmouth-Hitchcock Medical Center, has also been temporarily appointed to head ONC’s patient-safety portfolio.

In addition to the recent staff departures, ONC has also seen organizational changes this year.  As illustrated below, Dr. DeSalvo consolidated ONC’s seventeen offices into ten.  According to DeSalvo, part of the impetus for the reorganization was the end of the HITECH Act’s health IT infrastructure and program investments and a corresponding need to streamline functions and offices.

The recent transitions have created uncertainty about the future direction of the agency.  Some stakeholders have expressed concern about a leadership gap and loss of institutional knowledge, while others see opportunities for change and a refocus in priorities.