On April 27, 2004, President Bush signed Executive Order (EO) 13335, creating the Office of the National Coordinator for Health Information Technology (ONC). Like touching the first domino, this single action is a pivotal moment in the history of US healthcare IT. Nearly two decades later, America's political and technological leadership in healthcare IT of health is recognized throughout the world.

Throughout this time, ONC has remained true to the original four duties of EO 13335 (paraphrased):

act as the principal advisor to the Secretary in the development, application, and use of IT for health; ensure that the health information technology policies and programs of the Department of Health and Human Services (HHS) are coordinated with those of relevant law enforcement agencies; coordination of public relations and consultation with public and private parties; Y
provide feedback and advice on healthcare IT at the request of the Office of Management and Budget.

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The last 18 years have seen notable market-moving events such as the passage of the HITECH Act (2009) and the 21st Century Cures Act (2016), as well as significant investments in electronic medical records (EHRs). by HHS and the acquisition of a commercial EHR system (ONC certified, I might add) by the Department of Defense and the Department of Veterans Affairs. Add in large financial investments from the public and private sectors, as well as a significant amount of "welding capital" from vendor organizations and technology developers, and you can see why more than 90 percent of hospitals and almost as many practices Physicians are now using EHR systems. This dramatic change in what is probably the most complex sector of our economy is a gigantic achievement.

In the midst of these and other defining moments, a few hundred past and present contributors have come through the ranks of the ONC with a simple goal: to improve the health of the nation through the use of IT for health. And that takes us further. Starting at ONC shortly after his first birthday, there were certainly months and years when the headwinds were strong. But we persevere. While much remains to be done, it is also important to take stock of how far we have come. This is a testament to all the National Coordinators (with whom I have been privileged to serve) and the remarkable continuity they have provided across administrations.