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Perspectives on the HCI Executive Summit: Dr. Mostashari's Dilemma

May 31, 2011
by By Mark Hagland
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Smiling or stern? Can the National Coordinator set just the right tone in his public interactions? Renata Tebaldi would know exactly what to do

When Farzad Mostashari, M.D., the National Coordinator for Health IT, spoke at the Healthcare Informatics Executive Summit last month in San Francisco, it’s clear he had found his footing with our audience of healthcare IT leaders. Dr. Mostashari was engaged and engaging, charming, yet also naturally authoritative in the way in which he presented himself, during his presentation on meaningful use to the leaders assembled for our magazine’s summit.

Dr. Mostashari’s presentation focused on some of the key policy and procedural successes so far on the meaningful use journey, as well as on his perspectives around next steps and the path ahead to and beyond 2015. Nothing he said was particularly surprising, but his summation of perspectives around MU was helpful, and his audience seemed very appreciative. Everyone I spoke to afterwards was delighted by the speech, and glad to hear directly from Dr. Mostashari on how he sees things right now—since of course, his perceptions will be very important in how he helps to guide policy at the ONC.

What I thought was particularly interesting in the presentation, and in how he answered questions during the QandA session that followed, was how carefully and precisely Dr. Mostashari crafted his tone in this public appearance (and how he has done so in other appearances as well, though this was his first public appearance that I had seen since he was elevated to National Coordinator in early April). He clearly wants to get the best responses and participation possible in the HITECH/meaningful use process from providers; and so, appropriately, his tone was positive, optimistic, and encouraging, while at the same time, he consistently made it clear that he’s not going to get dragged down “into the weeds” when it comes to specific details of meaningful use requirements.

So, despite the very legitimate concerns on the part of provider IT leaders regarding such issues as quality data reporting, attestation timing, vendor certification, meaningful use and physician participation in ACOs, and a host of others, Dr. Mostashari has clearly chosen to maintain an upbeat, yet authoritative tone, in his public appearances before provider audiences. I think that is a very smart strategy, as it’s the most likely one to elicit the kinds of responses he and his colleagues at ONC, CMS, and HHS want to elicit from the industry.

It also reminds me of a well-known anecdote (among opera-philes like myself, at least!) about the great Italian soprano Renata Tebaldi, an operatic artist who knew what and when she could sing, and who graciously but firmly resisted being coerced into performing repertoire she felt wasn’t appropriate for her. Once, when Metropolitan Opera General Manager Sir Rudolf Bing was asked what he thought of Madame Tebaldi, he famously said, referring to that well-known resolve of hers, “She has dimples of steel.”

Given the complexity—and, let’s face it— fragility of the policy and political process around meaningful use at this point in time, it would certainly help Farzad Mostashari to cultivate the same “dimples of steel” as had La Tebaldi. Based on his appearance at our Summit, he seems well on his way to working those smile muscles into prime fitness, and resolving the inherent dilemma around tone as the meaningful use journey goes forward.

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Mark, Your post brought a smile to my face, and, I'm sure many, many others. Dimples of Steel, indeed!

Dr Mostashari's presentation was noteworthy to me in two ways:

1) He moved the discussion forward to "now if the time for implementation." I'm sure he's seeing some focus and energies that are discordant with that framing!

2) He suggested that we all get back to basics. He framed the MU requirements in terms of objective, high-level gaps in how information is used today in care delivery. They are not arbitrary, politically-motivated daggers being thrust at providers, as some cynics might opine.

Any chance we can provide a link to that presentation here?

Regarding tone, I had the pleasure of attending the Bipartisan Policy Center meeting this week, "Leveraging Health Information Technology to Build a Strong Foundation for America's Health Care System." Don Berwick, M.D., M.P.P. Administrator for Centers for Medicare and Medicaid Services was challenged in the Q & A session regarding feedback to the ACO NPRM. With a similar and elegant positive tone, Dr Berwick said that the feedback, including the critical comments are absolutely essential for us to evolve to a program that makes sense, has the best chance to work, and can lead to vital subsequent learning.  More on learning from success and failure here.  For a recent article that approximates Dr Berwick's message at the BPC, see "We can have it all" here.

A positive tone is so vital. It's alternative, energy-depleting diatribes, rolling out dated and non-productive arguments is all-to-common. Those dimples [of steel] need to be connected to a genuine smile, and an open mind and heart.

David and Joe,

Thank you both for your great comments and questions!

David, what I menat specifically about Dr. Mostashari is that, whenever confronted with very, very specific questions, took a quick stab at answering them, but pushed the focus back up to the broader level, which, given his position, made sense. Plus, I'm sure he doesn't want to make any misstatements that could complicate things down the road. But I think the audience understood this (though Joe, since you were there, you can contradict me on this if you'd like!). In terms of his differences in style, Dr. Blumenthal definitely came across as an older, academic person, and Dr. Mostashari naturally gives the impression of a younger, more informal, highly engaged individual.

Joe, I completely agree with the two statements you made above, about Dr. Mostashari. And I also agree that tone is incredibly important. I guess one way of restating some of what I said in my original blogpost is that in one sense, how Dr. Mostashari said what he said in San Francisco mattered at least as much as what he said. part of is job is to engage, as well as reassure, the provider community, around MU. It would be an enormous strategic and tactical error to alienate provider leaders by communicating the wrong tone that in itself would send a negative message and he needs all the positivity around MU that he can muster, these days.

Very interestingand gratifyingto hear that Dr. Berwick's tone at the Bipartisan Policy Center meeting was also very positive!

Thank you both for your great comments! My steel dimples are glowing. :-)

Mark

Mark,
I think it's great that you found an operatic comparison! When you say he doesn't allow himself to get dragged down into the weeds, does that mean he doesn't give direct answers to these pressing questions? I would thing that would frustrate CIOs. Have you heard positive impressions from the CIOs you have interviewed? And how does his presentation style compare with Dr. Blumenthal's?

Mark Hagland

Editor-In-Chief

Mark Hagland

@hci_markhagland

www.healthcare-informatics.com/blog/mark-hagland

Mark Hagland became Editor-in-Chief of Healthcare Informatics in January 2010. Prior to that, he...