CEO Spotlight: Former ONC chief Farzad Mostashari on EHR shortcomings and pop health potential

Mostashari, now the chief executive at Aledade, discusses how technology must better address the needs of population health and ACOs, and wages a complaint against many EHR vendors.
By Bill Siwicki
02:54 PM
Mostashari pop health EHR

Farzad Mostashari, MD, has a unique vantage point over the health information technology industry. Previously he served as the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. Today he is founder and CEO of Aledade, a company that markets technology and services designed to help independent primary care practices come together to form accountable care organizations (ACOs) that can take on the total cost of care and share in value created.

Aledade operates ACOs across 11 states and handles nearly 100,000 patients in more than 110 physician practices. In June 2015, the company raised a Series B Funding Round of $30 million and now employs a staff of more than 80 experts in health policy, technology and practice transformation. This growth, the company said, is driven by the need of primary care physicians to begin the shift from volume-based care to value-based care with the aim of delivering better care at a lower cost.

Healthcare IT News spoke with Mostashari about about a variety of topics, from ACOs and technology trends to EHR shortcomings.

Q: What is the state of technology within accountable care organizations? What must technology do, and what is the role of population health within an ACO?
One way to think about the role of technology here is the electronic health record is the transactional piece of healthcare where a patient’s care needs to be delivered. But it does not address very well – despite many years of effort on the part of meaningful use and other programs – the concept of population health. So the needs from a population health tool perspective are, first, get the data, so there is a whole lot of infrastructure work around assembling and integrating claims data, clinical data, ADT data, event notifications from hospitals, practice management system data, and scheduling system data. And then, collecting data from the use of apps to understand what physician practices are doing and what they need to be doing.

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Then comes creating insights. So I’m a physician and I have all the data in front of me, and if I am going to call 10 people today, who should I call, what should I say, who just left the hospital, who needs a wellness visit who has opportunities for quality improvement? And then comes making data and insights actionable. That is a fair description for the three steps that any population health tool needs to provide: Get the data, get insights, help me take action.

Q: What are you seeing happening in smaller and rural practices when it comes to healthcare information technology?
They are under a tremendous amount of pressure and they are wondering if they can continue to stay independent. The burden of administrivia, the quality reporting, the feeling that once things like MACRA and MIPS come in, and public reporting, that they will be working harder and harder and getting less and less of the healthcare dollar. That they are wondering if they can continue being alone. They do not want to become employees, they want to retain their autonomy. That is what I am seeing, practices that are delivering very good care but feeling increasingly squeezed, and they want help. That is what Aledade offers, a way out for them.

Q: From your vantage point, what is the status of health information exchange and interoperability?
We now have in the population health space a clear business model for a very specific interoperability for HIE as it pertains to event notifications. Put this way: Tell me when my patient got discharged from the hospital because otherwise I might not hear about it and I cannot help them. So, just give me my patients’ ADTs to HIE, it is simple, cheap and actionable. To me that should be the highest priority both for local HIEs and for states as well as for federal officials. When it works, it is amazingly helpful and effective. What we need are policies and governance that encourages or requires participation in those information exchanges. It’s not as far-reaching as creating a virtual clinical record and assembling everything and making it respond to queries. It is much more finite and much less sensitive in terms of the information, and it creates immediate value.

In product parlance, it is the minimum viable product, the MVP. The MVP is ADT. To be clear, the challenges there are not technical. It took us literally 15 minutes to set up an ADT feed from the hospital once we got the engineers on the line together. There are very high degrees of reliability and standardization. The challenge is on the business side. Does a hospital want to share this information with providers outside of its network? As far as patient care goes, I believe there is an ethical mandate here that policy should reflect.

Q: Are you seeing any shortcomings with EHRs as they are implemented today, and if so, what could vendors be doing better?
Clearly a lot of EHR vendors, not all by any means, but a lot of them, took the meaningful use requirements as a certification exercise and the result has been that many providers are dissatisfied with usability. Potentially even more of a shame is even after all of those hours spent on the data entry, the data is not as usable as it should be for the purposes of population health, for quality reporting, or for predictive modeling. And the data is not as liquid as it should be. A provider organization might have spent tens of thousands of dollars on an EHR system and countless hours feeding data into it, but then they cannot get their own data out as promised in the EHR certification that the vendor did. These are challenges that EHR vendors need to step up to, and if they want to be preferred EHR vendors for the value-based world, they need to make the data necessary for population health much more easy to collect and use.

And the data needs to be more reliable and more liquid. By liquid I mean that if I have a physician who has bought an EHR that was certified to give that physician a batch download of patient care summaries with all the clinical data and that was tested in a lab by the vendor and it was assured the system could do that, then when that clinician wants to join the population health world of value-based care in an ACO and goes to the vendor and says I want my batch download, the vendor should not be able to say that actually only works in a lab on five patients and does not work in the field. Or say that it will cost you $50,000 more to achieve.

That clinician is the person who bought the system and entered the data into the system, it’s their data, their patients’ data, and they should be able to get the data out. The longer term ideal is that data is not just accessible in batch or in a push model, but it’s available through third-party applications via APIs. I’m not expecting that this year or next year, but I am expecting vendors to be true to the promises they made in the EHR certification program. 

Helpful advice for planning to purchase a population health platform:

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⇒ Comparison chart of 8 population health products 
⇒ An in-depth look at 8 population health software programs


Twitter: @SiwickiHealthIT
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