Farzad Mostashari, M.D., deputy national coordinator, programs and policy, in the federal Office of the National Coordinator for Health Information Technology (ONC), spoke recently with HCI Editor-in-Chief Mark Hagland regarding his perspectives on the progress being made by providers on meaningful use, under the HITECH (Health Information Technology for Economic and Clinical Health) Act. Dr. Mostashari will be the opening keynote speaker at the HCI Executive Summit, to be held May 11-13, 2011, in San Francisco, Calif. ( www.HCIExecutiveSummit.com). Below are excerpts from that interview.
Healthcare Informatics: What can you talk about right now, with regard to progress on meaningful use?
Farzad Mostashari, M.D.: I can talk about the principles we're using to help drive our strategy. First of all, let's talk about the importance of having these principles, not only for our senior leadership, but for our staff. In some ways, our staff is relatively new. And we want our staff to feel empowered to make decisions; but we don't want them to get off the farm, off the reservation, so to speak. So we can give them a sense of guidelines, a design framework.
LET'S BUILD ON WHAT'S ON THE GROUND TODAY, AND ADAPT. BUT THE TECHNOLOGY EVOLVES VERY RAPIDLY; AND WE NEED TO BE CONSTANTLY AGILE, MONITORING AND ADAPTING, AND AWARE OF WHAT'S GOING ON IN THE REAL WORLD.
And principle number one is, “eye on the prize.” You can never be reminded enough that the goal is not IT itself. The best articulation of this is our policies and programs in the meaningful use framework. We didn't start with the technology; we started with the goals of quality, patient safety, care coordination, and so on. So at the end of the day, you move forward, based on backwards-towards-the-goal planning. Otherwise, you end up with IT for the sake of IT. So principle number one is, “eye on the prize.”
Principle number two is, “feet on the ground.” Let's build on what's on the ground today, and adapt. But the technology evolves very rapidly; and we need to be constantly agile, monitoring and adapting, and aware of what's going on in the real world. An IT corollary of this is, “don't rip and replace.” And another corollary is “bold incrementalism,” building on what you've got.
A good example of this is health information exchange. In some ways, we were building for version 5.0 before version 1.0 was in place. So we said, let's start with something that will add value now, and that departs as minimally as possible from what's in place policy-wise now, yet adds value. So it will end up in some ways being incredibly bold, but it starts with the question of what is the simplest set of protocols that can ensure the security of data as it moves from one place to another. And basically, SMTP protocols have been embraced, but because we started with the lowest common denominator, we've been able to get the participation of the major EMR vendors, lab system vendors, and so on.
HCI: Do you think clarity is emerging now on what works in HIEs?