One down, four to go. The number of open chief information officer positions across the Department of Health and Human Services dropped by one when the Centers for Medicare and Medicaid Services hired Patrick Newbold.

Federal News Network has confirmed that Newbold, who is the deputy CIO at NASA, will start Nov. 4.

Once Newbold joins CMS, there will be only four open CIO jobs across HHS, including the departmental technology leadership position, which as been open since November when Karl Mathias left to take a different role at NASA. In addition to the top HHS job, the Centers for Disease Control and Prevention, the National Institutes of Health and the Administration for Strategic Preparedness and Response are all looking for CIOs.

CMS’s hiring of Newbold closes a position that has been open since November when Rajiv Uppal left to join the IRS to be its CIO.

Newbold joins CMS after having similar experience in working at a large citizen facing organization. He was the deputy CIO for more than two years and served as acting CIO for a short time at the Social Security Administration before joining NASA in January.

He also spent more than two years with the Army Corps of Engineers as its deputy CIO from 2019 to 2021.

As for the other open CIO roles, the NIH one is most intriguing. NIH officials broke up the CIO and director of  Center for Information Technology roles back in January 2023, saying at the time that the CIO will focus “more on compliance and security standards,” while the director of CIT will focus “on the unique needs of NIH’s research and clinical enterprise.”

NIH named Dr. Sean Mooney to be center’s director in March, but the agency hasn’t hired a new CIO. Dennis Papula, the deputy CIO at NIH, has been in the acting position since Andrea Norris left in December 2022.

Over at the CDC. Suzi Connor transitioned out of that role in June after more than seven years. She is now “spearheading several, strategic initiatives that align with our agency’s long-term objectives,” an agency spokesperson told Federal News Network.

Jason Bonander, deputy CIO, is serving as acting CIO.

And at ASPR, Tracey Trautman, the deputy assistant secretary, has been acting CIO, but sources say a new permanent CIO could be named in the coming month.

All of these open positions across HHS also are happening as departmental leadership reorganized the technology oversight and management structure last July.

HHS outlined three major pieces to this reorganization:

• The Office of the National Coordinator of Health IT (ONC) will be renamed the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ASTP/ONC);
• Oversight over technology, data, and artificial intelligence policy and strategy will move from the Assistant Secretary for Administration (ASA) to ASTP/ONC, including the HHSwide roles of chief technology officer, chief data officer and chief AI officer.
• The public-private effort between the health sector and the federal government on cybersecurity (“405(d) Program”) will move from ASA to ASPR, joining the other health sector cybersecurity activities already located in ASPR’s Office of Critical Infrastructure Protection.

HHS named National Coordinator Micky Tripathi as the assistant secretary for technology policy/National Coordinator for Health Information Technology. The agency currently is trying to hire for the CTO, CDO and CAIO positions.

“HHS is unlike any other public or private entity. Recognizing the department’s uniqueness, both in size and scope, Secretary [Xavier] Becerra and Deputy Secretary [Andrea] Palm are continually working to ensure the department is optimized to meet the needs of the American people. Efforts in recent years, such as the HHS Data Strategy, the Health IT Alignment Policy and ongoing work through the department’s AI task force, made it increasingly clear the need to streamline and ultimately consolidate technology, data and AI strategy and policy functions under one organization,” said a HHS spokesperson in an email to Federal News Network. “ONC, which already played a critical role in health IT across our agencies and with the industry, was a natural fit to harmonize those strategy and policy functions under one proverbial roof; that being the newly formed Assistant Secretary for Technology Policy. Thus, it made sense for ASTP to establish an Office of the Chief Technology Officer and reinstitute the role of Chief Technology Officer to oversee department-level and cross-agency technology, data, and AI strategy and policy. We believe these organizational changes will ensure that HHS is best situated to serve the American people during this incredibly dynamic time in the technology space.”

HHS CIO authority a long-time concern

But former and current HHS technology executives question this move, asking if the problem the secretary is trying to solve is the right one.

One former HHS technology executive, who requested anonymity because they still do business with agencies, said this reorganization continues a pattern of undermining the agency’s CIO’s authority.

“The CIO is supposed to report directly to the secretary. HHS has skirted that issue for years and made the CIO report to ASA. The CIO has never had the ear of the deputy secretary or secretary,” said the former HHS executive. “Moving functions to this new organization isn’t going to help that. My sense is this continues to undermine position of the CIO and chief information security officer. Unless this new organization is totally policy, which these things never are, it will cause confusion within the operating divisions and staff divisions about who should they talk to about what.”

The HHS CIO’s role has been a revolving door for much of the past decade. Mathias, before leaving in November after only 20 months, was the 8^th CIO in seven years and Jennifer Wendell, who has been acting CIO for almost a year, is the 9^th CIO in eight years.

Rep. Gerry Connolly (D-Va.), author of the Federal IT Acquisition Reform Act (FITARA), which requires agencies to ensure the CIO reports directly to the secretary or deputy secretary of the agency, said HHS implementation of that requirement has been a long-time concern.

“Through the FITARA scorecard, we have consistently raised concerns that HHS is one of the large agencies that has long resisted empowering its CIO with a direct reporting relationship to the secretary in all IT decisions,” Connolly said in an email to Federal News Network. “To that enduring concern, it is telling that the CIO is not even mentioned in this major health IT announcement. I think HHS owes Congress an explanation of how this decision enhances instead of dilutes IT leadership and accountability at the agency.”

In the latest FITARA scorecard from September, HHS received an “A” grade, but only a “partial” under the CIO reporting category.

The committee says, “Of the 24 major agencies, 17 CIOs report to the head of their agency (or the deputy) and seven CIOs have established agency policies that allow for direct reporting over some, but not all, IT decisions. CIOs’ ability to effectively manage IT is weakened when they do not report to the head of the agency.”

