Mostashari: 'This time is different'
CHICAGO—This is “a heady and hectic time” for healthcare, said Farzad Mostashari, MD, ScM, national coordinator of health IT, speaking at the CMIO Summit on Transforming Healthcare through Evidence-Based Medicine. “The pace of change only seems to be accelerating,” including change in the structure of delivery and in how care is paid for, he said.
With all the change in healthcare, including hospital consolidation, patient-centered medical homes, bundled payments, accountable care and much more, “there is a lot of uncertainty about exactly what shape” the healthcare system will take in the future. “Increasingly, the position of CMIO is at the center, at the fulcrum of translating the transformation work between the C-suite and the patient’s bedside.”
Mostashari uses Meaningful Use with "humility," as he and his staff don’t really get to define the term. “Meaningful Use is going to be defined and determined by you all. You can make it meaningful or not. We can put out the tools but, ultimately, if it ends up being meaningful it will be because of you.”
Despite the challenges, he is optimistic about the future of healthcare, and he appreciates that transforming healthcare is a “tall order” and “sometimes it’s hard to feel that this time is going to be different.” However, healthcare has to find a way to deliver higher quality care at lower cost. “We have to.”
This time is different, he said, because “we have tools we never had before.” Plus, the three things that have to change in the ecosystem are, in fact, all changing. Those three essentials are how care is paid for, how care is delivered and how patients care for themselves. If just one of those essentials was changing, it wouldn’t work. “All three are lining up,” he said. It’s not easy, partly because no one entity controls healthcare. But, “the changes are being brought together in a triple strand for a new DNA for our healthcare system.”
Population health management is “the clearest form” of change in the delivery of care. It’s the “phrase that’s all the rage.” But, providers have to get the data first. That’s why, he said, quality measures were included in Stage 1. So providers could get the data, work on the workflows and get feedback from the data. Those measures “set the foundation for data collection and data use, and improvements and quality within the practice.” Providers should collect, monitor and review data over and over in small cycles, he said.
Providers could simply meet the Meaningful Use requirements but “what a complete waste. Waste of the highest order. That would be a missed opportunity to make it meaningful in your hospital or your practice,” he said. Rather than focusing on the what—the regulations—providers should help their staffs focus on the why and how to do it best. "If you’re just focusing on what to do to check a box, you’re missing the opportunity to change your culture and your mission.”
Anyone who’s been through an IT rollout has probably experienced cultural issues, Mostashari said. “That’s what meaningful use of Meaningful Use Stage 1 is about—improving the quality of organizations and making it meaningful and their own.”
Mostashari is aware that many people said Stage 2 wasn’t tough enough when it comes to interoperability. He disagrees, however. “1,800 ballot issues were resolved through HL7. More than 1,000 volunteers shepherded each and every issue through the process.” That process normally would have taken years but it only took nine months thanks to his office accelerating the process.
As a result, there are now 43 standards achieved through consensus. “Stage 2 is all about interoperability,” he countered. Now, providers must ask their vendors for Stage 2, not another custom interface. “Let’s be pushy customers on interoperability and exchange.”
Speaking of information exchange, Mostashari said the business case for exchange is emerging. In the past, there wasn’t exchange because it wasn’t in the hospitals’ best interest. Now, if hospitals are getting adjusted payments for poor outcomes even if their patient goes to another hospital’s emergency department, the original hospital is going to want to exchange information. “Incentives are a wonderful thing,” he said.
In the future, providers are going to have to coordinate care through exchange as well as better engage the patient. Although many people said requiring hospitals to get a certain percentage of their patients to use a patient portal isn’t fair, Mostashari said patients want messaging and a portal. Plus, “medicine is all about teaching and engaging.”
He said ONC set the threshold low for that required use of a patient portal but “that will be the foundation for patient engagement. We can’t achieve lower costs for healthcare without the patient. Patients are the biggest resource we have and they’re not being used.”
Mostashari said if providers embrace “true meaningful use of Meaningful Use tools” and make them their own, that “will be the foundation of your success for delivering care for the entire patient population. Many of you are doing that. I have the utmost confidence that, working together, we can do what we couldn’t do on our own. There’s a bright future ahead for healthcare."
