A Conversation With the Nation’s Health IT Chiefs

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Farzad OstashariAttestation for stage 1 meaningful use is underway in radiology, and expectations are rising about the ability of IT to reduce cost and increase quality in health care. In separate interviews with Radiology Business Journal, Farzad Mostashari, MD, ScM, national coordinator for health IT, and Todd Park, CTO for the US DHHS, clarify their perspectives and positions as the nation’s most influential health IT appointees.

Framing National Health IT Policy

Farzad Mostashari, MD, ScM, joined the DHHS Office of the National Coordinator (ONC) for Health IT as national coordinator in July 2009.

RBJ: What are the obstacles to having a national health-care identifier issued at birth to help in aggregating each person’s health information?

Mostashari: The one obstacle to that is that Congress has been quite clear that it’s not something it wishes to see any money spent on, and that’s been consistent over several years.

RBJ: What’s your opinion about how valuable it would be?

Mostashari: I think we should probably leave it at that. I’ll say this: A lot of people assume that if we had a single patient national identifier, it would solve all problems having to do with patient identifiers, patient matching, and records being misattributed. I think there’s a little bit of magical thinking around that.

I’ve suggested we move on and think about how we can find better ways within the world we live in, where we don’t have a national health identifier at birth, where we can do a better job at having identity validation as a service (whether it’s commercial based or state based) and work on improving our workflow around data collection and data quality. That may end up doing a lot more for the issue than I think people assume a national patient identifier would.

RBJ: What about interoperability? What can/should government do to encourage vendors to make it easier for health information systems to communicate?

Mostashari: We see the government playing a critical and limited role. There are three areas where we are active: first, simply convening people to come up with shared solutions to common problems—bringing people together with a sense of urgency. It’s about providing a place where competitors can come together and work on common solutions around the standards.

The second area is curating the collection of the standards and implementation specifications that can be used and reused to solve certain problems, so we don’t end up reinventing the wheel for every problem people have. If you dealt with medication codes for medication ordering in one system, you should reuse that, if we’re talking about quality measures and it involves a medication.

The third area is enforcement through certification of electronic medical records (EMRs) and testing tools as part of that process. It really starts first with convening industry, academics, provider groups, and others around the standards and interoperability.

RBJ: Are we unlikely to see a top-down approach to setting a national standard?

Mostashari: It’s both bottom up and top down. The development of the standards is done from the bottom up in the sense that we’re not going to pay a contract to someone to come up with what the standards are going to be. It really has to come from the people who are going to have to live with it. The top-down approaches are the convening and the enforcement. I actually think the bottom-up approach is more important than the top-down approach.

RBJ: Many specialties complain that the generic set of meaningful-use criteria forces them to invest in meaningless IT capabilities or in duplicative work. How are you addressing these complaints?

Mostashari: It is a challenge. It’s a national program. Eligible professionals come in many different specialties. To have a common platform and a common set of measures that all specialties are going to feel are equally relevant to them is a real challenge.

It becomes particularly difficult when we’re talking about some specialists, like radiologists, who often don’t have direct patient contact and opportunities to do some of the things you would want to have as meaningful use for the large majority of physicians whose job (in large part) is patient contact. It is a challenge, and we and our CMS colleagues have tried to provide accommodations and exclusions where something is not part of the scope of practice.

The ACR® has been quite helpful and constructive in its comments and suggestions about