Karen DeSalvo's departure from ONC — she was tapped yesterday as HHS acting assistant secretary and will be part of the Ebola response team — creates a new set of challenges for an agency that's seen a fair amount of shake-up in its leadership ranks during the past several months. It also presents ONC — and the industry — with a chance to reimagine the next phases of health IT implementations.

"With change comes great opportunity to look at things with a fresh set of eyes," Russ Branzell, president and CEO of the College of Healthcare Information Management Executives, told me this morning. "Now is the time to do that. We are just entering Stage 2 [of meaningful use] and there shouldn't be a rush for Stage 3."

Although DeSalvo was only at ONC for 10 months, she laid the groundwork for accelerated work on such things as standards and interoperability, culminating with the unveiling early this month of a 10-year strategic plan for achieving that long-sought goal for disparate health IT systems to actually speak with one another, as they do in nearly every other industry sector.

Observers expect that work to continue and hope new leadership will carry on DeSalvo's approach of reaching out to the industry and listening to various stakeholders.

A public health physician, DeSalvo was "very attuned" to fostering policies that could be implemented on the ground, says Chantal Worzala, director of policy at the AHA. DeSalvo understood the usability question — having tech in place that truly aids those caring for patients.

To be sure, hospital leaders and vendors have concerns about meaningful use regulations, especially with Stage 2, but, generally, they appreciated DeSalvo's approach to governance.

DeSalvo's departure caps off a slew of changes at ONC. Deputy National Coordinator Jacob Reider, M.D., plans to leave at the end of November. Other departures since this summer include: Lygeia Ricciardi, director of eHealth; Joy Pritts, chief privacy officer; and Judy Murray, director of the office of clinical quality and safety. Lucia Savage last week was tapped to lead the privacy office and Lana Moriarty has taken over the eHealth office. Lisa Lewis, ONC's chief operating officer, will head the agency until an acting national coordinator can be found.

Both Worzala and Branzell hope the Obama administration will turn to someone with change management experience, as well as familiarity with implementing and using a health IT system. In other words, someone who has spent time in the provider sector.