Moving Forward on Meaningful Use

Mostashari: I think we need to establish a universal base of simple exchange that can support planned care and simpleness, so that when a patient asks for their record, or asks for their record to be continually forwarded to their electronic health home, that can take place; and so that when someone sends a referral, that that can take place. I think that's transformative, and I think we will create a universal base for the facilitation of care coordination. Now, not all care is going to go as planned. And we want to minimize how often we rely on these safety nets, right? But inevitably, someone will end up in an emergency room, and the information won't have followed them. So in most cases, you need to develop local networks of trust-and you get there by sharing, and by showing leadership locally. And there aren't that many technological models, there are more governance models there. I think in the upcoming 12 months, we're going to remove a lot of the uncertainties. And I'm seeing a rapid warming of interest in that area.

YOU NEED TO DEVELOP LOCAL NETWORKS OF TRUST-AND YOU GET THERE BY SHARING, AND BY SHOWING LEADERSHIP LOCALLY.

And a third principle is, “foster innovation,” and its corollary is, “use the market.” There are ways that government can play a role in fostering innovation, and we're doing that through some of our grantees. But more important is creating the policy context around which innovation can flower-things like permitting modular certification. But importantly, it's to fundamentally have a market-based approach where people can compete. And when you look at what we're doing compared to what many other countries have done-using the market and fostering the market, is a key part of our approach, and that is different from other countries. An example of that is the regional extension center program.

And the fourth principle is, when you use the market, the role of the government is to watch out for the little guy.

HCI: Some people are concerned that the net effect of the certification program and the short timeframes will be to solidify the positions of the largest EMR vendors, and foster consolidation. Your thoughts?

Mostashari: I don't think we're seeing that. Number one, demand is up; and two, the established vendors have their hands full, and people are going to be looking for alternatives. Number three, we now have some sophisticated purchasers who are willing to take some risks. And in terms of the regional extension centers, it's really interesting: many of them are looking to local vendors, local companies, and saying, we can partner with you, and help you improve your product to meet the needs of our customers. And you can have not only the benefit of marketing that you might not otherwise have had, but also the benefit of our providers in terms of getting feedback on what they want. And in turn, you'll become more responsive vendors. And the other element here is modular certification, where you don't need to do everything in the marketplace.

HCI: One area of deep and immediate concern among some healthcare CIOs has to do with the need, under the current rules, for hospital organizations to essentially obtain multiple certifications, if they want to use best-of-breed emergency department or other solutions, since right now, the way the rules are written and articulated, there is no allowance for the use of a core EMR minus an ED system, for example.

Mostashari: It's a bit of a complicated discussion there. And by the way, we have over 180 products now that have been certified, within weeks of certification opening. So I see that theoretical concern, but the evidence doesn't bear it out. Meanwhile, the bottom line is that people have to have certified products, and you have to buy what a vendor certifies. So it's really a vendor decision as to whether they certify their product in total or in chunks; and it's really their customers that have to make the decision as to whether to tell the vendor, I don't want to use your ED module, so you need your product certified without the ED module. But I don't see it as fundamentally a real problem.

HCI: Do you have any closing thoughts?