In a 40-minute address on Oct. 17 to several hundred of the 730-some attendees at the CHIME Fall Forum, being held at the Renaissance Esmeralda Resort and Spa in Palm Springs, Calif., Farzad Mostashari, M.D., the National Coordinator for Health Information Technology, spoke with intense passion about his vision for the healthcare system of the future, placing the meaningful use process in the context of a broader drive towards a system with greater patient safety, care quality, efficiency, and cost-effectiveness.
Executives and leaders from the College of Healthcare Information Management Executives (CHIME) had given Dr. Mostashari a special platform on Wednesday afternoon, crafting a “Special Plenary Session” for healthcare IT’s top federal official, and giving him free rein to speak on the subjects of his choice, followed by a 20-minute question and answer session, with Randy McCleese, vice president-IS and CIO, St. Claire Regional Medical Center (Morehead, Ky.) reading questions from the audience immediately after Dr. Mostashari’s speech. McCleese is a member of the board of CHIME and is chair of CHIME StateNet, the association’s state-level advocacy collaborative.
Farzad Mostashari, M.D. (r.) responds to audience
questions conveyed to him by Randy McCleese
As he had in past appearances before CHIME and other healthcare IT audiences, Dr. Mostashari used the opportunity to urge CHIME’s CIO and other healthcare IT executive members forward, exhorting them to move forward with meaningful use out of a dedication to a vision of a new healthcare, rather than “checking off boxes in order to get the check” that the HITECH [Health Information Technology for Economic and Clinical Health] Act offers successful providers.
Mostashari called CIOs and other healthcare IT executives “heroes,” and spoke of the internal reform of the healthcare system as “this incredible journey we’re on, this incredible challenge as a society.” Reducing costs while improving patient safety and care quality, he said, “is the most important thing we can do. And we’re going to do it through technology.”
Intensifying his broad remarks, Mostashari moved on to describe in some detail a situation involving his own mother that unfolded just before he joined the Office of the National Coordinator for Health Information Technology (ONC) in the middle of 2009 as deputy to then-National Coordinator David Blumenthal, M.D. Speaking with intensity, Mostashari described a systemic failure of information, communication, and care management that had put his mother into mortal danger, and that made him feel nearly helpless, even though he was a physician, a public health expert, and an expert in medical informatics. “We can do better,” he urged his audience, and repeatedly emphasized the power audience members had and have to create the fundamental changes necessary to bring about internal revolution in healthcare.
Mostashari, speaking for 40 minutes without any notes, circled back several times to three key themes: population health, health information exchange, and patient engagement, citing those as meta-level goals that should encourage healthcare leaders forward as they work to rework the healthcare system to better serve patients, families, communities, and the broader society.
Acknowledging the widespread anxiety felt by many healthcare and healthcare IT leaders in the rapidly changing operating environment, Mostashari told his audience, “Sometime said to me recently that it feels like we’re all going down the rapids now, and there are lots of rocks, and it’s very scary. But,” he added immediately, “if you dip your oar in and you push, then you’re in control; you’re not a passenger. You’re leaning into it, you’re guiding it. So if there’s one thing I ask of you, it’s to use meaningful use, use certification, as your tool. And help us improve every part of it.”
And he then turned back once again to the theme of patient engagement, saying that “When I was in the hospital with my mom, the one place where all the information was, was in the chart; that’s where care was being coordinated. And,” he said, returning to his personal story of watching while clinicians struggled to save his mother’s life in the summer of 2009, “it didn’t feel to me—from a pretty empowered guy, I’m a doctor, I have a sister-in-law who was the chief resident of the hospital—but I didn’t feel like I could ask to see the chart. There was something rude about the idea of asking to see the chart to save my mom’s life. That’s messed up. That’s messed up,” he repeated. “We’ve got to empower the patient—better yet, a person who loves the patient. And we’re making ourselves vulnerable. But we’re not going to make things better without being open to the government, open to the patient,” in terms of creating transparency in care delivery and communication processes.
Mostashari then responded to several questions conveyed to him by Randy McCleese, clarifying the intention behind the requirements around the continuity of care document (CCD), or, as he gently urged it be better termed, the “consolidated CDA” [consolidated clinical document architecture], and deftly sidestepping political issues, including a question around what might happen to healthcare reform if former Gov. Mitt Romney were elected president in November, though he endorsed the CHIME advocacy team’s response to the letter sent recently by Republican members of the House of Representatives to Health and Human Services Secretary Kathleen Sebelius urging that the meaningful use process be shut down over interoperability concerns.