Health IT Czar on Making Meaningful Use 'Meaningful'

Outgoing ONC Chief Farzad Mostashari offers advice to clinicians during an interview with Eric Topol

; Farzad Mostashari, MD


September 04, 2013

In This Article

A Big Dream in Healthcare Information

Dr. Topol: Let's say that you can dream and you have a really big idea. We are not talking about big data; we're talking about a really big idea, kind of like Elan Musk with the Hyperloop, the 30 minute-ride from LA to San Francisco in an air hockey tube.

Dr. Mostashari: I love it.

Dr. Topol: A big idea like that -- a dream for healthcare information. Where could this go if it had all the right steps and resources? Where do we land with this?

Dr. Mostashari: The dream is that with every encounter [you have with a patient], you know everything about the patient. You know everything about any medical knowledge that has ever been generated and you know everything about what is happening right now in the community where we are. Because the treatment for a sore throat is going to be different in January with the flu epidemic than it is going to be in September when asthma is peaking. So you have to bring in the 10 to the 6th power, the 10 to the 3rd power, and the 10 to the zero in that encounter. Whatever you do generates and goes back to teaching everybody else what is going on in the community, what is going on in medicine, and contributes to this patient's knowledge. Right now my visit doesn't even contribute to my next visit.

Dr. Topol: It's pretty pathetic.

Dr. Mostashari: We are far from there. But the first step is bringing the digital -- the data -- revolution to healthcare.

Dr. Topol: And that includes genomics and sensors and all of that stuff?

Dr. Mostashari: Absolutely; the Internet of everything.

The Impossible Push for Meaningful Use?

Dr. Topol: You have been pushing meaningful use, which is kind of a precursor to where you want to go.

Dr. Mostashari: Oh, it's a blunt tool.

Dr. Topol: It's a pretty powerful position. You had about $37 billion to give out for this effort.

Dr. Mostashari: I think doctors would say that they earn it. No one gives out anything.

Dr. Topol: Sure, they earn it. You have a lot of funds and resources; it's a pretty powerful position to basically try to catalyze this movement going forward. Is it possible? With all the inherent blocks and legions that we have with lack of interoperability and fragmentation, can we get there? Can we get to this dream?

Dr. Mostashari: Yes, absolutely.

Dr. Topol: You think so?

Dr. Mostashari: Absolutely.

Dr. Topol: What is going to hold us back? It's not just money, right?

Dr. Mostashari: What is going to hold us back is a belief that healthcare can't change. That is the biggest barrier I see.

Dr. Topol: But you are the ultimate charismatic guy who is a force; you are the perfect one to have kept this ONC [effort going].

Dr. Mostashari: You're making me feel bad.

Dr. Topol: And it seems like nobody does it for more than 2 years.

Dr. Mostashari: Well, it is an intense job. It is an intense job.

Dr. Topol: Is it just burnout?

Dr. Mostashari: You know, I think that the institution is bigger than any person, and everyone has to look in their heart to see what is right for them. I guess it is highly unscientific, Eric. It is not really data-driven. It just felt like it was the right time, and it was also a time when things are going pretty well. We are getting data back. When I started, 96% of prescriptions were on paper. Now, most prescriptions are electronic. Nine percent of hospitals were electronic. Now, 70% have attested to meaningful use. I mean, the flip has happened. We have passed a certain tipping point on adoption and on interoperability. All of the vendors are now implementing the step-up in the interoperability standards that they are going to kick in. So, it seemed like a good time.

The Blue Button App

Dr. Topol: I did want to talk about one program that I think has immense potential: the Blue Button app. Maybe you can tell its story, because not everyone is familiar with the story of your mother and tapping into Blue Button. I think your father also had some personal experience with it?

Dr. Mostashari: Blue Button is a concept. It is not just an app. It is the concept that patients should be able to get easy electronic access to their own health information.

Dr. Topol: But it's only [for Medicare patients] right now, right?