Reorg puts CIO in tactical position

Another former HHS executive said HHS has never fully supported the CIO authorities provision under FITARA. The executive said HHS leaders back in 2014 told the Office of Management and Budget and lawmakers that giving the departmental CIO the authority and management of all IT projects wasn’t going to work.

“The appropriations committees direct funding at operating divisions and the secretary has little ability to control the operating divisions appropriations. That is the law and in practice,” the former executive said. “FITARA tried to do something that in some agencies made sense and there is a need for CIOs to have some authority, but there are other ways to get at the goals of FITARA. The tricky part, particularly for HHS, is how to make all laws and policies work best to deliver the best technology for your agency?”

The former executive said HHS has tried to explain that it complies with FITARA because the CIO reports to the secretary, but operationally works closely with the assistant secretary.

“It’s rare for the CIO to get an audience with secretary or deputy secretary unless there is something wrong,” the former executive said. “The turnover in the CIO shop is very much related to the lack of support from the upper levels. IT is seen as extra things to the mission, but it is a huge part of everybody’s mission. People who have been around for a long time understand, it’s important to get IT right because if something doesn’t work, the CIO is the one that is blamed. It’s unclear at this time what difference this reorganization will make. Will it add to the confusion or eventually clarify it?”

The HHS spokesperson said under this new set up, the CIO will focus on the tactical implementation and operational management of IT systems across the department.

“This focus ensures that IT projects are executed efficiently and support the diverse functions of HHS, from public health to biomedical research,” the spokesperson said. “HHS is committed to fostering a strong connection between the CIO’s office and the ASTP to ensure cohesive IT governance and strategic alignment. OCIO and ASTP staff and leadership have been working closely together throughout this reorganization process to clearly define roles and responsibilities in the new structure and establish ways of collaborating that will ensure ongoing coordination.”

New structure encourages agility, innovation

The spokesperson said HHS has strengthened CIO authority and governance, empowering CIOs with greater authority over IT decisions.

“The current structure, where the CIO is a dual report to the HHS Deputy Secretary and the Assistant Secretary for Administration (ASA), offers significant strategic advantages by integrating IT with the department’s broader administrative functions, while also retaining reporting channels to top HHS leadership as needed. This setup allows the CIO to align IT initiatives with operational priorities, facilitating seamless integration and execution across the department,” the spokesperson said. “The ASA’s oversight ensures that IT initiatives are closely aligned with the department’s operational needs, providing a comprehensive perspective that supports holistic decision-making and resource allocation. The CIO receives focused support in governance, resources and strategic alignment, enabling more effective implementation of IT projects across HHS. This approach enhances the department’s ability to respond to emerging challenges and opportunities. The ASA’s position allows for better collaboration across various HHS divisions, ensuring that IT strategies align with the department’s mission and operational needs. This structure encourages agility and innovation, positioning HHS as a leader in IT innovation within the federal sector.”

The spokesperson added, HHS is committed to complying with FITARA and the Clinger-Cohen Act by ensuring IT governance and alignment with federal requirements.

Scott Cory, a former CIO with the Administration for Community Living in HHS and who worked at that agency in IT for 18 years, said the IT challenges the agency faces are because of “deep systemic” problems.

Cory, now a principal with Scory LLC and who works with Deepwater Point, said different authorizing legislations, an assortment of funding streams and the disparate missions all make management and control over IT more difficult.

“If you are trying to use data and technology to change how HHS deals with healthcare or human services and if you are in the management office, you are on a back foot. You have a difficult time playing with the experts in healthcare or  in human services or in insurance and public health,” he said. “ONC, on the other hand, since 2009 has been hub of bringing together disparate threads to address health IT through incremental work. ONC has done a remarkable job to provide rules, regulations and guidance that helps across the healthcare and human services industries to make things better. They have been able to do that because of where they are in the organization. They don’t have a management role.”

Potential for positive change

Cory said putting the CTO, CDO and CAIO functions in the new office means that they inherently have to work across the operating divisions as well as across all federal government, health care, insurance and human services providers.

“ONC is in a unique position to take all of HHS forward in using data and technology in a way that may never happen in the Office of the CIO,” he said. “The new office will need to establish bright lines of authorities and responsibilities for the CTO, CDO and CAIO as well as how they are expected to coordinate and where boundaries on different things need to be with the CIO’s office. There also needs to be clear understanding of relationships between CTO, the operation division heads and their CIOs. I think they have to all understand the potential to leverage these benefits, how they expect their programs to be data and technology informed and how open they are to digital transformation and all benefits derived from that.”

The HHS spokesperson said moving the CTO, CAIO and CDO under the new assistant secretary clarifies their roles and responsibilities.

“ASTP is set up to clearly lead policy development, strategic planning and internal and external stakeholder engagement in rapidly evolving areas like AI, while CIO is able to focus on core service delivery for HHS’s customers, enterprise technology management, and internal cybersecurity,” the spokesperson said. “This new structure will leverage the unique cultures and skills of ASTP and OCIO, building on ASTP’s history of cross-HHS and external coordination to develop data standards and health data exchange ecosystems to cover new areas like AI, while also allowing OCIO to fully focus on its core expertise in areas like enterprise technology, customer service, and risk management.”

Cory said one of the biggest challenges of this reorganization is clearly defining the roles of the CIO and CTO and how they will work together.

“This reorganization offers the potential for a lot of positive change. If it’s done right, the operating division CIOs could be more empowered than they are now,” he said. “You need to have those conversations about the roles and authorities, where the constraints are today, how do you create transparency and accountability at all levels. If they can use these things to reduce the burden on CIOs while also letting them work better and faster without compromising safety and security or accountability, then this will be a good thing for everyone.”

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