The exodus of top-tier ONC leaders continues. In fact, it might now officially be called a brain drain. Not long after news broke that National Coordinator Karen DeSalvo, MD, was stepping out of her post on Thursday, word came down that Deputy National Coordinator Jacob Reider, MD, would depart the agency as well, leaving in November.

[See also: Whither ONC?]

The departures of the Office of the National Coordinator's top two executives comes as the group is sculpting two critical plans for its future: the 10-year interoperability "roadmap" and its next Federal Health IT Strategic Plan.

What’s more, DeSalvo and Reider are just the latest in a string of high-profile ONC departures. During the past few months, Chief Nursing Officer Judy Murphy accepted a post with IBM and chief science officer Doug Fridsma, MD, resigned to take the helm at the American Medical Informatics Association. Chief Privacy Officer Joy Pritts and Lygeia Ricciardi, director of ONC’s consumer eHealth program, left without detailing their immediate career plans.

The fact that so many executives are stepping down from their posts at ONC raises a number of questions: Who will champion the interoperability roadmap and strategic plan? What does all this mean for the meaningful use program moving forward? Will HHS Secretary Sylvia Mathews Burwell appoint a new permanent national coordinator in the near future and, if so, who?

When Burwell announced that DeSalvo would be joining the emergency response team at HHS to work on Ebola, among other things, she also said that ONC chief operating officer Lisa Lewis would become the acting national coordinator. A request sent to HHS asking whether DeSalvo will return once Ebola is under control, however, has so far been unanswered.

Reider, for his part, said he has been planning to leave ONC for weeks because he currently lives and practices medicine in Albany, N.Y., and had an agreement with his family that he would commute to Washington, D.C. for just three years -- a time period that's elapsed.

“Karen and I worked closely on the timing of both this announcement and my departure so that there would be a good transition, strong clinical leadership at ONC, and continued ONC strength on the issues that remain so important: decision support, quality improvement, health IT safety and usability," Reider wrote in an email to ONC staff.

"In light of the events that led to Karen’s announcement, it’s appropriate now to be clear about my plans as well. With Jon White and Andy Gettinger onboard and a search for a new Deputy National Coordinator well underway, I am please that much of this has now fallen into place – with only a few loose ends yet to be completed."