With the reorganization of the U.S. Department of Health and Human Services announced last week, there’s been little explanation of why whole departments have been cut. There’s also been no analyses shared on how IT and digital infrastructure systems will be managed, their security maintained and program operations assured after the intended upheaval.
Without such analyses or transparency on plans after the cuts have been made, lawmakers and others can only speculate on the effects staff and contract cuts will have on these systems and the people relying on them. It’s unclear if divisions have any acquisition authority, fiscal oversight or strategic continuity.
HHS said by email Monday that its leaders focused personnel cuts on “redundant or unnecessary administrative positions,” according to information provided as background by the/a deputy press secretary at the department and referred to a previous statement, fact sheet and Secretary Robert F. Kennedy’s X social media post.
We interviewed two individuals with inside knowledge of last week’s cuts of senior executive service at the Office of the Chief Information Officer and the contract lead on a data project still in operation to get their perspectives.
Loss of knowledge transfer leaders
“It was a huge shock to everybody,” said a former leader with a CV rich in health technology programmatic leadership across multiple federal agencies who agreed to be interviewed without further identifiers.
“Our entire division of information technology was RIFd. That includes our chief information officer, our chief security officer and all our IT folks who manage the IT for the agency,” they said.
“The Office of Management Services that has HR and contracts – they were also all RIFd.”
The former hybrid full-time employee with first-hand knowledge of OCIO operations took a retirement option that keeps their benefits and pay active until September 30, they said.
“There was never a plan, there was never a process – and there was never any input from any government employees on what was going on,” they told Healthcare IT News on Tuesday. “None of the senior heads had any insight into this. None. Nobody.”
According to an HHS deputy press secretary providing background, across the department’s 28 divisions, it had 41 chief information officers.
But the idea that there are too many CIOs could be an oversimplification when the sheer amount of data and systems for the nation’s second largest federal department are considered.
“It was very CIO-heavy,” they acknowledged.
“Part of that was the specialty of systems, the special knowledge that you needed to have with these systems, the capabilities that you needed to have, and certain development teams you needed to have because they have very unique applications – especially at [National Institutes of Health],” they explained.
“They change frequently because you’re in a development environment. You have to be ready and be very flexible and agile and you have to have your different types of security paperwork work and government compliance that you need for these systems.”
While some think the department’s CIO designations were “territorial,” the sheer number of systems and their complexities account for a degree of necessity.
“What HHS has is not uncommon,” they said, adding that there were efforts to consolidate CIO roles.
But with SES staff all gone from the OCIO – through the Fork in the Road program and voluntary retirement or by being cut on April 1 – the loss of policy and governance expertise and function at HHS cannot be understated.
Shed from HHS in the purge are government careerists who garnered 20-30 years of enterprise knowledge.
“We were all the policy, we were all the governance, we were what got back to [Office of Management and Budget],” they said.
“Being the policy arm, you’ve crippled it. Now, we can’t funnel up any of the information that you need for Congress or OMB or funding – and we can’t issue the policies and guidelines down. They basically crippled the system.”
When asked about the current holes in the oversight and operation of the department’s digital infrastructure, they registered concern for cybersecurity and data reporting.
“Well, we’ve let go of the lead of cybersecurity,” they said.
“You’re impacting development, you’re impacting growth, you’re impacting research systems, you’re impacting facilities systems, and even tracking those high-value assets is an impact because those are mission-critical systems.
“Now we’ve got nobody to report it, too, because they basically got rid of the SES who runs security.”
Some HHS leaders were offered the option of relocating to a new job in Alaska, Montana, New Mexico or other postings within the Indian Health Service, according to National Public Radio.
“They told him to move to Montana, and he was the one that was leading all the governance and policy,” they said.
Before La Monte Yarborough became the lead chief information security officer of HHS in January 2022, he previously served two years as CISO for HHS’s Office of Inspector General. He spoke with us last year about the department’s cybersecurity outreach efforts to bolster healthcare organizations’ cybersecurity postures.