The conference was produced by Clinical Innovation + Technology and Clinical-Innovation.com. The event was sponsored by Elsevier ClinicalKey.
With all the change in healthcare, including hospital consolidation, patient-centered medical homes, bundled payments, accountable care and much more, “there is a lot of uncertainty about exactly what shape” the healthcare system will take in the future. “Increasingly, the position of CMIO is at the center, at the fulcrum of translating the transformation work between the C-suite and the patient’s bedside.”
Mostashari uses Meaningful Use with "humility," as he and his staff don’t really get to define the term. “Meaningful Use is going to be defined and determined by you all. You can make it meaningful or not. We can put out the tools but, ultimately, if it ends up being meaningful it will be because of you.”
Despite the challenges, he is optimistic about the future of healthcare, and he appreciates that transforming healthcare is a “tall order” and “sometimes it’s hard to feel that this time is going to be different.” However, healthcare has to find a way to deliver higher quality care at lower cost. “We have to.”
This time is different, he said, because “we have tools we never had before.” Plus, the three things that have to change in the ecosystem are, in fact, all changing. Those three essentials are how care is paid for, how care is delivered and how patients care for themselves. If just one of those essentials was changing, it wouldn’t work. “All three are lining up,” he said. It’s not easy, partly because no one entity controls healthcare. But, “the changes are being brought together in a triple strand for a new DNA for our healthcare system.”
Population health management is “the clearest form” of change in the delivery of care. It’s the “phrase that’s all the rage.” But, providers have to get the data first. That’s why, he said, quality measures were included in Stage 1. So providers could get the data, work on the workflows and get feedback from the data. Those measures “set the foundation for data collection and data use, and improvements and quality within the practice.” Providers should collect, monitor and review data over and over in small cycles, he said.
Providers could simply meet the Meaningful Use requirements but “what a complete waste. Waste of the highest order. That would be a missed opportunity to make it meaningful in your hospital or your practice,” he said. Rather than focusing on the what—the regulations—providers should help their staffs focus on the why and how to do it best. "If you’re just focusing on what to do to check a box, you’re missing the opportunity to change your culture and your mission.”
Anyone who’s been through an IT rollout has probably experienced cultural issues, Mostashari said. “That’s what meaningful use of Meaningful Use Stage 1 is about—improving the quality of organizations and making it meaningful and their own.”
Mostashari is aware that many people said Stage 2 wasn’t tough enough when it comes to interoperability. He disagrees, however. “1,800 ballot issues were resolved through HL7. More than 1,000 volunteers shepherded each and every issue through the process.” That process normally would have taken years but it only took nine months thanks to his office accelerating the process.
As a result, there are now 43 standards achieved through consensus. “Stage 2 is all about interoperability,” he countered. Now, providers must ask their vendors for Stage 2, not another custom interface. “Let’s be pushy customers on interoperability and exchange.”
Speaking of information exchange, Mostashari said the business case for exchange is emerging. In the past, there wasn’t exchange because it wasn’t in the hospitals’ best interest. Now, if hospitals are getting adjusted payments for poor outcomes even if their patient goes to another hospital’s emergency department, the original hospital is going to want to exchange information. “Incentives are a wonderful thing,” he said.
In the future, providers are going to have to coordinate care through exchange as well as better engage the patient. Although many people said requiring hospitals to get a certain percentage of their patients to use a patient portal isn’t fair, Mostashari said patients want messaging and a portal. Plus, “medicine is all about teaching and engaging.”
He said ONC set the threshold low for that required use of a patient portal but “that will be the foundation for patient engagement. We can’t achieve lower costs for healthcare without the patient. Patients are the biggest resource we have and they’re not being used.”
Mostashari said if providers embrace “true meaningful use of Meaningful Use tools” and make them their own, that “will be the foundation of your success for delivering care for the entire patient population. Many of you are doing that. I have the utmost confidence that, working together, we can do what we couldn’t do on our own. There’s a bright future ahead for healthcare."
The conference was produced by Clinical Innovation + Technology and Clinical-Innovation.com. The event was sponsored by Elsevier ClinicalKey.
Beth Walsh,
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.