Q: Talk about Stage 3. CMS has talked about simplifying things, reducing the reporting and measuring and focusing on eight core measures. Does it strike the right balance?

A: I would love to give you all sorts of comments. It's a proposed rule. But even more so it's not my rule, its CMS'. But what I'll say is I think it's a very interesting and exciting rule. And we look forward to comments. A lot of people have been very engaged, and we're starting to hear comments back now.

Q: Meaningful use is a CMS rule and certification is an ONC rule. Ho much do you compare notes as you're developing them?

A: Through all the different stages the rules get developed in tandem. Obviously the timing gets a little off sometimes, but yes, they initially get developed at their respective agencies but then go thorough a clearance process within the department, and then the broader administration. By the time you get to the published NPRM, you've had a lot of weigh-in from across the administration: These rules affect not just the private sector, but impact the government too, so it's obviously important to get their feedback. And then on to the public stage, which is where we are now.

Q: Talk a bit a about the new 2015 Edition certification criteria. We ran a Stage 3 analysis whose authors said that, while "the the CMS rule is laid out logically and pretty easy to follow," they wished they "could say the same about the ONC Certification Rule." There are more than 400 pages of regulations. Talk about the balance you have to strike between certified products and allowing the vendors the latitude to innovate.

A: It's a great question. And it is a balance. Without trying to comment specifically on what's in the NPRM, because of course it's in a public comment period, I would say that any time you're working on one of these rules, you're trying to balance the public good versus the burden that it causes. And that's reflected in the actual structure: there's the rules, and then there's the analysis of what happens when you put the rules in place. The public feedback is tremendously valuable.

There are a lot of different demands. Not just in healthcare, but on ONC and the federal government. I know that a 400-page rule sounds like a lot. But on the other hand I can promise you that my pathology textbook was a lot bigger than that.

Again, there's a lot of things that are in there for which public feedback would be really valuable. There's a lot of very smart people out there and we look forward to their feedback to make it the best rule it can be.

Q: Just as meaningful use has evolved in recent years, so has ONC. You guys have had some pretty big turnover this past year and a half, and a lot of people were questioning just what the agency's role will be going forward. How do you envision it?

A: Well, of course, Karen is the national coordinator, and she ultimately sets the vision, and my job as acting deputy is to be good support for her. I'm a career fed, and one of the ways I'm able to complement Karen is I have a lot of longstanding working relationships with other staff, and a lot of the federal programs and operating divisions. I also have worked with a lot of the ONC staff for a long time.

But ONC has gone through a pretty big transition, we've gone through the past five years where ARRA and HITECH set up a lot of different programs, and the funding for those is winding down, but I think what you're seeing is the work is not done. It's pretty clear that in addition to the things that we see – for example, Congress asking about information blocking – there are a lot of ongoing phases in adoption and use.

I don't see the information systems staying static, there are a lot of very smart people, and they're going to innovate. I think we're here to see that the public is best served by those systems, and by the healthcare system more generally.

Q: Do you worry that as the money runs out, and we move away from the carrot phase and into the stick phase, your job will get harder?

A: I think it's just a different phase. Again, what this gets back to is working with those in this country who provide care, and those in this country who receive care, to understand that to get the best care you really need great information systems, great tools and practices. That need is not going away. And although there are challenges associated with it, I think most folks do understand that promise.