October 14, 2013
Farzad Mostashari, outgoing National Coordinator for Health Information Technology, was blunt in declaring that his departure would offer no respite from the rapid-fire pace of federal IT change initiatives in the healthcare industry.
Speaking with his characteristic high energy at the CHIME CIO Forum in Scottsdale, Mostashari instead challenged the several hundred hospital CIOs and IT vendor attendees to join together as “a community that wants to make life better” through its unique ability to apply information technology to the nation’s healthcare issues. Citing the concept of “disruptive innovation,” he called for a “revolution” in healthcare delivery that would not just accept incremental change. He emphasized that “only technology provides the kind of disruption that can actually change the slope” of healthcare delivery.
Most of Mostashari’s remarks referenced continuing controversy over Meaningful Use / MIPS deadlines. Agreeing to the industry’s repeated requests for delays, according to Mostashari, would mean “The longer we have hundreds of different versions of software, the longer we’ll wait for interoperabiity. Folks should assume that timelines will stick.” He reaffirmed that national policymakers stand unified in their goal to achieve interoperability throughout the nation and across all health organizations and IT platforms. He also reminded the audience that delays in any of ONC’s mandated programs would throw them out of the alignment needed to realize interoperability and the ultimate goal of national population health management.
In addition, Mostashari emphasized that Meaningful Use / MIPS regulations represent a final rule. “There is no legal way to change the final rule without a pretty elaborate process that takes nine to 12 months.” Instead, he recommended that those needing relief from penalties for noncompliance might look to “sub-regulatory guidances” such as the hardship exemption in the Rule. “You wouldn’t get the payment, but you wouldn’t get the penalty.”
Saying he feels that he can share his private thoughts more openly now that he has left ONC, he introduced some personal “worries.” With regard to the expected long-term move from pay-for-service models to new payment systems such as bundled payments, he said he was concerned that “we may have the right incentives, but too many institutions don’t know how to do population health management.” He pointed out that “flipping the practice, flipping the hospital, so that everything doesn’t take place in an eight-minute visit, that’s a cultural challenge…it’s a business practice challenge. And we have providers who are struggling with the pace of change.” “We cannot bludgeon the docs,” he said, and cited the need, instead, for creating standard protocols, and using change management and good governance to achieve “the motivation (to change) that will be needed, particularly with clinicians.”
Other worries Mostashari shared centered around problems he is seeing with the plethora of new technology products. “Innovation…we want this,” he said. “But I’m seeing a problem between matching up supply and demand.” Too much time “is being spent on things others have already done.” He expressed doubts about the duplication and usability of many products, saying “Everyone rediscovering everything is unnecessary…we have to do more information sharing, and not much of that is happening.” He noted that there are so many products being introduced that it is hard to evaluate them, and that innovations need to be “matched up” with shared learning. He reemphasized that a greater shared concern for the future of healthcare should be as much an incentive to vendors as money, and would help the industry accomplish more.
Mostashari also addressed a question from CHIME’s CEO, Russell Branzell about the likelihood of the government’s move towards a “patient identifier,” long felt by many to be necessary for more efficient healthcare management. Mostashari offered little encouragement, saying that rather than creating a patient identifier per se, we should be thinking about better “patient matching.” “Let’s improve the quality of attributes for matching,” he said, “(such as) better methods for verifying Social Security numbers, birth dates and other new attributes that would improve identification while still preserving privacy.”
Branzell asked Mostashari a final question: if he could recount his proudest moment during his four years at ONC. The usually voluble Mostashari was surprisingly quiet and visibly touched.
Finally, he said, “One moment does stick out.” He remarked on a town hall meeting at another convention where several top ONC leaders, were gathered on the dais. The group included David Muntz, former principal Deputy Director of ONC; Joy Pritts, Chief Privacy Officer, Jodi Daniel, Director of Policy and Planning, and other ONC leaders.
“You just looked up there (at) person after person who really knows their stuff, and all of them had been out there in the field and probably could have done other things. But, they chose service, and (saw) the crowd really appreciating them for their service. That was my proudest moment,” he said.
Accepting the CHIME Board of Trustees Legacy Award for leadership and dedication to healthcare IT, Mostashari received a standing ovation after his final summation: “The road ahead is hard, and the challenges are immense for our industry and our country. This is a big thing we need to do, we have to do, and we can do it.”