Q&A with Deputy National Coordinator Steven Posnack, Part 1: “It’s Incredibly Rewarding Work.”

“I really enjoy complicated problems.”

Of the many qualities that are beneficial — possibly essential — in government leaders, perhaps none is more important than a willingness to tackle thorny issues. Because when you hold the role of a Deputy National Coordinator or HIT, for example, there’s no shortage of them.

Luckily, Steven Posnack is up to the challenge. Although he was appointed to the position in July, he’s no stranger to ONC, having spent a decade and a half in various policy and technology capacities, and therefore having a solid understanding of the barriers that exist—and how they can be managed. Recently, healthsystemCIO spoke with Posnack about what it’s like to work in an environment where things “move quickly and slowly at the same time,” why he believes the industry is poised for tremendous growth, and what he has learned from his mentors and predecessors.

Chapter 1

• Named Deputy National Coordinator in July
• Learning from Jon White – “We see eye-to-eye on the best way to run an organization.”
• “Hybrid experience” with policy & technology
• Opportunity as a new leader to “step back & do a little introspection.”
• ONC’s Tech Lab
• Thinking outside of the managerial & hierarchical structure
• DEA & push for e-prescribing of controlled substances

Bold Statements

We see eye to eye on the best way to run an open organization; we’re cut from the same cloth in that respect, and I think that helped. We share a sense of humor that make the interpersonal dimensions and dynamics easy for people to adjust to.

Any time you’re taking on a new role, a new job, or even a new project, there’s an opportunity to step back and do a little introspection.

There are many issues we work on from both a standards and a policy perspective that require a certain individual or element from different teams across ONC — not just one particular branch or division in a hierarchical sense.

I really enjoy complicated problems, and the policy and regulatory portfolio fed that for me. Throughout my time at ONC, the work we’ve done across the board has really had a cross-sectional impact on the healthcare system at large. 

Gamble:  First of all, congratulations on being named Deputy National Coordinator. I know you’re new to the role, but certainly not to the organization. What were your thoughts on being named to this position? Was it something you had set as a goal?

Posnack:  It was pretty surreal. When I first started at ONC, I was at the general staff level, and I didn’t necessarily have any aspirations for the Deputy National Coordinator role. But as I matured with the organization, I recall thinking at some point, ‘Not only is it a position I’d be interested in, but I think I could do a good job based on the experience that I have.’ I’ve worked some really accomplished professionals, including Judy Murphy and Farzad Mostashari, to name a few, and was able to learn from them. And so it was a real privilege when Dr. Rucker tapped me for the role.

 

Gamble:  Talk a little bit about your experience working with your predecessor Jon White, who is now with the Salty Lake City VA.

Posnack:  Jon and I have had a long history of working together, both with the AHRQ, and during his as the Deputy National Coordinator. He and I had a great relationship, so it made it easy from a handoff perspective. We see eye to eye on the best way to run an open organization; we’re cut from the same cloth in that respect, and I think that helped. We share a sense of humor that make the interpersonal dimensions and dynamics easy for people to adjust to.

 

Gamble:  Obviously you were already quite familiar with the organization, but it’s always an adjustment when you’re taking on a new role. What was your approach going in?

Posnack:  Any time you’re taking on a new role, a new job, or even a new project, there’s an opportunity to step back and do a little introspection. For me it was interesting, because I had really been focused on ONC’s technology portfolio; I knew it very well. I needed to look at things from an organizational perspective, and focus on what my priorities were going to be, how I could help drive the agency’s mission forward, and make sure I’m up to speed on the various subcomponents of ONC and their missions.

I actually spent the better part of my time at ONC doing policy-related work. That’s my first love, and so I’m really grateful to be back in that realm, even though it’s laid across many other portfolios I have, and to have a deeper understanding of that work. Elise Anthony, who is the executive director of the Office of Policy, is like a sister to me, which definitely is an advantage. We work really well together and get things done in a collaborative fashion.

 

Gamble:  I do want to talk about your policy experience, but you also spent some time as director of the Office of Technology. Can you talk about what you were able to gain from that experience?

