Mostashari: A look back at the headlines
After an eventful two-year stint as deputy national coordinator, Farzad Mostashari, MD took the helm at ONC just as the meaningful use program began to gather steam. His tenure will be remembered as one of unprecedented change for the industry. Here's a look back at some of his star turns in Healthcare IT News over the years.
Having announced just two weeks prior that he was stepping down as national coordinator, David Blumenthal, MD, was in was not in attendance at the popular annual ONC town hall meeting at the HIMSS11 conference in Orlando.
Instead, Mostashari, second-in-command at ONC since 2009, led the meeting – declaring that, "With David's departure, this is a time to analyze if we're on the right track."
It wasn't much of a surprise a couple months later when Senior Editor Diana Manos reported that Mostashari would succeed his boss as head of ONC.
His bona fides were indisputable. At the New York City Department of Health and Mental Hygiene, he served as assistant commissioner for the Primary Care Information Project, where he facilitated the adoption of prevention-oriented health information technology by more than 1,500 providers in underserved communities.
Prior to that, Mostashari graduated training at the Harvard School of Public Health and Yale Medical School, and did an internal medicine residency at Massachusetts General Hospital. He was also one of the lead investigators in the outbreaks of West Nile Virus and anthrax in New York City, and among the first developers of real-time electronic disease surveillance systems nationwide.
In his first Health IT Policy Committee as head of ONC, Mostashari admitted that Blumenthal was a "tough act to follow." Nonetheless, he said he would emulate his former boss's "very attentive, inclusive process of listening." While sympathetic to various health IT stakeholders and their sometimes conflicting interests, Mostashari said he would keep the public in mind first: "I think listening yields the best product for the public interest."
Toward, that end, he urged better communication between providers, frontline staff and consumers. "We will work harder to be good communicators of our vision and what it will mean for you," he said.
He added, "We have to continue to watch out for the little guy. The market doesn't look out for the little guy – that will have to be the role of government."
As the realities of attesting for Stage 1 meaningful use began to set in for many providers, Mostashari assured them that the program is more than just an arbitrary set of requirements designed to cause frustration.
"I beg of you to take another look," he told a group of stakeholders. "Look at meaningful use not as a distraction or a bureaucratic list of hoops to jump through.
"Meaningful use is the best-we-could-make-it roadmap to prepare for delivery of higher quality care and mitigating some of the costs toward getting there," he added. "If it's a distraction we need to change it, and I want to hear from you personally."
Stage 2 ready for primetime (2/22/12)
HIMSS12 in Las Vegas was abuzz with anticipation over the proposed rules for Stage 2 meaningful use. Mostashari offered a 'sneak peak' of the proposed rules for an overflow crowd of a couple hundred people.
Editor Bernie Monegain set the scene: "Once the doors closed, a few outside knocked, and then pounded to be let in. The last to walk in was Mostashari, who strode to the stage amid a rousing round of applause – a rock star with a power team and a Power Point presentation."
He promised the new rules would be tough, but fair.
"We are pushing for the first time a single standard for lab results, public health," he said. "There's a lot of interoperability being added into the 2014 certification. There is a very ambitious push for actual exchange across organizations and vendor boundaries.
"There's going to be a push on patient engagement," he added. "There's going to be a push on patient quality improvement in hospitals. There's going to be a push on patient quality measures.
"We listened, and we learned from what you have been telling us," Mostashari said. "We take seriously the need for flexibility. We have done whatever we can to increase flexibility and to reduce the burden."
When a controversial report in Health Affairs suggested that electronic health records can actually increase costs and lead to more tests ordered, it garnered lots of national attention in the mainstream media.
Mostashari pushed back, saying the study was good for "grabbing headlines," but not accurate.
"I want to set the record straight on what the study found and what the study actually did," said Mostashari. "The study was not about EHRs, much less about the meaningful use of EHRs. It was about the electronic viewing of imaging results."
Moreover, the researchers failed to take into account the use of decision support and information exchange for reducing costs enabled by health IT, he said.
One more thing: The data was from 2008. "And, as we know, a lot has changed," said Mostashari.
Mostashari: Technology is not enough (10/17/12)
As electronic health record adoption continued to gain ground, Mostashari reminded the industry that technology is merely a building block. The true change, he said, comes from "how we use the technology and how we accomplish the goals we set for ourselves."
"Technology is the enabler; the foundation," said Mostashari. "Patients need to care for themselves and become partners in their care."
He urged providers to not lose sight of the role they play in improving the system. "We've set the adoption in place and clearly that is moving," said Mostashari. "Meaningful use Stage 1 got people on the escalator, but that's not enough. We need to keep constantly moving up."
The usually-sunny Mostashari took a different tone earlier this year – turning bad cop for a moment as he issued a warning to unnamed EMR vendors whose products were too-expensive, opaquely-priced, insufficiently-interoperable and otherwise poorly-prepared to meet their customers' needs.
"There are some vendors who are 'beyond the pale' in their conduct, and it is part of society to create codes of conduct to say this is what we believe in and this is what we do not believe in," he said.
"It is not in the patients' and providers' best interests," Mostashari added – promising that new rules might be in the offing. "We will take regulatory action where needed," he said. "We can't have it purely be a function of, 'I will do what is legally required of me, no more and no less.'"
Part of the job for the national coordinator is to make periodic trips to Capitol Hill and sit before skeptical lawmakers who question the efficacy of programs such as meaningful use.
That's what Mostashari did this spring when he testified before the House Energy and Commerce Committee.
One lawmaker, Republican Texas Rep. Michael Burgess, MD, vice-chairman of the House Subcommittee on Oversight and Investigation, wondered why interoperability was still so elusive.
"We do hear about this a lot," Burgess said. "Even anecdotally, hospital systems in the same city, that have the same operating system aren't talking to each other. You're the head, why don't you fix that? Why don't you just make that happen?"
"We are using every lever at our disposal to increase the sharing of information," Mostashari answered.
But he insisted that while ONC was a key enabler, the private sector has a big role to play, too. "We don't want to be the ones to say, 'We'll choose the standards,'" he said. "We want to really work with industry to get consensus and to accelerate this."
Mostashari proud of progress so far (7/10/13)
Perhaps knowing already that he'd soon be stepping down, Mostashari took a nostalgic tone earlier this summer at the 50th meeting of the Health IT Policy Committee, which also marked his fourth year in government service.
"It's remarkable to look back at where we were four years ago and take stock, measured through these meetings, how far we have come and what the complexity of the policy issues that we've had to consider as we reach toward our goals – and to hold those goals to better health, better care and lower costs firmly in mind," he said.
Sometimes it's easy to get lost in "the day-to-day, week-to-week struggle," and forget to step back and take a look at the "broad sweep," he said. But he reminded committee members that, just four years ago, 90 percent of hospital patient records, 80 percent of physicians' patient records and 93 percent of prescriptions were written on paper.
"We haven't slain all the dragons just yet," said Mostashari, "But we sure have made a dent."
Headlines photo from Shutterstock.com.