HIMSS: Resistance is just uncertainty, says Mostashari

NEW ORLEANS—“Healthcare is broken not just when it comes to the cost but in so many other ways,” said National Coordinator of Health IT Farzad Mostashari, MD, ScM, delivering a keynote address at the Health Information and Management Systems Society (HIMSS) annual convention. “Healthcare is broken as a system…as a lack of systems.”

That system is failing everyone in healthcare and everyone we love, he said. More important than errors of commission are errors of emission—“the errors we never see. Surgeons save lives, but we don’t know whose lives we’re taking when we only control blood pressure for half of the people who need it.”

Data and information can make the invisible visible. “And then we can do something about it. We can do quality improvement not just retrospective accounting.”

To fix the system, incentives matter. “If you pay people for the outcomes they’ll figure out away to get the outcomes.”  The species Homo economicus is limited to CFOs of hospitals, Mostashari joked. “They are a rare breed” that operates purely on rational economics.  

Professional ethos is at play as well, he said. “It’s not just about the money.” He cited an outcomes project during his time as public health director in New York City, in which “we said that we recognize that it takes more time and effort to bring someone’s blood pressure under control and here is some money to offset the costs. It turns out, that works better.”

Payment rules make a big difference too, he said. He cited the Centers for Medicare & Medicaid Services' Acting Adminstrator Marilyn Tavenner who said without that new payment and delivery models cannot succeed. “Fee for service isn’t dead yet, but there are a lot of plans for its demise.”

You need the incentives and the IT, he said. “The ability to manage information is going to be a part of doing business. In healthcare, when things just happen based on standing orders they get done more often. You don’t need pop-up reminders every second saying ‘give the flu shot.’ Just give the flu shot!”

The economic system responds, Mostashari said. “Things aren’t static.” For example, the percentage of providers using computerized physician order entry has increased from 65 percent to 85 percent and e-prescribing went from 55 percent to 73 percent in one year. Having the functionality and ability to do it is the first step, he said. “What remains is the will and leadership to use it well.” 

Mostashari addressed complaints that various measurement thresholds in the Meaningful Use requirements are too hard. “You destroyed those thresholds! And once you do it, you’re not going to do it for every fifth patient. You’re going to change the workflow and do it for everybody.”

He acknowledged that Meaningful Use is not easy, and meaningful users are earning their incentive pay. Looking ahead to penalties for not meeting Meaningful Use, he said “my goal is for nobody to be penalized. We want everybody to succeed on this.”

Don’t tell me healthcare can’t change, he said. “It can. A lot of what seems to be resistance that is just uncertainty.” Regional extension centers were developed to “shrink the change and provide a script.”  How are these organizations that didn’t even exist three years ago doing? More than 130,00 providers registered with a REC, 101,000 have gone live on an EHR and more than one-quarter of providers have demonstrated Meaningful Use.

Mostashari said he spent time in the HIMSS13 exhibition hall and saw many claims regarding scalability. “You know what scales? Hard work, determination, perseverance. Grit scales.” He also visited the Interoperability Showcase which first debuted at the HIMSS convention in 2006. “Best. Interop. Showcase. Ever,” was his evaluation this year.

He also addressed recent studies that claim that physicians are increasingly dissatisfied with their EHR. “You can’t beat the data,” he said. Some of those studies have a 1.3 percent response rate. The gold standard U.S. physician survey is from the National Center for Health Statistics, he said.

Going forward, “our shared challenge this year is the exchange of information. Does it get from where it is now to over there? Interoperability is not the same thing at all. Interoperability is when you get information can you understand it, can you use it, can you incorporate it into your own information?”

Despite the successes to date regarding adoption of health IT, only 24 percent of hospitals are exchanging clinical summaries with outside hospitals. “This is not where we want it to be. Twenty-four percent is nothing to celebrate even if it’s triple what it was three years ago. It’s not good enough and we’re going to change this.”

Mostashari chastised his audience for not being more aware of the final criteria included in the 2014 edition of EHR standards. “I am shocked at how many people who should know better don’t even know what’s in there.” Many of the complaints and suggestions people have made over the years are included in the 2014 edition, so providers need to review it and be aware of the new certification standards.

Mostashari said his office and the industry must work on privacy and security issues. “That’s one area where we intend to be forward leaning. You said don’t regulate too soon and don’t set in stone regulations before we know what the problems are. We plan to do a lot of education and a lot of listening. My hope is that you will step up and do self-regulation that we can endorse.”

He also cited the recent announcement from CMS and ONC that the agencies intend to make sure it is more profitable to share information than to hoard it. “That’s a big deal. No one should make a profit holding patient data hostage,” he said to enthusiastic applause.

In the future, “the patient certainly is going to be that blockbuster drug.” He referenced studies indicating text messages are as effective as pharmaceutical agents in helping people quit smoking. “We are going to need smart patients who access their own information. They are going to push the culture change that has to come.”