As journalists, it is our job to remain impartial and have a healthy dose of skepticism when speaking with vendors and government officials, and usually that is pretty easy to do.
But I have to admit that over the last few years, although I don’t always agree with him, I often found myself impressed with the way Dr. Farzad Mostashari could bring the focus of conversations about e-health regulations or standards development back to the larger picture of improving care and patient engagement, and he did so in a way that seemed inspirational to those doing the heavy lifting in this field.
So although no one could be expected to stay in the position of national coordinator for more than a few years, I was a little sad to hear he would be leaving that position. Whatever you think of the program, I would argue that he could fairly be given a lot of credit for sustaining the momentum of the meaningful use movement through its most critical phase. (Of course, Dr. David Blumenthal gets a lot of credit, too, for meeting the daunting challenge of getting it off the ground in the first place.)
When I heard that Dr. Mostashari was leaving, I looked back through my reporting on his comments at Office of the National Coordinator meetings, and chose a few of my favorites to reflect on:
In noting that 86 percent of hospitals said they intended to apply for meaningful use incentives: “Wow!” he said. “They are not doing it just because of the money. They are doing it because it is aligned with what they need to do. Meaningful use is not a distraction. It is a roadmap to prepare, and it helps mitigate some of the costs. But if we are not succeeding, if it is a distraction, then we need to change it.”
“Five years ago, if you were in market for health IT products, many systems looked like they had DOS roots and many functionalities weren’t there. The market has been absolutely transformed over two and a half years. The products and choices are better, cheaper and faster than just a little while ago.”
There have been big necessary changes that have come to healthcare in the last three years. The framework is right; the foundation and building blocks are there. But we have to get so much better…It is not enough to have adoption of systems, certified products, attestations to meaningful use. It’s not enough to have improvements in process measures. We have to help doctors, hospitals, and patients make it meaningful. We have to help them make it meaningful for actual coordination of care and enabling new models of care and patient engagement.”
“Our longer term vision is that every healthcare interaction benefits from all the world’s knowledge. Every encounter that generates knowledge should add to the world’s knowledge. If we aren’t accomplishing that in the next seven years, we won’t have met the challenges in time.”
“We are halfway through the process of computerizing and digitizing healthcare settings, but only 5 percent of the way through redesigning work flows….Payment reform and tools without know-how will not in the short run accomplish improvements in quality and cost we are rooting for. How do we scale up the hard-fought knowledge about what works? We can’t just rely on large integrated delivery networks that have strong quality control infrastructure. This effort isn’t just about 3,000 hospitals; it is about 180,000 physician practices…That is going to be the most interesting challenge for the next few years.”
As to who might succeed Mostashari, there are several worthy candidates, including Judy Murphy, R.N., deputy national coordinator for programs and policy at ONC, and Paul Tang, M.D., chair of the meaningful use work group. Perhaps the best-positioned person for the job would be Dr. John Halamka, who has done a lot of valuable work as co-chair of the Health IT Standards Committee. I always have the impression that he is the smartest guy in the room. He is good at being both diplomatic and enthusiastic (as was Mostashari), plus he can get into the technical depths of standards development, yet his experience as both a physician and as CIO of Beth Israel Deaconess Medical Center lends credibility to his arguments. (Whether any of these three are interested in the position is another story.)