We reached out to HHS again on Tuesday, asking for a statement on how SES staff from OCIO fall in the department’s definition of redundant or unnecessary administrative positions, and we will update this story when and if there is a further response to our questions.
Deleting entire operations
Getting rid of duplicative administrative functions doesn’t cover “entire operational division,” said an HHS IT employee affected by the reduction-in-force cuts.
“Even if there’s program staff working, in order to work effectively in the government, you still have contracts,” they said.
“You still need to get government-furnished equipment, [personal identity verification] cards for your contractors. None of that can happen without what they term admin support. It’s especially problematic for our division of IT because they do things like oversee our cloud environment and manage the government websites.
“Right now, you have scenarios where that tractor is working, but they have no technical oversight right now because all of the IT business owners, the government officials, are RIFd,” they said.
HHS had noted on background that there were “dozens of IT departments,” along with 40 procurement departments and eight senior finance officials.
The department said its reorganization from 28 to 15 divisions is necessary and is now detailing the structure of each redefined division to streamline operations, enhance responsiveness to the American people, and ultimately improve the nation’s health as part of the Make America Healthy Again initiative.
“I don’t think there’s any plan for how that’s going to work right now. In the meantime, you just have everything existing without the oversight or even ability to get things done in the interim,” they said.
According to the SES OCIO insider we spoke with, HHS is looking to centralize development at Centers of Information Technology at NIH.
“That’s really not their mission,” they said. Beyond supporting NIH campuses and functions, they “now have to support all the IT structure and be the central hub.”
“They don’t even have the network diagrams or the understanding of all the components.”
Potential cracks to follow cuts
Because big data programs at ASFR Response Coordination & Data Integration Team rely on contractor support, “I think the first immediate crack is there are no contract staff to renew some of these contracts,” the HHS IT employee said.
That team is supposed to merge with the Assistant Secretary for Planning and Evaluation to create a new Office of Strategy.
“I think there’s a lot of work that has to be done to figure out how to keep basic operations moving, both in interim and then also in the future,” they said.
Regrowing HHS operational functions
“I think first people are going to have to realize what they’re missing out on,” such as Head Start, the Children’s Health Insurance Program, government research grant funding, many university partnerships, and pencils down on development new treatments, the OCIO insider said.
“The clinical center has been locked down,” they noted. “People were more stressed out there during this time than they were during COVID because you didn’t have the freedom to treat people.”
Without anyone overseeing HHS contracts, whatever IT, cybersecurity, and innovation work there could be will likely go to a contracted federal workforce.
“But then again, they just fired all the people who administer the contracts and administer [human resources],” they said.
Ethical bind for cut employees
After two decades of service, the SES OCIO insider also said they could see where the agency was heading, “especially when they started shoving us into offices.”
President Donald Trump questioned the productivity of federal employees working from home and ordered a return to federal offices by the end of January. In some cases, the resulting overcrowding at offices and overreliance on connectivity have also reduced employee productivity and hobbled service delivery.
“We had no office space. We had no room…You had no privacy or confidentiality,” they said.
Contractors could overhear “every word I said.”
Terminations came so swiftly that some employees who oversee contracts never saw their RIF letters sent by email just after 5 a.m. on April 1 when they were locked out of networks at midday.
The HHS IT employee, who has been with the agency for more than a decade, speaking on the condition of anonymity because they expect their official termination of benefits and pay to be June 2, has direct hands-on knowledge of data and oversight of certain data partnership contracts. They described sitting at their desk and suddenly not able to access anything, including their email.
“I think for the time being, considering we weren’t provided with complete and accurate information for our separation, we’re still waiting to get clarity on some of those details before we can really move on and start taking new jobs.”
They also said they may be on a short list to be rehired, as they were assigned to oversee contracts of a data partnership of a presently active HHS program.
But, there’s the “ethics prohibitions for federal staff to work as a contractor on things that they were involved in previously,” they noted.
“From what I’m understanding, the contracts, writ large in the government, are at risk, and some are being terminated or cut, reduced. So I think it’s very much uncertain what the contracts will look like,” the OCIO insider said.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.