National Health IT Coordinator Mostashari Outlines Challenges

Upon assuming Dr. David Blumenthal’s role at the helm of the Office of the National Coordinator for Health IT, Dr. Farzad Mostashari discussed his vision for how IT adoption will transform healthcare, progress made so far, and the road ahead.

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Last month, Dr. Farzad Mostashari was named national coordinator for health IT, taking on the job from Dr. David Blumenthal, who held the post for two years and left to return to an academic role at Harvard Medical School.

Mostashari has the background to hit the ground running in his new job. During Blumenthal's tenure, Mostashari had been deputy national coordinator for programs and policy since July 2009. Prior to that, Mostashari had real work experience in employing health IT to improve public health. Before joining the Office of the National Coordinator for Health IT (ONC), Mostashari led the New York City Department of Health and Mental Hygiene's primary care information project, which helped more than 1,500 providers adopt health IT to encourage preventive care in underserved neighborhoods. Mostashari also was the founding head of the New York City health department's bureau of epidemiology services and helped the city develop a real-time electronic disease surveillance system.

Mostashari spoke to InformationWeek Healthcare senior writer Marianne Kolbasuk McGee about his priorities as the new ONC leader and the challenges ahead as the country's healthcare system undergoes reform, and as U.S. healthcare providers move forward implementing health IT systems under the Health Information Technology for Economic and Clinical Health (HITECH) Act's meaningful use programs.

McGee: As you take on the job as national coordinator and continue the work started by Dr. Blumenthal with the HITECH Act programs, what are your top three, most urgent priorities?

Mostashari: The most important thing to recognize is that there will be continuity with what we did before as I served as deputy with David [Blumenthal]. We have the right strategies, the right partners, and we're moving ahead, that's the biggest message. There are three issues for which the time is now and right. The first is implementation. Now is the time for implementation. We're in the deep part of implementation [of meaningful use stage 1] now and all our programs are hitting on all cylinders. Healthcare providers are in full swing and I think we have to really focus like a laser beam on excellence in execution. That's focus one.

The second focus area now is to link what we're doing to specific outcomes and goals for our healthcare system as a whole. We know that our healthcare system needs to be safer. We need to link what we're doing to the federal health policies that were recently announced, whether it's the National Strategy for Quality Improvement or the Partnership for Patients that calls for a 20% reduction in hospital readmissions and 40% reduction in hospital acquired conditions. That can only be done through the appropriate and I would argue meaningful use of health IT. Linking what we do with those particular goals is priority two.

Priority number three is putting the patient at the center of everything we do, including privacy and security. I think this is going to be the year where we really see an additional focus not only on doctors and hospitals and medical records but also on patients and their use of information and IT, and being able to speak to them about how this will impact them.

Health IT Boosts Patient Care, Safety
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McGee: Related to your number two priority, where it comes to improving health outcomes and quality of care, are electronic health records (EHRs) enough to help make that happen? Or will that require additional investment in technology by healthcare providers?

Mostashari: What's really exciting is that I believe we're moving to a phase where we're getting a virtuous cycle between the goals of delivery system reform, healthcare transformation, and healthcare IT. Obviously the technology on its own is not sufficient. It needs to be part of a system that includes payment that rewards safety, quality, and care coordination. IT enables those payment systems and in turn creates a context in which people invest in those technologies, make use of those technologies, and refine those technologies. I think the stars are aligning with all that's happening out there now.

When people talk about bundled payments, shared savings, accountable care organizations, patient-centered medical homes, IT is the critical foundation for that transformed healthcare. So that's really coming together now.

If you look at what's in meaningful use stage 1, I think that's really the basic building blocks. I think we have to maintain momentum up that escalator of progress, and that it's achievable. We need to keep pushing the boundaries of accomplishing these goals. So, we can't sit still. Stage 1 meaningful use was the right start and we have to keep making progress. Our recommendations from our Health IT Policy Committee [which Mostashari chairs] will be very much in line with that.

