On April 27, 2004, President Bush signed Executive Order (EO) 13335 and created the Office of the National Coordinator for Health IT (ONC). Like tapping that first domino, this single action is a key moment in United States health IT history. Nearly two decades later, US policy and technology leadership in health IT is world-renowned.

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

1. serve as the Secretary’s principal advisor on the development, application, and use of health IT;
2. ensure that health information technology policy and programs of the Department of Health and Human Services (HHS) are coordinated with those of relevant executive branch agencies;
3. coordinate outreach and consultation with public and private parties; and
4. provide comments and advice on health IT at the request of the Office of Management and Budget.

The past 18 years has seen its share of remarkable, market-moving events, such as the passage of the HITECH Act (2009) and 21st Century Cures Act (2016) as well as major electronic health record (EHR) investments by HHS and the procurement of a commercial EHR system (ONC-certified, I might add) by the Departments of Defense and Veterans Affairs. Add in large financial investments from the public and private sectors as well as a significant amount of “sweat equity” from provider organizations and technology developers and you can see why more than 90 percent of hospitals and nearly the same amount of physician practices now use EHR systems. This dramatic change in what is arguably the most complex sector of our economy is a mammoth achievement.

Amidst these and other marquee moments, a few hundred past and present staff have come through ONCs ranks with a simple purpose in mind – to make the nation’s health better through the use of health IT. And that’s what keeps us going. Having started at ONC shortly after its first birthday, there have certainly been months and years where the headwinds felt strong. But we persevered. While there is no shortage of work to be done, it’s also important to take stock of how far we’ve come. That’s a testament to all of the national coordinators (with whom I’ve had the privilege to serve) and the remarkable continuity they’ve offered across administrations.

Thank you to everyone out there who has ever submitted a public comment, participated in an advisory committee, attended an ONC event, or supported an ONC project. We know if we invited you all, it would be one heck of a party!

As we celebrate our 18th birthday, it’s with a continued sense of pride, patriotism, and optimism about the future of health.