Dr. Mostashari: Actually, right now there are about 100 million Americans who can access and download their information, so it includes health plans; Aetna and United Healthcare have signed on. About 400 organizations have signed on to enable it. Veterans can download their full medical record, including their progress notes.

Dr. Topol: When patients do that, do they see stuff that they can understand or is it gobbledygook?

Dr. Mostashari: That is one of the barriers that has held us up -- providers saying, "Is the patient going to understand this? Isn't it my job to mediate this, to translate this medical knowledge?" Let's let the patients get help understanding it, interpreting it, using it, processing it, from other people too. It doesn't mean that we are not the most important person that patients want to hear from. But just as they do go online and Google search terms, which is probably a good thing, providers can engage them in that partnership. It is probably a good thing if they can have an app that can help them understand prices, because, frankly, I don't. It is probably a good thing that they have an app where, before the visit and after the visit, they can have a list of what their medications are and have something that helps them with medication adherence, and that connects to other people who have the same condition. We can't even imagine what all the tools are going to be, but where we are today [is that we have patients], 37 million Medicare beneficiaries, with the most complicated conditions. They have 15 different doctors, lots of chronic conditions. For me personally, I didn't even know my mom's ophthalmologist's name.

[What we told] Medicare patients is that we are not going to try to make [this app] pretty, we are not going to try to interpret it for patients. If you want it, you can download 3 years' worth of claims that Medicare has paid for you. We also said, "Let's do an app challenge. Let's have people make sense of it for you." And it turns out that it is actually pretty cool. I really recommend to everyone who has someone they love who is on Medicare, to help them get access to this information. Search for Blue Button in the Android or Apple app store, download that information, and see what it can turn into. Because instead of providers trying to do everything, these great entrepreneurs have developed a bunch of different apps, and I think there are many, many more like this coming that can do things like tell me all of the different providers my mom has seen, with their phone numbers, addresses, and specialties.

Dr. Topol: Prescriptions too?

Dr. Mostashari: If she gets Part D, right. It will tell me the prescriptions that she is on, the procedures she has had, the labs she has had done, the inpatient stays she has had, the diagnoses she has been given. It's all here, and it just comes from being open. To me, open data means open hearts, open minds, and letting other people help.

Dr. Topol: That has been one of your big messages, about liberation of data, right?

Dr. Mostashari: It's really the message of US Chief Technology Officer Todd Park, "Brother Park."

Dr. Topol: It's amazing to me that you guys were roommates.

Dr. Mostashari: When we both moved to DC for the first time, our families were on different coasts, and we rented a little apartment together -- without air conditioning in July.

Dr. Topol: That is a hell of a lot of energy in one apartment. That is a lot of heat.

Dr. Mostashari: We had a good time. We just actually had our 4th anniversary in DC. We went back to this Mexican restaurant with fluorescent lighting that we had gone to 4 years back. It is quite a change.

Balancing Work, Family

Dr. Topol: That is great. So, you have 3 kids. Do you ever have time when you are not at the ONC, when you have a chance to have fun and do stuff?

Dr. Mostashari: I plan to spend a lot of time making dinner. I love making dinner for them, baking stuff with them, and biking on the bike path. I just did a rowing camp with my son.

Dr. Topol: Tell us about that. I saw your tweets by the way. That is how I got to know you -- through Twitter.

Dr. Mostashari: That is how you knew I was here today.

Dr. Topol: There you go. I said, "Farzad is here because he just tweeted that he is here." Pretty wild, isn't it?

Dr. Mostashari: It's crazy. I was pretty seriously into rowing in college and a couple of years after that. Now, after 23 years, my 13-year-old son and I went to rowing camp, and it was great.

Dr. Topol: Wow. So the both of you were rowing all day long?

Dr. Mostashari: Rowing all day long.

Dr. Topol: Did you get sore muscles and everything?

Dr. Mostashari: Blistered hands. And it was wonderful.


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