Farzad Mostashari, MD, ScM, is the national coordinator for health information technology at the Department of Health and Human Services. In a telephone interview with HealthLeaders Media Mostashari spoke about the challenges his office faces, the importance of patients being involved in their care, and how his office is working to protect patient medical records.
HLM: What are three toughest challenges you plan to tackle in 2012?
Mostashari: Adoption of meaningful use, information exchange and interoperability, and maintaining privacy and security. We want 2012 to be a huge year for meaningful use. I think doctors, hospitals, and vendors are geared up. It will be an enormous year for providers who qualify for the incentive, but more importantly to start to establish the information foundation for delivering care that is inconceivably better in all ways—higher quality, safer, more patient-centered, and more coordinated.
It is fantastic to have the records in an electronic format in the doctor's offices and to have those records used to take better care not just of individual patients, but of the entire population of patients.
It is just as important that those records be shared across the different settings when the patient moves from outpatient to inpatient care, then back home or to a long-term care facility, and back to the primary care doctor's office and then to specialist. We're really pushing in major way on information exchange and interoperability.
Of course, what has to be paramount for everybody is the shared responsibility of maintaining the privacy and security of those patient records.
HLM: Where will meaningful use be at the end of 2012?
Mostashari: Wildly successful! In the last two years more doctors adopted electronic health records than adopted them in the 20 years before that. Adoption doubled in two years. It's intense.
When you look at gold standard surveys out of the CDC, over half the doctors intend to go for meaningful use and for hospitals it's even higher. If you look at registrations for the meaningful use program, over 100,000 doctors have registered for the program and over half of all hospitals have registered for the program.
They're not doing it for their health. They are doing it because they intend to apply for meaningful use and we intend to help them get there.
HLM: What do you think has been the big hang-up in implementing the exchange of patient information?
Mostashari: It's really three things: reducing the cost of exchange, increasing the value, and creating the preconditions for trust to emerge. The bottom line is that the cost of exchanging patient information has to be less than the value that the provider gets from moving that information. We're trying to reduce the cost of those transactions through standards, so you don't have to build $10,000 or $50,000 interfaces to get through to whoever you want to talk to.
We're getting the industry to come together to create how the information will be packaged, the code systems to be used, and the interfaces and specifications to be used so we're driving down the cost of those standards.
We're working with states to have some shared services to make sure everyone has access and to reduce costs there.
Private health plans, Medicaid and Medicare are putting out new models for paying for care that rewards coordination (so) we're seeing the value proposition start to emerge for information exchange.
On the technology side, we're going to see standards that enable of low cost exchange so we're going to see the value proposition rise. Once the preconditions are there for information exchange, the only thing needed is trust.
I think we're going to see information move in a trickle in local networks where people have relationships and know each other and trust each other for particular purposes. That trickle will become a flow and that flow will become a flood as trust grows.
HLM: A recent PWC consumer survey indicates that patients are willing to share their data to improve care.
Mostashari: How about that! You know why patients say that? Because when they go to the specialist the specialist says: "Tell me why you are here. I didn't get anything on you." People like their doctors. They like their doctors' office. They like their healthcare providers. They respect them and they trust them. One thing that no one would question is that it's a problem that doctors and hospitals don't talk to each other. That is abundantly clear.
When we look at diabetes care and there's a landmark study out of Cleveland that found that if you look at the basic stuff, the right care for someone with diabetes like getting their eyes and blood sugars checked, only 7% of people with paper records had that basic standard of care compared to 51% with electronic records.
But people don't see that. They don't know that and maybe they don't want to know that. That advantage of electronic health records maybe is a little bit lost on people. But the part about sharing information, nobody doubts that their doctors and hospitals could be talking more.
HLM: In terms of privacy and security, there have been so many breaches. How are you going to bring everything under one umbrella and make this all happen?
Mostashari: It has to be a shared responsibility, so we have to work with our partners. That's the only way we're going to be able to succeed. People trust their doctors and one of the things they trust their doctors for is to keep their record secure. That goes back to the Hippocratic Oath.
We're working with doctors, hospitals and clinics all over the country to have them learn the best practices, to make sure they are meeting the HIPAA security standards, and to mitigate risks so they don't put patient data in harm's way. It's simple things like making sure if there's data on a laptop then the laptop is encrypted, so if stuff is stolen or lost you don't have a breach of privacy.
There's also the important partnerships. The Office of Civil Rights enforces those breaches and makes sure that if there is willful disregard on the part of a covered entity for protecting that information that enforcement takes place. There have been literally millions of dollars in fines levied against organizations.
The new protections under the HITECH Act mean not only do they have to pay higher fines but they literally have to alert the media and the patients if they have a significant breach of patient records. We're working with vendors to make sure they have the capabilities within certified electronic health records to do the encryption, to make sure there are audit trails that track who opens a file, and to make sure access is protected so that clerical workers don't have to see the clinical data to do their job.
These are just some of the things we are doing with our partners to get all hands on deck to protect the privacy and security of patient information.
HLM: Patient engagement is a priority under healthcare reform. How do you respond to the argument I hear a lot that physicians really can't lead disengaged patients to water?
Mostashari: I think there's a germ of truth to that. I think in many ways we (patients) are the ones that are most responsible for our own behaviors, for taking our medications, and for going to the doctor's office in the first place. But I think there is something to the other side too. If we (doctors) get our hackles up when patients ask for copies of their records, which is all too often the approach that some providers have taken, then it changes the conversation.
One of our meaningful use vanguards says 'I love it that the patients correct my medical records. I have an army of fact checkers who care more about this than anyone else possibly could. I give them a copy of their visit notes and they help me correct their records. They tell me what medications they are on that I don't have on my list. They help me fix the diagnosis or whatever else is in my record. I use that as a tool to help engage with the patient, their family and their caregivers.'
There is a difference in providers who don't put the computer screen between them and the patient, who really use the information tools as a way to engage with the patient, and who say to the patient: Look at what I am typing or look at this graph. Here's what is happening with your blood sugars. Log onto a portal and look at your lab results. Feel free to send me a message.
What they find is that patients don't abuse those tools. Not all patients want to, but a lot of patients take advantage of those tools. It does make a difference.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
