The Department of Health and Human Services’ (HHS') technology office is poised to bring significant technological expertise to the department, which the Office of the National Coordinator (ONC) has struggled to retain amid stagnant funding.
The Office of the Assistant Secretary for Technology Policy (ASTP), formerly the Office of the National Coordinator for Health Information Technology, announced a major reorganization at the end of July that tacks on new functions previously held by other offices in HHS.
ASTP/ONC is poised to bring innovative health technology policy to HHS, including in artificial intelligence and cybersecurity.
HHS will hire three new technical experts: a chief technology officer, a chief AI officer and a chief data officer. Tom Leary, director of policy and vice president of government affairs at HIMSS, said the reorganization of ASTP/ONC is consistent with responsibilities the office has taken on.
“It formalizes several functions that (National Coordinator Micky Tripathi) and team have been given over the course of probably the last 18 months or so,” Leary said. “They've been doing a lot of guidance with respect to technology, and so bringing the Chief Technology Officer into that new Assistant Secretary for Technology [policy] office makes a lot of sense.”
ONC has struggled to retain talent, Leary said, because its funding levels have been essentially stagnant for two decades.
When ONC was first created by President George W. Bush’s administration, it was allocated $50 million. The office received funding bumps when major health technology legislation like the Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 and when the 21st Century Cures Act passed in 2016. Besides these spikes, ONC has been appropriated between $50 million and $65 million through FY2024, despite presidential budget requests in recent years to allocate over $100 million to the technology office.
Leary said the funding stagnation has continued in part because Republicans have historically wanted to defund ONC. Republicans have argued that ONC’s responsibilities could be distributed throughout HHS, he said. Because Democrats pushed back on cutting the office, and because of the irregular appropriations processes for the Labor/HHS appropriations bill over the last 15 years, ONC continued to be funded at approximately the same amount as it was in 2004.
ONC ultimately remained funded, but at a price.
“As they've had to ratchet back down to that … $50 million to $65 million, they've lost some talent to other places,” Leary said.
Leary said HHS chief technology officers have been prominent administration officials since the Obama administration.
“CTOs have this persona, regardless of gender, they just seem to have this way of thinking about what's on the horizon, how to bring the horizon closer to now, and being able to incorporate some of the innovative thinking that's out there, how to bring it to your average American now,” Leary said.
The post has been vacant since February 2020.
Whereas ONC has been focused on the nuts and bolts of health IT certification, a CTO can think more broadly, Leary said.
“There's more of a bridge and a formalization of the bridge between how the whiz bang, exciting future also is safe and affordable and it meets the requirements for delivering on government healthcare, government reimbursement for care,” Leary said.
President Joe Biden’s executive order on AI, released in October 2023, mandated each agency to appoint a chief artificial intelligence officer. Micky Tripathi, Ph.D., the national coordinator, has been acting CAIO for HHS since May.
ONC’s authority lies with the certification of health information technology. Thus, its attempts to create AI policy have been limited to electronic health record certification.
HHS has restructured the CAIO to fall under the assistant secretary of technology policy.
Because the CAIO is going to be under the office of the assistant secretary, Leary believes they will have the purview to consider AI strategy for all of HHS and not be limited to health information technology.
“I do think that part of this is a way to sort of fill a gap and a void that exists in the legislation around this, around artificial intelligence and cybersecurity,” Jason Johnson, healthcare lawyer at firm Crowell & Moring, said.
Through the creation of the ASTP, Leary is hopeful that ONC and HHS will experience a spike in creativity that he says CTOs are known to bring. He thinks the new technology experts will also help ensure HHS is as up to speed technologically as the healthcare industry itself.
When asked if the reorganization would require additional appropriations, a spokesperson for ASTP told Fierce Healthcare the reorganization of the office will be budget neutral.
Leary said in an email that ASTP/ONC has been consistently underfunded.
“We are still very supportive of full funding for ASTP/ONC, to include any funds that were associated with the CTO, CDO, and CAIO offices,” Leary wrote. “If we’re going to achieve true digital health transformation in the U.S., it starts with proper funding of ASTP/ONC to perform their responsibilities.