On the third day of the HIMSS12 conference in Las Vegas, Farzad Mostashari, MD, took to the stage in what ended up being a rousing address to a packed room of attendees. Addressing everything from the nation's progress in the past two years to the work still needing to be done, he touched on all aspects of what the industry had seen, is seeing, and will see in the years to come.
Here are seven key highlights from Mostashari's keynote speech.
1. Within the past two years, greater emphasis was placed on rural communities. According to Mostashari, back in 2009, the infrastructure didn’t exist for health IT to take off like it currently is. “The road wasn’t built, and there were a lot of people who couldn’t access the roads that were built,” he said. “There was an infrastructure that was slacking.” After being asked by the newly-named national coordinator to join the ONC, Mostashari said he worked to implement policies and programs to build the infrastructure, while the legislation established the health IT regional extension program. As a result, “we have 62 local nonprofits who are responding to local needs with local solutions but making sure small primary care practices, rural health clinics, and critical access hospitals aren’t left behind,” he said. Throughout the past two years, these extension centers have worked with more than 130,000 primary care providers, along with 70 percent of rural primary care providers to ensure they weren’t left behind. Funding was also given to support health IT coordinators in every state, who made sure every provider in the state had access to some means of health IT exchange to help them achieve meaningful use.
[See also: Mostashari backs Stage 2 delay to 2014.]
2. Key programs are thriving. The workforce shortage was another key issue addressed, with universities and community colleges helping to create 10,000 graduates a year who went on to work in health IT with the help of specific curricula and competency exams. Seventeen Beacon Communities were founded across the country "to demonstrate what the future of health IT is,” he said. “We worked with CMS to launch a new competitive certification program, and the health IT incentive program—the results have been breathtaking.” According to Mostashari, the industry has made more progress in the adoption of EHRs in the past two years than “we have done in the nation in the past 20. By next year, I predict the majority of care delivered in this country in hospitals and doctors’ offices will be done on EHRs, and not paper.”
3. Health IT is as “healthy” as ever before. Mostashari gave numerous examples of the progress the industry has made within the past two years, including rural pharmacies’ ability to accept electronic prescriptions and the number of hospitals eligible for meaningful use payments. In addition, 50,000 jobs have been created in the health IT space—a “bright spot in this economy,” he said. “Health IT is as healthy as every before, and innovative startups…are tapping to the opportunities and mission to use health IT to improve health and healthcare.” But, he added, we need more than adoption of meaningful use. “As independent doctors, we need interoperability and exchange. This requires a different infrastructure, or standards and rules for the roads, to allow trust to emerge and payment systems that encourage care coordination. That too is happening.”
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4. Other societal trends need to be intertwined with health IT. “There is a massive river flowing of advance in health IT, and there’s no going back,” Mostashari noted at one point. But, he warned, along with this massive trend are two other societal trends we have to “intertwine to twist health IT into alignment. If we’re going to create a new triple strand of DNA for our nation’s healthcare system, I’m talking about delivery and payment reform.” He added the nation is seeing a “thrust” of payment reform, whether it’s value-based purchasing, accountable care, or a myriad of other programs. “It doesn’t matter what you call it or how it’s implemented, and there’s uncertainty about how it’s going to be implemented,” he said. “Medicare is leading, but so are the states and the private health plans…there is a massive change underway, and what we do know is to be prepared, we need information and information tools.”
[See also: Mostashari expects big year ahead for data exchange.]
5. The relationship between provider and patient needs to be more than that between seller and purchaser. Quality had been put front and center, said Mostashari, with organizations that have never considered population health management jumping on the bandwagon. “[They’re] now intent…we’re seeing that in the market…it’s fundamentally a return to the ethos of medicine, where the relationship between patient and provider is more than the relationship between seller and shoe purchaser.” Doctors no longer have to wait for patients to walk in the door, and instead, the industry is shifting and automatically adding the responsibility of population health to physicians. “And if [patients] don’t come in, those are the ones we need to be worried about...[it’s about] engaged and empowered patients,” he said.
6. We still have a lot of work to do. Looking ahead, despite all the progress made, there is still work to be done, said Mostashari. For example, vendors are still learning how to meet certification criteria, and we are still in need of information regarding health IT-associated adverse events. “Rural providers still face higher barriers…it’s also not just doctors, but also their partners, like pharmacies that they exchange information with. And on the other side, reducing readmissions, behavioral health…the workforce needs vendors and providers and apprenticeships, and internships. We still don’t have quality measures that are parsimonious that makes use of the best of EHRs, not tap into the worse of them and that are designed from the ground up.” We still need to take advantage of the strength of EHRs and the integration of patient-generated data, he continued. “Coordination on all these issues. Between programs on in the federal government, whether CMS…DoD, the VA, the whole alphabet soup, and between public and private and the states. It’s an ongoing challenge; change takes time and change takes innovation—it takes sustained will.”
7. But we’re on the right track to “make meaningful use meaningful.” Those are the exact words Mostashari used to wrap up his address, noting the Office of the National Coordinator for Health IT is small but dedicated. “We stand at the intersection of these issues, and we’re proud to serve with you,” he said. “We have set a course, and we will be steadfast partners with you on this voyage. We’re going to listen and listen some more, and we’re going to engage and partner with you and with all the stakeholders in a democratic and transparent process…we’re going to keep our eye on the prize and our feet on the ground. We’re going to set ambitious and achievable goals and achieve them through incremental steps. We’re going to use a market-based approach, but we’re also going to make sure that we ensure a safe and effective industry that helps everyone.” Lastly, Mostashari said to the room of attendees, “I solute your daily work in our shared mission to place the patient and their interests at the center of everything we do. I’m honored and privileged to serve you.”
Follow Michelle McNickle on Twitter, @Michelle_writes
