Hard on the heels of my own departure from the US Centers for Disease Control and Prevention (CDC) on September 30 comes a clean sweep of high-level informatics leaders in the organization. Sources now confirm that James Buehler, MD the current Director of the Public Health Surveillance and Informatics Program Office (PHSIPO) will depart before year’s end. His supervisor, PHS Rear Admiral (ret.) Steven Thacker, a long-time advocate for cross-cutting integration, is also slated to leave his post as Director of the Office for Surveillance, Epidemiology and Laboratory Services (OSELS). These departures follow at least three years of marked funding reductions at CDC’s informatics core.
[Update 12/11/12: We’ve learned Dr. Buehler is departing for family reasons, and Dr. Thacker for health reasons. Friends and colleagues of Dr. Thacker can connect with him and his family here.]
Few signals indicate the future direction for informatics at the Agency. Acting leadership for OSELS will be placed in the hands of Denise Cardo, MD, director of the Division of Healthcare Quality Promotion, and Dan Jernigan MD, MPH of the National Center for Immunization and Respiratory Diseases (NCIRD) as her deputy. While Buehler and I were recruited from outside CDC, both of the new OSELS leads come from powerful National Centers in CDC’s Office of Infectious Disease. This may (but also may not) indicate a plan to redistribute the OSELS portfolio across the National Centers (sometimes called “Silos of Excellence”).
The timing for an apparent leadership vacuum and dwindling resources could not be worse. It comes in the middle of a massive one-time Federal investment of tens of billions of dollars in healthcare information technology and exchange. Standardization engendered by the “Meaningful Use” electronic health record incentive program could enable major progress in public health programs if two conditions are met. First, cash-strapped local and state public health agencies must make it a priority to migrate to new, more uniform standards and must have the resources to do so. Second, critical public health requirements for information exchange must be successfully negotiated with cost-averse healthcare providers and their information system vendors. Neither can be accomplished without dedicated leadership and resources. The need for a confident, skillful, flexible and funded approach to public health information exchange with healthcare providers has never been greater. We anxiously await the announcement of both new a new informatics vision and stable leadership at CDC.
It occurs to me that the term “clean sweep” might lead people to think that Drs. Buehler and Thacker were discharged from their positions rather than left voluntarily, but I have no reason to believe so. Dr. Buehler announced he will be moving to reunite his family. My comments are not focused on past leadership but about the need to continue and indeed to accelerate time-critical work related to public health and electronic health records.
In a posting elsewhere, former National Center for Public Health Informatics Les Lenert applauded the choice of acting leaders given their successful work in the National Healthcare Safety Network and immunization information systems. I concur that Dr. Cardo and Jernigan bring excellent experience and perspective to their acting positions. I hope their involvement will usher in strong leadership, and support at the Agency level for a coordinated approach to prepare states for opportunities and challenges in Stages 2 and 3 of Meaningful Use. These will likely affect disease reporting, syndromic surveillance, immunization registries, cancer and other disease registries, communication to and from laboratories, and public health efforts to improve healthcare quality and safety. High stakes and tight timelines require not only good acting leaders, but active support for this effort from the Agency itself.