McGee: Speaking of progress, how would you assess the progress so far by U.S. healthcare providers in their efforts to comply with the meaningful use stage 1 program? Are there groups of healthcare providers having more difficulties than others?

Mostashari: I think we're making remarkable progress. If you think where we were just a year ago to now, we have 62 regional extension centers working with over 60,000 primary care providers. Our community college program is graduating over 2,000 health IT professions this month and another 3,000 over the summer.

Nearly all of the health information exchange grantees are moving from planning to implementation stages, same with the Beacon Communities. We have over 500 products in the marketplace now that are certified [for meaningful use]. We have attestation for meaningful use that started in April and seems to have gone off without a hitch.

I think it's too early to tell whether there are groups that will have more difficulties than others achieving meaningful use or any particular aspect of meaningful use requirements. I'm heartened by the increased adoption rates of health IT among primary care providers jumping up from 21% to almost 30% in one year. So that's promising and I think the regional extension center program is specially aimed at helping out those organizations that have the least resources, whether it's small practice, critical access hospitals, rural health centers, or others. The centers are helping these providers benefit from technical assistance and make progress to meaningful use.

So we're making progress and we're going to be monitoring it closely to see if a digital divide does begin to emerge and the take steps to redouble our efforts to close any gap that develops. So far we're hitting our milestones, but it's a sprint not a marathon.

McGee: You mentioned the 30% adoption rate for primary care physicians, how about the adoption rate of other groups of providers, such as small rural hospitals?

Mostashari: The particular statistic I cited was from the National Ambulatory Medical Care survey. It doesn't have the specific subgroup you're asking about, but we're developing monitoring capabilities to look at other groups like the one you're asking about, such as rural adoption rates versus urban. We hope to have something on that later this year.

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McGee: With the HITECH programs, and all the implementation of health IT that's underway right now, is there one thing in particular that you think will have the biggest impact in terms of achieving goals associated with healthcare reform?

Mostashari: I think most people would agree that reform--no matter what their perspective is--needs to get the most value of healthcare spending, improve patient safety, reduce avoidable hospital admissions and readmissions, and none of that is possible without effective use of IT; what I really mean is better information.

You can't fix what you can't see. And I think IT is essential to that. Here's an example. If a provider or organization or ACO must identify their patients at greatest risk and want to reach out to them, such as send a reminder for missed follow-up care, they can't do that without electronic health records with registry functions.

If they want to measure the progress they're making in terms of controlling blood pressure over time, they can't do that without electronic health records. If they want to have reminders at point of care that someone needs a flu shot, they can't do that effectively without electronic health record systems. If they want to reach out to patients and educate them with a summary of their visit, and access to their records and the ability to ask questions and request refills online, you can't do that without electronic health records.

So, I think information technology is really is an integral part of being able to transform healthcare so that it is more coordinated, is more patient centric, is more efficient, and I think we're going to see those synergies more and more. Obviously, care coordination--and we know how hard that is in the current fragmented healthcare system, the hand offs, the discharges from hospitals, the people showing up in ERs and the admissions that take place because of missing information--those I think are all critically linked to the availability and use of health information technology.

McGee: How important are health information exchanges in all this?

Mostashari: We [at ONC] talk of health information exchange as a verb not as a noun. The goal is health information exchange, and there's not going be a one-size-fits-all solution to how health information exchange will happen. It's happening today. There is a variety of means, and needs will continue to be met by a variety of organizations and through a variety of technological approaches.

I think we've taken very concrete important steps forward in terms of assembling the building blocks for information exchange and interoperability. Whether it's the standards around vocabulary and terminology in our final rule for electronic health records for routing protocols for secure, private transmission of health messages over the Internet, or the governance rule around trusted intermediary that's going to be coming out later this year--those are the essential building blocks for information exchange and interoperability. And I think we'll see incremental but overall dramatic improvement in liquidity of data in the year to come.

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