With all the problems that have plagued the rollout and operation of the federal exchange website Healthcare.gov, the announcement that Kathleen Sebelius has decided to resign as Secretary of Health and Human Services makes perfect sense. Sebelius is trying to leave on a "high note," timing her resignation with the end of open enrollment on March 31, which marked the milestone of an estimated 7.5 million Americans having signed up for healthcare coverage under the Affordable Care Act.

During her five-year tenure, Sebelius presided over a government behemoth at HHS, helping to usher in a host of new programs expected to improve the quality and efficiency of care. President Obama in 2009 signed the HITECH Act to lay the ground work for an information technology infrastructure to support health reform, which came a year later through the Affordable Care Act.

Also See: How CIOs, Others View Sebelius' Tenure

Now, five years later, about $24 billion has been spent on driving EHR adoption--$22 billion on the Medicare and Medicaid incentive program and $2 billion on other programs--which has resulted in a dramatic increase in EHR use among eligible professionals and eligible hospitals. However, for all her leadership at HHS, Sebelius did not have hands-on involvement in the day-to-day design and implementation of the health IT initiatives that are driving adoption among healthcare providers, and it is for this reason that her departure will have a negligible effect on those ongoing efforts. 

"Her time at HHS was focused on healthcare reform, for obvious reasons. Unfortunately it meant that she had little time for FDA or for health information technology," says Bradley Merrill Thompson, an attorney at the law firm Epstein Becker Green, who counsels medical device companies on FDA regulatory issues. "While the Affordable Care Act is extraordinarily important, my hope is that the next secretary will be able to be a bit more balanced, investing time in making sure that the work of the FDA gets done appropriately, and in a timely way."

Russ Branzell, CEO of the College of Healthcare Information Management Executives, says that Sebelius took over HHS “during probably some of the most tumultuous times in healthcare.” Branzell argues that with transformation on this scale there’s always going to be challenges and issues. “She was extremely supportive of both CMS and ONC with their HIT initiatives,” he says. “Our hope is that with her replacement that will continue at the same level or maybe even greater.”

The Office of the National Coordinator for Health IT has been at the forefront of the Obama administration’s efforts to promote the adoption of HIT and health information exchange nationwide.

When Farzad Mostashari stepped down as ONC's national coordinator for health IT in October 2013 after a two-and-a-half-year tenure, it caught everyone by surprise. That cannot be said about Sebelius's resignation. Mostashari, who previously served as principal deputy national coordinator for programs and policy and had spent four years in total at ONC, was centrally involved in leading a broad range of health IT initiatives during a critical period of healthcare changes required by the HITECH Act. 

What's more, Mostashari's departure came at a time when ONC, along with the Food and Drug Administration (an HHS agency) and the Federal Communications Commission, was in the midst of a study of the nation's healthcare IT system. That long-awaited report on a proposed strategy and recommendations for a risk-based regulatory health IT framework was only released last week by the three agencies involved and is merely a first draft that will need revisions based on public comments from stakeholders. 

Sebelius’ departure at this time is not surprising. She had become a lightning rod for Republican critics on Capitol Hill who incessantly called for her removal over what even Democrats admitted had been a botched rollout of the landmark healthcare law.

“I can’t imagine what she has gone through over the past few months in particular,” says Jim Turnbull, CIO, University of Utah Hospitals and Clinics. “She is a strong leader…her support of the Meaningful Use program has led to some great advances in the use of technology in our industry.  It is unfortunate that the Healthcare.gov launch was such a disaster. Having the ICD-10 conversion put on the back burner was probably the last straw.”

She has served longer than many Cabinet members and has faced more political fire than most. It has been known for months that the White House did not want her leaving during the Healthcare.gov debacle when she was taking much of the political heat, but later when there was better news to report. That opportunity came with publication of the open enrollment numbers.

“Sebelius can go out on this ‘high note’ and clear the deck for a new HHS secretary. The confirmation hearings for the new nominee, Sylvia Mathews Burwell, should be interesting and politically charged coming just before the off year elections later this year,” says Mitch Work, CEO of The Work Group, Inc.  “This story is far from over.”

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