In April, ONC commemorated its 20^th birthday. Milestones like this offer the opportunity to take a break from our busy schedules to pause and reflect. I have been privileged to play a part in ONC’s journey throughout these past two decades, and I would like to share some of my reflections. But first, I would like to share some exciting news.

Today, a Federal Register notice posted that has written the next chapter of ONC. Going forward, our office will be the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC). In addition to our ongoing work in health IT, we will now lead HHS technology and data policy and strategy to help ensure that our complex and multi-faceted department continues to be more than the sum of its parts.

ONC’s 20-year Journey

A short twenty years ago, medical records resided primarily in color-coded manila folders stacked on shelves and in filing cabinets in physician offices and hospitals. Clinicians had limited ability to use information technology to even measure, let alone improve, quality or safety or efficiency. Patients also had no tools to easily or meaningfully exercise their newly established right of access to their records created by the HIPAA Privacy Rule in 2003.

Recognizing that the federal government could play an essential role in catalyzing adoption of health information technology, President George W. Bush signed an executive order establishing ONC in 2004. Shortly after ONC’s creation, I had the opportunity to meet with the first National Coordinator, David Brailer, who had graciously accepted an invitation to come to Massachusetts to keynote the launch of the Massachusetts eHealth Collaborative, a multi-stakeholder project to jumpstart adoption of health IT in the state. We joked at the time about the fact that our Massachusetts project had about the same level of funding ($52 million) as he had for the entire country, but we were both incredibly excited about the potential for ONC to improve health care and I was very inspired by his vision.

In 2009, President Obama signed the American Recovery and Reinvestment Act into law, which established ONC in statute and launched what would turn out to be a $35 billion voluntary incentive program to propel medical record technology adoption into the 21^st century. Working closely with our partners at the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and the National Institute of Standards and Technology, ONC established the voluntary Health IT Certification Program to help motivate the market to build and adopt health IT systems based on transparency and open-industry, consensus-based, data and interoperability standards.

ONC-certified products are now used by 97% of hospitals and 80% of physician offices across the country, making the program a bulwark of our health care delivery system. Our health care system is highly fragmented in almost every way imaginable, but baseline standardization of electronic health records is one of the few things that helps to tie it together. There is a common digital foundation that we can now count on whether it’s in a rural solo practice in Wyoming or an academic medical center in Pittsburgh which we have come to take for granted but is making meaningful impacts on people’s lives every day. No large program – public or private – is perfect, but the simple fact that almost all Americans can use smartphones to get on-demand electronic access to medical records and telehealth visits would have been beyond our wildest hopes when ONC started its work twenty years ago, three years before the release of the first Apple iPhone.

In 2016, President Obama signed the 21^st Century Cures Act into law. This legislation was championed by then Vice President Biden who said that “[t]he 21^st Century Cures Act is going to harness America’s best minds of science, medicine and technology to tackle some of our biggest and most complex health challenges of today,” which eloquently spoke to the opportunities that are opening up after many years of hard work.

Leading ONC for the last three-and-a-half years, I have the privilege of standing on the shoulders of my predecessor National Coordinators and an exceptionally talented and dedicated ONC team. With the dust now largely settled on basic adoption of EHR technologies in hospitals and physician offices and much (though certainly not all) of the rest of the care continuum, our industry is now able to look forward as digital natives to reimagine processes inherited from a paper-based world and conceive new possibilities unconstrained by cellulose, bricks, and mortar.

We have focused our efforts on collaborating with our agency partners and with industry to establish a fertile ecosystem for innovation based on open-industry standards, market transparency, and the protections necessary for responsible stewardship of patient information. In December the Trusted Exchange Framework and Common Agreement™ became operational, and on July 1 opened up to support FHIR API exchange, fulfilling a 20-year goal of having a nationwide network-of-networks based on trust through public-private collaboration, strong participatory governance, common rules of the road, and modern technology standards. We’ve expanded certification requirements to embrace and encourage use of trustworthy AI-based technologies. Our agency partners are helping us to extend the United States Core Data for Interoperability (USCDI) data standards to meet critical policy priorities such as cancer, public health, quality, behavioral health, maternal health, and sickle cell disease. And we are moving forward to break down the silos separating providers, payers, and public health through standards and certification for integration of clinical, administrative, and public health information and transactions.

Looking Ahead

Under the vision and leadership of Secretary Becerra and Deputy Secretary Palm, HHS is fully embracing the importance of information technology to the department’s mission, and consolidating organizational resources accordingly, to lead and shape technology policy across the department’s broad array of external and internal activities. The Office the National Coordinator for Health Information Technology will become the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology, and we will expand our role by adding a fourth office, the Office of the Chief Technology Officer, which will include the Office of the Chief AI Officer, Office of the Chief Data Officer, and a new Office of Digital Services. We are actively recruiting for these positions.

For some time, and especially over the last few years, ONC has played an informal role shaping technology and data policy across HHS; this move formalizes this function, which will allow us to build synergies with the work that we’ll continue to do in health IT, and stand-up dedicated organizational capacity to ensure that HHS is making the best use of technology and data across all operating and staff divisions.

At HHS, we take extraordinary pride in our collective work to improve our health system. We at ASTP/ONC are grateful for the confidence being placed in us by the department. I don’t know what the health system will look like 20 years from now, but I can assure you that ASTP/ONC will do everything we can to make it work better for the American people.