Mostashari goes Harry Potter on EHRs

By Neil Versel
11:00 AM

Last week in Washington, national health IT coordinator Farzad Mostashari, MD, said that technology alone is not sufficient to reform healthcare in America.

Wednesday, on the other side of the country at the College of Healthcare Information Management Executives (CHIME) annual CIO Forum in Indian Wells, Calif., Mostashari explained why, with the help of a little theatrical flair.

"We're dealing with a lack of systems, a lack of incentives, a lack of information that is killing people today," Mostashari said. In other words, processes are broken and the healthcare industry is set up to reward volume rather than quality and to encourage episodic rather than continuous care. Patients have been conditioned to deify physicians and not ask questions about their own care.

"What happened to that sacred professional bond between physician and patient in a transactional world when they don't come back?" Mostashari wondered.

He then told the chilling story of accompanying his mother to a hospital emergency department shortly after joining the Office of the National Coordinator for Health Information Technology in 2009. He couldn't get answers about his mother's condition from anywhere in the department, and not because the doctors and nurses didn't want to do the right thing. "The systems are failing them," Mostashari said.

Even as a physician, he felt like he would be imposing if requested to look at his mother's paper medical record to see if he could help. "There was something rude about trying to save my mom's life by asking to see the chart. That's messed up," Mostashari said.

He ended up asking, and found the answer he was hoping for buried deep in the paper file, the national coordinator reported, leading him to compare and contrast paper with electronic health records.

A paper chart has evident flaws. "It closes, and it's gone," Mostashari said. "You can't use it, you can't move it. You can't do anything with it," he explained.

"That's our healthcare system, and that's good enough."

Mostashari reminded all the healthcare chief information officers in attendance of the important role IT needs to play in reengineering care processes. "It's just a tool, but what a tool," he breathlessly said.

Mostashari then had wizardly visions of Harry Potter. Open a manila folder and that "paper is alive" for a fraction of a patient's life before the chart goes back on a shelf. But what if a doctor could conjure up a magical spell and have all the charts of patients with diabetes fly off the shelves, opening to the pages that would show whether or not each person got the recommended care? Properly implemented EHRs can do this, virtually.

"That is the essence of population health management. It sounds so buzzwordy," Mostashari conceded, "but it's a simple concept." He said physicians have an obligation to all of their patients, even those they see once and don't come back.

Right now, care is a coin toss in that physicians follow the recommended protocols only about half the time. He cited studies indicating that a patient with diabetes has just a 7 percent chance in paper world of receiving all five "important" checks and tests, including a pneumonia vaccine. Only 14 percent have the right outcomes, Mostashari said.

"You feeling lucky?" he asked.