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Blunt Talk from a Newly Liberated Former National Coordinator: Dr. Mostashari Speaks Plainly

October 9, 2013
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Dr. Mostashari’s session at this year’s CHIME Fall CIO Forum was an eye-opener

Farzad Mostashari, M.D. and Russell P. Branzell

To say that the audience at the CHIME Fall CIO Forum, being held this week at the Westin Kierland Resort in the Phoenix suburb of Scottsdale, was curious to hear what Farzad Mostashari, M.D. might possibly say, would be an understatement. Just days after Dr. Mostashari had left the most prominent position in U.S. healthcare IT as National Coordinator for Health IT, and announced that he was joining the Washington, D.C.-based think tank the Brookings Institution as a visiting fellow, most audience members were probably prepared for just about anything.

And what they got was a mix of (welcome) predictability and surprise. On the one hand, Dr. Mostashari was as passionate and articulate as ever about the cause of leveraging healthcare IT to transform patient care delivery in the U.S. From the opening sentences of his prepared remarks, such was clearly the case. The man who had taken the helm of the ONC, in the wake of the academic reserve and Ivy League hauteur of his predecessor, David Blumenthal, M.D. , and turned the National Coordinator role into one of passionate champion and cheerleader (in the very best sense) of transformation, remained as incisive and energized as a speaker as ever. He certainly will be missed as National Coordinator, and his departure from the ONC (Office of the National Coordinator for Health IT) has left many in the industry wondering whether his successor can recapture the fire and momentum of his tenure, particularly at a time of tremendous uncertainty around any federal policy issue these days.

So the persona that Dr. Mostashari presented on Wednesday was reassuringly familiar. But what was different was the candor with which he approached certain sensitive subjects—not surprisingly, given that he now is free to speak his mind without shading his public comments for diplomacy or political exigency.

Instead, he told CHIME’s CEO Russ Branzell quite bluntly that the chances that a much-hoped for reprieve that would relax Stage 2 meaningful use timetables for hospitals and physicians were highly unlikely, given that any such action on the part of the incoming National Coordinator would require a complex, arduous public rulemaking process that would only endanger the stability of broad elements of the MU program, including, potentially, ongoing  software standards development.

He was also exceptionally plainspoken, in proactively initiating a discussion of the federal budgeting process of the past few years and its impact on ONC as an agency. Calling $60 million a year wholly inadequate to fund the ever-growing list of responsibilities requiring handling by the healthcare IT policy agency, he underscored what he saw as the damage that the current federal sequester (not to mention the current shutdown), and a series of annual budgetary freezes have had on ONC’s ability to meet the needs of the healthcare industry, and therefore of patients and communities nationwide.

Seeing Dr. Mostashari in action this year at the CHIME Fall CIO Forum was fascinating. Last year at this same time, he delivered a movingly impassioned speech about the absolute urgency of the success of the meaningful reform process, in a presentation as compelling as any I’ve heard in healthcare. This evening’s remarks in no way diminished the power or impact of last year’s speech, even in retrospect; but they did remind one of the limits of even this most explicitly powerful healthcare IT policy position in the country to compel forward change and progress.

One can only hope that the next National Coordinator will have the same combination of brilliance, passion, and political skill as Dr. Mostashari. In the increasingly bleak and cramped policymaking environment in Washington these days, every centigram of diplomatic skill and savvy will be needed by his successor in order to keep the MU train running on its tracks.