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?

They surely were not thinking about the fact that state Medicaid programs alone use a bewildering variety of mostly outdated information systems.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.

But ONC officials and the members of the Health IT Standards Committee, an advisory body, are aware that much of the eligibility data is scattered across government systems, including those of the Departments of Treasury, Agriculture and Housing and Urban Development. They also know that some of the data is in social service and agency databases, such as those of the food stamp program, the school lunc

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h program, and state tax departments. So the government must not only develop standards but must also locate the data and link it together so it’s easy for people to find out what they’re eligible for and enroll in those programs.

Good luck.

Let’s not forget that ONC spent nearly a year putting together the “meaningful use” criteria for providers to obtain government EHR subsidies. Those requirements — and the standards to support them — have received voluminous public comments that ONC is still sifting through. By the time the agency publishes its final rules, probably close to the June 30 deadline, there will not be much time left to help doctors and hospitals figure out how to adapt to those criteria so they can get the 2011 subsidies. And then ONC will have to prepare the next round of meaningful use requirements, scheduled to take effect in 2013.

At the same time, the agency is supervising the development of regional HIT extension centers to train physicians; disbursing grants to community colleges to train the trainers; and helping states get health information exchanges up and running. Put it all together, and ONC already had a full plate before it took on enrollment in government-sponsored insurance programs.

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.”

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.