There is little debating that when HHS drafted its contingency blueprints for a government shutdown, the architects of that strategy had to make some very difficult decisions — literally gutting ONC among those.
“The fact is ONC’s work is very important and it does disappoint that they aren’t able to continue doing that,” former deputy principal director of ONC David Muntz said in an interview with Government Health IT after leaving the office for a new job. “Because ONC is focused on deployment of HIT, anything that might slow that down, I think, is unfortunate.”
Muntz was not alone in expressing such disappointment. And with meaningful use Stage 2 commencing on the same day much of the government closed down, not to mention the health insurance exchanges opening, the timing was, at best, ill-fated.
And so the question: Should HHS re-chart its backup plan such that during the next government shutdown at least part of ONC remains operational? Perhaps enough staff to manage the Certified HIT Products List and some of the standards development driving EHR adoption and health information exchange? Or, is ONC simply non-essential enough to leave the plan as is?
Turns out, that answer is not so clear. Some experts interviewed for this story felt that ONC was not necessarily critical during a shutdown but definitely more important than other facets of the government.
“I think a lot of the work that ONC does is very important and high-value,” said Steve Sisko, a healthcare business and technology consultant. Sisko added that is particularly true as “compared to government funded pork barrel-like projects such as $505,000 to promote specialty hair and beauty products for cats and dogs, and $27 million for Moroccan pottery classes.”
And while no one is disputing that, in a breakdown of ONC activities, Keith Boone, a.k.a. @motorcylce guy, concluded that ONC overall is not essential but that it is missed when not operating at full capacity.
“I think the most hurtful component of ONC cutting back to the healthcare economic sector is what these delays mean for healthcare providers and healthcare IT vendors with respect to Meaningful Use stage 2. There seems to be some economic impact here,” Boone wrote on his blog Healthcare Standards. “The next most challenging impact is on the final quality of results should ONC try and hurry up to hit some of its internally set deadlines with regard to new regulations. If congress shuts you down, and you wind up being late, I don't think they should count that against you.”
The way things stand today, ONC has what Muntz called “a skeleton crew” in place to ensure that the office is honoring its obligations. Indeed, exactly 4 out of a total 184 ONC staff were retained for orderly phase-down and suspension of operations, according to a chart at the bottom of the HHS contingency plan.
“While it is not likely that all 184 ONC staff fit the description of essential, well, I would think that there would be more than four,” said Brian Ahier, founder of Advanced Health Information Exchange Resources (AHIER).
Whether HHS will re-architect its plans to keep more than four employees should another government shutdown happen — and what it might deem non-essential to make that happen — remain to be seen.
But ONC is not the only unit within the Department of Health and Human Services to be hit hard by the government shutdown. The Office of Civil Rights, likewise, was reduced from 221 to 5 staffers, and the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) are already feeling the impact of furloughed workers. In the case of CDC, it has been unable to conduct basic lab work amid a salmonella outbreak.
“More than a week into the shutdown, it is acutely apparent that there are many government services that are vital,” said Steve O’Keeffe, CEO of MeriTalk, which dubs itself the government IT network, “even if they are not usually thought of as essential in historically defined terms.”
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