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Mostashari, Bria, Cite Turning Points in Healthcare IT

July 13, 2011
by Mark Hagland
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AMDIS chairman, national coordinator for health IT, see progress in clinical transformation, meaningful use

As the first full day of the annual Physician-Computer Connection Symposium, sponsored by AMDIS (the Association of Medical Directors of Information Systems) began at the Ojai Valley Inn and Spa in Ojai, Calif., both AMDIS chairman William Bria, M.D. and national coordinator for health IT Farzad Mostashari, M.D., made comments around milestones for the audience of 200-plus CMIOs gathered from all around the country.

In the case of Bria, part of the message was congratulatory. This meeting marks the 20th time CMIOs have gathered annually to network, share stories, present to one another, and engage in a spectrum of discussions around clinical IT and clinical transformation. And Bria, who is corporate director of medical informatics at Shriners Hospitals for Children, is in a better position than anyone to look back at the progress both of the organization and of the CMIO profession over the past two decades, having co-founded AMDIS two decades ago.

“This is a celebration of 20 years,” Bria told attendees. “All those of you who have been in this room know that this has gone from a couple of a guys in a room to a roomful of people. We have transformed healthcare in this country; there’s no question about it; we will not go backwards.” Bria noted that c-suite executives in patient care organizations are now “engaged, and they’re becoming increasingly aware” of the need for clinical transformation. The ever-deepening professionalism of the CMIO role, including the current development of medical informatics as a recognized medical specialty, and the exploding interest among younger physicians in medical informatics work, Bria said, reflects the distance senior medical informaticists have taken the profession, and the “demonstrable value” they’ve brought to patient care. He urged his fellow CMIOs to push forward with everything they’ve been doing, while taking satisfaction with what they’ve already achieved.

William Bria, M.D.

Mostashari, who last year appeared before this same audience in person, was telephonically connected to his audience on Wednesday. The national coordinator began his comments by noting how far the industry had come in the past year; in 2010, Mostashari (who was then chief of policy for ONC; he became national coordinator in April 2011) spoke before the AMDIS audience literally one day after the final rule for stage 1 of meaningful use had been released by the federal government.

“We have come a long way this past year,” Mostashari said, continuing the same theme of positive encouragement he brought to the Healthcare Informatics Executive Summit in San Francisco in May, and has brought to other recent appearances. “If you recall, last year, we were still trying to get our heads around what all these new structures would be, and the meaningful use rule had just come out. And now we are very much currently in the implementation phase,” he said.

Farzad Mostashari, M.D.

Among the advances that have been made, Mostashari said, have been greater understanding of meaningful use overall, a growing comprehension of how meaningful use and healthcare reform goals dovetail, and of course, significant numbers of patient care organizations and some physicians attesting to stage 1 this spring and summer.

“We are now in an incredible position” to leverage clinical information to meet important national goals for care quality and effectiveness improvement, Mostashari continued, saying that “we are moving away from a fee-for-service model comfortably faster than we had even anticipated it. And as a country I think we are increasingly focused on the practical aspect of implementation,” citing a statistic he did not reference that “57 percent of hospitals have said that achieving meaningful use is their top priority, and 92 percent have said that it’s one of their top two issues.”

Mostashari went on to cite as signs of progress the fact that “We now have 454 certified, complete EHR systems—386 ambulatory, 68 inpatient,” plus “over 400 modular products.” And he predicted that “In a couple of years from now, we’ll have more than 80 percent of primary care providers on the e-health record. That,” he said, “will be a primary change in healthcare.”

Mostashari also felt the need to clarify and contextualize comments he had made in the past month around stage 2 requirements for early-attesting organizations and individuals, given the controversy in that area that has preoccupied many in healthcare this year. “Let me talk about the recent discussions that got translated as [supporting] ‘delay’ in the stage 2 transition,” he said. “Here’s how I see it and would explain it. The health IT policy committee looked at the national health IT policy and said, there are some big things that need to get done. And stage 1 provided a really good framework, roadmap. But there are a few things that are going to be challenging, including with quality measures development, and the current schedule allowed for little room for products to get upgraded and rolled out across the country… meaning that we would be severely limited in how robust stage 2 would be. And the committee said, by giving the early movers one extra year, we can continue to [advance progress]… They will have more time setting up for stage 2, so they’re incented to not rush for anybody who is ready to go. So I would characterize the shift as leading to a more robust stage 2 and also saying that there is no reason for delay on stage 1 work.”

Following Mostashari’s speech and question-and-answer session, three officials from the federal Centers for Medicare and Medicaid Services (CMS) discussed timelines around the Medicare and Medicaid EHR incentive programs, and answered numerous audience questions revolving around practical concerns over meaningful use, including concerns over how hospitals can help physicians attest to meaningful use.

Some industry experts looked a bit askance at certain comments made by the CMS officials. “One of the obvious takeaways that this morning’s session with CMIOs emphasized is that CMS, in the meaningful use process, has failed to recognize how much aggregation of providers and hospitals into large health systems has occurred over the last decade. Whereas other CMS requirements have provided the means for a large entity to efficiently such processes, meaningful use has not yet done so,” said Vi Shaffer, research vice president for healthcare at Gartner, Stamford, Conn. “They really should develop a means to help these entities report on behalf of sometimes 1,000 or more providers in an organization.” Shaffer noted that the ACO model under healthcare reform further encourages provider aggregation.

Bria’s and Mostashari’s comments initiated the formal part of the Symposium program (following an opening reception Tuesday evening). The conference will continue through midday Friday.

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