The Office of the National Coordinator for Health Information Technology, formed in 2004 as kind of a bully pulpit to rally the troops behind health IT, has widened its responsibilities over time. First there was Dr. David Brailer's strategic roadmap for getting interoperable EHRs to most Americans within a decade. Then there were the contracts to demonstrate health information exchange and to set up an EHR certification program.

With passage of the American Recovery and Reinvestment Act in February 2009, ONC became the key agency for doling out $2 billion in discretionary funding to support the Medicare and Medicaid incentive program for EHR adoption, by way of regional extension centers, state grants, "beacon communities" and other initiatives. ONC also is helping to develop a new certification paradigm in which the federal government oversees multiple private-sector certification bodies.

And now, with the advent of the Patient Protection and Affordable Care Act, ONC is working on data standards for electronic enrollment of millions of people in health insurance exchanges and expanded state Medicaid programs. This has gotten veteran health IT columnist Ken Terry to wonder if the office isn't being stretched too thin.

"Naturally, this effort, which recalls the Manhattan Project in its complexity, must be completed within five months [180 days from the signing of the bill]. What were the legislators thinking when they set that deadline?" Terry writes at the BNET Health Care Blog.

"They surely were not thinking about the fact that state Medicaid programs alone use a bewildering variety of mostly outdated information systems. They were also probably not thinking that whatever enrollment systems are devised for the state insurance exchanges will have to be linked with existing state systems that contain various kinds of eligibility data."

Remember, it's taken almost a year to get the rules for "meaningful use" together. Does ONC have the wherewithal to get this new set of standards together in half that time? "In Blumenthal's remarks to the Standards Committee, he said of the online shopping site that people will use in the health insurance exchanges, 'The point is to make it as easy to buy health insurance as it is to buy from Amazon,'" Terry notes.

"That's great, but maybe what ONC needs is an Amazon or a Google to figure out the myriad details involved in setting up this enormous database. I don't believe that private enterprise is always the answer, but this might be a case where properly incentivized entrepreneurs could get the job done faster, better, and more easily."

For more:
- read Terry's BNET commentary

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