Posnack:  Absolutely. I first came to ONC as more of a technology person. I have a background in computer science, but did some of my master’s work in health policy. That hybrid experience made ONC a really attractive place for me. I initially got on the policy track and pursued that for many years, and when the opportunity came to fill the role as director of the Office of Standards and Technology (and more recently, the Office of Technology), I was really at home again in terms of being able to geek out and work on some of the more detailed technical nuances.

But there’s a shift when you go from working on policy development to a more program execution mindset. My portfolio of responsibilities included administering the health IT certification program and working on the regulatory aspects, which means having to execute on the words I wrote on a page that’s now part of a 700-page regulation. That’s where the rubber really meets the road.

It’s taking that turn and transitioning from the policy development to an overall perspective of the projects the Office of Technology is working on, including the standards development space.

That’s another area where I went much deeper into the standard realm. And I have to say, it was a fun job in terms of being exposed to new content. I learned a lot about HL7’s role in regulating standards for e-prescribing and administrative transactions, as well as some of the broader network-related transactional aspects. That was really rewarding.

 

Gamble:  Let’s talk about the ONC Tech Lab. So many organizations are looking to do something similar, but are running into challenges.

Posnack:  I appreciate you bringing this up — it doesn’t get highlighted as often as we’d like. It has a couple of different dimensions. To pull back the curtain a little bit, there’s an internal component as to how we approach our work in general. ONC, as a whole, runs a really matrixed team. We have great diversity from an experience perspective, with staff that have worked at for federal agencies and private sector jobs, and have backgrounds you wouldn’t traditionally expect in health IT.

Part of the Tech Lab construct is around thinking outside of our managerial and hierarchical structure to focus on the work we do — not who we work for. That gets into the matrix aspect. We’ve adopted that mindset because it allows us to categorize our work in a way that doesn’t reflect the org chart. I’ve found there are many issues we work on from both a standards and a policy perspective that require a certain individual or element from different teams across ONC — not just one particular branch or division in a hierarchical sense.

We give a lot of thought to the categories of work we’d like to represent back to the community at large. In the Tech Lab, we work on standards coordination, on testing utilities, on innovation, and on piloting. We’ve learned that if we’re going to do a pilot or another prototyping activity, there should be some policy component. If it something like consent, there’s a technology component as well. And so we may have both policy and technology people working on it.

 

Gamble:  Your other passion is policy. What is it that draws you to that area?

Posnack:  It’s so interesting. Things in the policy space move fast and slow at the same time. Personally, I really enjoy complicated problems, and the policy and regulatory portfolio fed that for me. Throughout my time at ONC, the work we’ve done across the board has really had a cross-sectional impact on the healthcare system at large. There’s not an issue in healthcare today that doesn’t have an IT component to it.

And so, you have this really interesting precedent of interpreting policy. From the perspective of a government role, we believe we can help by making certain changes, either by issuing guidance, by issuing a new regulation, or by engaging in a some other type of public-private partnership.

For example, we work very closely with the HHS Office for Civil Rights. Since the HIPAA Privacy and Security rule was passed about 20 years ago, there have been so many changes in technology. We often her from the developer community — or, in this case, the app developer ecosystem — about issues they have at the intersection of HIPAA-related issues and health IT-related issues. It’s incredibly rewarding work, because you’re solving practical problems for stakeholders. We can help drive change and provide guidance through the work we’re doing with HHS.

Another challenge we face is in working with a mix of different agency missions, some of which have competing priorities. One example is the Drug Enforcement Agency and the move toward electronically prescribing controlled substances.

 

Gamble:  I’m guessing your earlier comment about the government moving slow and fast at the same time applies here.

Posnack:  Absolutely. That was an issue I worked on for five years, basically from my first at ONC in 2005, through 2010 when the Obama administration got the rules out to permit electronic prescribing of controlled substance. And it was complex because HHS and DOJ/DEA shared a common goal to enable e-prescribing of controlled substances happen, but we each had different objectives. Obviously, HHS wanted to ramp up, but DEA took more of a law enforcement perspective, trying to prevent and mitigate diversion as much as possible. And so were able to work out a compromise between law enforcement and the public health/public policy side and get that addressed.

That’s how things move quickly and slowly at the same time. It took a while for the policy to mature, but then things moved quite quickly when we reached a consensus and put all those pieces together.

Part 2