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What's Next for ONC? Dr. Mostashari's Departure and the Next Fork in the Road

August 6, 2013
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The announcement of Farzad Mostashari’s planned departure from the ONC raises important questions about what his successor must do

The announcement from the Department of Health and Human Services on August 6 that Farzad Mostashari, M.D. was preparing to leave his position as National Coordinator for Health IT this fall was very surprising. As far as I know, no one saw it coming.

And even in an e-mail message that he sent to staffers at the Office of the National Coordinator for Health IT (ONC) on Tuesday, Dr. Mostashari left things somewhat mysterious, telling his colleagues only that “It is difficult for me to announce that I am leaving. I don’t know what I will be doing after I leave public service,” he wrote, according to an e-mail obtained by members of the press, “but be assured that I will be by your side as we continue to battle for healthcare transformation, cheering you on.”

Whatever he does choose to do, I do believe that Dr. Mostashari was sincere in the sentiments he expressed in that e-mail. Anyone who has ever seen him speak (and a very large number of healthcare IT leaders in the U.S. have had that opportunity) will be aware of his great passion, his great enthusiasm, for the cause of clinical transformation in this country.

And, like my colleague, our Senior Contributing Editor, David Raths, I am sorry to see Dr. Mostashari leave. He has been instrumental in positioning meaningful use—and his agency, the ONC—as carefully as possible in order to address the concerns of healthcare provider leaders in the past two-plus years. Part of that positioning has been stylistic: in contrast to his predecessor as national coordinator, David Blumenthal, M.D., who had something of the hauteur of an Ivy League professor (which he in fact had been, years before he took the top ONC post), Dr. Mostashari has shared his passion, even his vulnerability (he has shared widely the story of his mother’s personal endangerment in the healthcare system because of problems over accessing her electronic patient records), in order to move and motivate his audiences forward on meaningful use.

And of course, the other part of his success in the national coordinator role has been his strategic vision, and the execution of that strategic vision, and his ability to persuade provider executives of his positions. Dr. Mostashari understands where we’ve been as an industry, and where we need to go; and he knows how to talk to a roomful of CIOs, a roomful of nurses, a roomful of physicians. But now, the question arises, will his successor be able to achieve the same things in terms of her or his vision, strategy, and presentation, in order to be effective moving the collective ball forward, as we move further into Stage 2 of meaningful use, and towards Stage 3?

Let’s face it: whatever is motivating Dr. Mostashari, he is leaving ONC at a time of complexity and tension. Leaders at hospitals, physician groups, and integrated health systems are finding the current phases they’re going through around meaningful use more difficult than most expected, while at the same time, healthcare reform-related mandates, particularly readmissions reduction and value-based purchasing, and even voluntary reform-related programs, such as the development of accountable care organizations and bundled-payment contracting, are all turning out to be truly challenging. It’s no wonder that all the major healthcare professional associations have been nervous, and asking for some version of delay or extension of the process around meeting the Stage 2 MU requirements. As the CMIO of a large integrated health system told me recently, “We’re a fairly advanced health system in terms of IT, and Stage 2 of meaningful use is scaring us half to death.”

So, will Dr. Mostashari’s successor have the same combination of strategic savvy and friendly persuasiveness that he has demonstrated? I wrote back in March that he shares the “dimples of steel” for which renowned Italian soprano Renata Tebaldi was famous. Indeed, if anything, his successor is going to need a titanium jaw, as we head into the most difficult and challenging phases of meaningful use ahead.

Already, there is widespread speculation about Dr. Mostashari’s successor. Two absolutely logical candidates at ONC are David Muntz, Deputy National Coordinator, and Judy Murphy, R.N., Deputy National Coordinator for Programs and Policy—the number-two and number-three officials at the agency. Both are very widely admired in healthcare, and both have the intelligence, vision, and character to make it all happen. There are of course also a large number of potential external candidates out there, including John Halamka, M.D., CIO at Beth Israel Deaconess Medical Center in Boston, and Paul Tang, M.D., vice president and chief innovation and technology officer at the Palo Alto (Calif.) Medical Foundation, among the better-known potential candidates.

In any case, whoever succeeds Farzad Mostashari will need exceptional strategic-vision and persuasive and political skills in order to get the job done. This really is a tricky moment in healthcare and healthcare IT, and the HITECH Act and meaningful use process are not assured of success.