# Open government examples from the ONC

## The Office of the National Coordinator has implemented a host of initiatives aimed at transparency and involvement

With the sea change caused by the Open Government Directive I know that many federal agencies might be struggling with how to actually implement this new policy. This is a major cultural shift in government and there are always challenges when trying to bring such broad changes to any large organization. Government bureaucracy is certainly no exception. But this last week I was encouraged by one agency’s office, which has shown a great start-up mentality in not only moving toward government 2.0 principles, but also achieving some pretty significant accomplishments along the way.

The Healthcare Information and Management Systems Society (HIMSS) hosts an annual event focused around health IT professionals and health IT vendors (Andy Oram has been covering HIMSS). I was fortunate at this year’s HIMSS conference to have conversations with staff from the Office of the National Coordinator. Much of the discussion revolved around the rules for meaningful use of electronic health records, the creation of a Nationwide Health Information Network (NHIN), and standards and certification. But of course, I couldn’t have access to federal officials without bringing transparency and open government into the conversation.

So what is the Office of the National Coordinator and why are they at a health IT vendor show? An April 27, 2004 executive order signed by President Bush established the Office of the National Coordinator for Health Information Technology (ONC) within HHS. This office was legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. President Obama named Dr. David Blumenthal as national coordinator for health information technology.

As the national coordinator, Blumenthal will lead the implementation of a nationwide, privacy-protected health information technology infrastructure as called for in the HITECH portion of the American Recovery and Reinvestment Act (ARRA). When President Bush created the ONC, the goal was for Americans to have access to an interoperable Electronic Health Record (EHR) by 2014. There has been bipartisan agreement that health IT can lower costs and improve quality and clinical outcomes. President Obama has embraced these goals. The effort has been funded with stimulus dollars and plans are well under way.

At least $20 billion in healthcare funding is included in the HITECH provisions of the ARRA for electronic health records. The ONC was funded$2 billion, along with additional funds for CMS as financial incentives for physicians and other providers to adopt and utilize EHRs, and funding for states, Regional Extension Centers (REC), workforce development and other programs to assist in implementation.

The ONC has a huge job ahead of it. Ramping up such a large organization is difficult, especially in light of the President’s promise in his Open Government Directive that his administration “would be committed to creating an unprecedented level of openness” to “ensure the public trust and establish a system of transparency, public participation and collaboration.”

The HITECH legislation created the HIT Standards Committee and the HIT Policy Committee under the auspices of the Federal Advisory Committee Act (FACA). The HIT Policy Committee is charged with making recommendations to the National Coordinator on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information. The HIT Standards Committee is charged with making recommendations to the National Coordinator on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. Both of the FACAs formed several workgroups to further their work comprised of stakeholder representatives and subject matter experts. With two FACAs and 10 different workgroups, there was initially some confusion about meeting schedules and difficulty sometimes getting meeting materials or accessing transcripts. There was also times when the workgroups were held in closed session, which made open collaboration more difficult.

On Decemeber 8, 2009, ironically the same day same day the Office of Management and Budget released its 11-page Open Government Directive, the Privacy and Security workgroup under the HIT Policy Committee met in a closed-door session. There was no notification of the meeting being closed in the Federal Register. The Dec. 16, 2009 NHIN workgroup met in public session from 10 a.m. until about 12:50 p.m., then re-convened behind closed doors. This was a troubling trend, and tweets, blog postings and media report from Joseph Conn at Modern Healthcare decried the practice.

Blumenthal responded on the ONC blog by announcing that all meetings would by default be open to the public, and exceptions would only be at the written request of the workgroup chair(s), reflecting a majority vote by the membership to hold a closed hearing and a justification to do so. But this was only the beginning of continuing efforts at transparency.

Federal CTO Aneesh Chopra has also been using the ONC blog effectively, evenasking for examples of struggles and opportunities in EHR adoption. I expect that as the use cases Chopra has asked for begin rolling in, we will see some great success stories and pitfalls to avoid.

Initially all of these meeting schedules were somewhat difficult to track (they have a lot of meetings), and sorting through the Federal Register can be tedious. The new calendar that allows you to drill down to meeting materials is extremely handy. This has made keeping tabs on what is going on more efficient and provided a much more open process for citizen participation.

Other areas that have been improved are the transcripts and audio portions of the meetings. But after bouncing back and forth many emails between ONC staff, Altarum (the contractor providing services to ONC) and myself, they were very responsive to making some great enhancements to the site. I’m sure that many of these enhancements were in the pipeline, but the fact that the ONC has reached out in a collaborative way to engage consumers of this public information is a testament to their efforts.

The two blogs, Health IT Buzz and FACA Blog, have been great examples of using social media to encourage participation in the process. With the recent announcement of NHIN Direct, there is another opportunity through this new blog to help expand the breadth of the NHIN to create a means for direct communication between providers. And now opening the @ONC_HealthIT Twitter account shows further efforts in using social media to provide a platform for civic engagement. I am very impressed with the ability of the staff to use these tools effectively.

Now of course, there are still some areas for improvement. The organizational chart was updated only after much pestering. And although I know it is not a top priority in their efforts, nor should it be, I hope to see much better transparency in the publication of a listing of public employees and contractors, with some clearly defined roles. The CMS organizational chart is a nice model for the type of information, although even this could be improved upon. I’m confident that as time goes by we will see the ONC continue to lead in innovative ways of communicating and collaborating using Web 2.0 technologies.

The ONC has a monstrous amount of work yet to accomplish, so there have been and there will continue to be challenges in their efforts to be as open and transparent as possible. But this office has shown a remarkable willingness to think outside of the box and try new ways of operating. I believe that the ONC can truly be a model for other offices within HHS and for other federal agencies that are trying to move toward government 2.0 practices.

• Keith W. Boone

One thing that isn’t open right now are the Task Orders for replacing the Harmonization work they were doing with HITSP, see http://motorcycleguy.blogspot.com/2010/03/title-of-this-post-is-secret.html

• Brian Ahier

Thanks for the comment Keith. I’m not familiar with that particular task order, and I appreciate you bringing it to light. This is something I hope the ONC is willing to respond to. Have you contacted them directly on this matter?

• Fast Eddy

And another thing: Are we going to be able to access and edit as may be required these medical records? Can we correct errors in our own data in this database? What happens if I am confused with may Dad? = we have exactly the same name.

• Keith W. Boone

I did indeed, via the e-mail address on the announcement, and I also spoke to an ONC staffer at the FHA Connect booth at HIMSS (thus my comment in my posting about it being difficult to track even inside ONC). I’ve gotten no response from the e-mail.