Health IT Chief Mostashari Details What's Next for ONC

by Kate Ackerman, iHealthBeat Senior Editor

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In an exclusive interview with iHealthBeat, Farzad Mostashari -- the country's new national coordinator for health IT -- discussed his top priorities, why some health care organizations might delay attestation of meaningful use, the importance of engaging patients in health IT efforts and the balancing act required to ensure that Stage 2 of the meaningful use program is ambitious yet achievable.

Earlier this month, Mostashari -- who previously served as the deputy national coordinator for programs and policy at the Office of the National Coordinator IT -- was selected by HHS Secretary Kathleen Sebelius to become the country's fourth national coordinator for health IT. Mostashari replaced David Blumenthal, who returned to academia after holding the post for about two years.

Mostashari said, "I learned a lot from David over the past two years. He really has been a great leader for ONC." He noted that his selection to replace Blumenthal helps ensure that ONC can provide continuity. Mostashari said that "the administration is completely committed to the health IT agenda, to our health IT strategies, to our health IT policies, and we're going to continue moving ahead. I think that continuity is a key point."

A partial transcript of the interview follows.

iHealthBeat: What are your top three priorities or goals for ONC over the next year?

Mostashari: It's really a question of timing, right? Where are we now in the arc of the activities of ONC and the health IT agenda? I think the first priority over the next year is going to be implementation. It's time to implement. It's time for doctors and hospitals to implement. It's time for us and our grantees and our partners to implement. It's hard work. I know that from personal experience in implementing electronic health records in small doctors' offices and community health centers and hospital outpatient departments. It's hard work, but we do have help in the regional extension centers and our work force program, and it's time to implement. It's time to get boots on the ground and to focus on excellence in implementation.

The second priority I think is making sure that what we do is clearly understood as linking to health outcomes and delivery system transformation. As we keep saying, it's not IT for the sake of technology. It's about improving health. And, tying [it] into the National Quality Strategy, tying [it] into the Partnership for Patients that was recently announced around patient safety and reducing readmissions. Having meaningful use and our health IT investments enable more and more organizations to become accountable for the care they deliver. Those are going to be a key priority for us over the next year.

And, the third priority I would say is doubling down on the concept of the patient in the center of everything we do -- the patient and their interests, which means privacy and security. And, it also means the consumer e-health agenda. Really focusing on that aspect of our agenda and personalizing what health IT means so people can understand what it means for them, what is the impact of health IT and what [are] the tools that they can use to help improve their health.

iHealthBeat: What do you think will be the biggest challenges in achieving those goals that you just outlined?

Mostashari: Well, the first challenge of course is that this is hard work. We're going to all need to really focus on quality improvement and continuous quality improvement. And that means identifying best practices and sharing them.

I think it's critical that we don't invent the wheel over and over and over again, and that we identify what's working, where it's working and adopt it and adapt it. But we have to really focus on sharing those lessons learned across the continuum.

iHealthBeat: You may have seen a recent CHIME survey that found that while 90% of CIO respondents expect their organizations to qualify for meaningful use incentive payments by fiscal year 2013, there was a decline in optimism about qualifying for the incentive payments within the first six months of the program. At the same time, several groups have encouraged hospitals and other health care providers to wait until FY 2012 to demonstrate meaningful use to give themselves more time to prepare for Stage 2. Is ONC concerned at all about health care providers delaying participation in the meaningful use program? And, if so, what is your office doing to combat that?

Mostashari: We recognize that people make decisions depending on where they are and what are the other things that their organization is dealing with and their particular circumstances. And, yeah, there are some organizations for whom it's going to make sense to go now, and there are others for whom it makes sense to go in six months and others for whom it makes sense to go in a year or 18 months from now. Every organization has to make that call for themselves.

I think that there are very good reasons for people to start early, start now. No matter when you are going to go for the actual attestation for meaningful use, start now because it's going to help the organizations understand the care they're delivering and understand the opportunities for improving the quality, safety and efficiency of the care they're providing.

Again ... the main reason that they should be implementing electronic health records and using them meaningfully is not attestation for meaningful use and the payment. The real reason that they should be doing it ... is this is what we need to be doing to understand the care we're delivering and improve the care we're delivering.

I will say that there are strategic reasons why hospitals even after they have implemented and are essentially meaningfully using electronic health records may choose to delay their attestation. And, we have to recognize that. I think when we look at the trends in meaningful use, we are going to see increasing numbers in 2012 and a great acceleration of the tempo in 2012. But I think it is important for people to start now.

iHealthBeat: You mentioned patients earlier. A survey conducted by Harris Interactive last year found that while about half of U.S. residents say they welcome the use of EHRs to improve health care quality and efficiency, they are unsure how the switch to digital records would affect them. The survey also found that just 16% of respondents had been approached by their health care providers to discuss switching to EHRs. What do you think can be done to better engage patients in the push for widespread health IT adoption?

Mostashari: I think there are some real key opportunities [that] we have. One is ... what my friend [HHS CTO] Todd Park calls "data liberación." Creating the context within which patients can get their own records in a format that they can use and reuse. [The] Blue Button [initiative] is a great example of that.

The meaningful use requirements, the HITECH Act actually and the modifications to HIPAA give people a right to their own information in an electronic format. And, the meaningful use requirements and certification requirements ... make sure that systems have the ability to produce those records.

As I think is evidenced in the [Health IT] Policy Committee discussions on this, we are going to keep making progress on that. I think we are going to see a real sea change in terms of the availability of that information electronically for patients.

But that's only half the battle. The other part is, what use can consumers and patients make of that information once they get it? That I think is where the market and the incredible innovation in the consumer technology space has the potential for explosive growth. [There are a] number of apps that could be built ... that would help turn that data into actionable -- perhaps entertaining, perhaps gaming -- information, social interactions between people.

I think that's a very exciting area for innovators in technology to engage in and to really bridge the gap between clinical information systems and population health management, which increasingly is being seen as critical for our communities as well as our health systems to succeed and thrive.

iHealthBeat: As you know, health care providers have a lot on their plates right now from meaningful use to ICD-10 to accountable care organizations. Members of some of the federal health IT advisory work groups and others have stressed the need to find a balance between pushing health care providers in Stage 2 of the meaningful use program and recognizing that providers face competing priorities and other limitations. How do you plan to ensure that the meaningful use program sets goals that advance health IT use but that also are achievable?

Mostashari: I think we have to continue doing what we've done. In a sense, how we will behave is predictable. We will focus on the goals. We want to move people up the escalator to make sure that we can get where health IT needs to be in terms of being able to support quality, safety, efficiency, patient-centeredness, care coordination, public health, privacy and security.

We need to keep raising that bar, but we need to listen. We need to understand where people are today and be pragmatic. And, we need to do that balancing act that I think we demonstrated very well in Stage 1 of meaningful use.

So, how do we do it? We listen, we understand the different stakeholder interests and then we act in the public interest, setting thresholds and structures that are going to continue movement up the escalator, that are ambitious, yes, but also achievable.


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