Live from the CHIME Fall CIO Forum: Post-ONC, Dr. Mostashari Offers Bracing Comments to CIOs

Oct. 10, 2013
Just days after ending his tenure as National Coordinator for Health IT, Farzad Mostashari, M.D. on Oct. 9 shared unvarnished comments, insights, and asides with an attentive audience at the CHIME Fall CIO Forum, being held this week in Scottsdale, Arizona. Most newsworthy were his comments around what he sees as the severe improbability of any timetable flexibility around Stage 2 of meaningful use.

Just days after ending his tenure as National Coordinator for Health IT at the Office of the National Coordinator for Health IT (ONC), Farzad Mostashari, M.D. on Oct. 9 shared unvarnished comments, insights, and asides with a very attentive audience at the CHIME Fall CIO Forum, being held at the Westin Kierland Resort and Spa in the Phoenix suburb of Scottsdale.

The guest speaker at a special plenary session at CHIME13, Dr. Mostashari first spent some minutes making broad comments about his experience at ONC, and his perspectives on the road ahead for meaningful use and clinical transformation, and then sat down with CHIME CEO Russell P. Branzell for a question-and-answer session in which some of the questions had been derived from audience questions texted to a special phone number in advance of the session.

At the very beginning of his remarks, Mostashari wittily quipped, in reference to the current federal government shutdown, that “It’s been kind of strange these past few days. I was at the office in DC on Friday, cleaning things out and leaving little notes for whoever the next National Coordinator was going to be, and there was no one to turn in my badge to,” to appreciate audience laughter. He went on to make a valedictory pitch for continued enthusiasm for the clinical transformation and healthcare system transformational work ahead, telling his audience that “Every one of you is going to have the opportunity to lead around care transformation… [as] transformation agents,” adding that “You’re going to have to be really strategic. You can use the technology as a bludgeon, we all know that. But that’s not going to get the motivation that we need” from the frontline clinicians who are “struggling with the pace of change.” Instead, he urged healthcare IT leaders to become facilitators for true care delivery transformation, using the rapidly advancing tools available to them.

A Stage 2 meaningful use scheduling relaxation? Fuggedaboutit

Very significantly, when CHIME’s Branzell asked him during the question-and-answer session that followed his prepared remarks, about the possibility of the industry’s obtaining some kind of timetable relaxation around Stage 2 of meaningful use, a policy change that Branzell has helped lead the charge for, Mostshari was very blunt, asking the audience to understand some very hard facts around the terms of the HITECH (Health Information Technology for Economic and Clinical Health) Act.

“I’m sensitive to all the pressures that are here and that would argue for some flexibility in terms of the timing,” Mostashari told Branzell and the audience. “Let me give you a couple of kind of insider clues, though, as to what this request will play on, on the policymaker side. Here’s what the policymakers are thinking. The biggest one, just practically speaking: to change anything that’s in the regulation, you need to do rulemaking, right? And there’s no legal way to change a final rule without doing a pretty involved process. It takes about nine to 12 months to propose a new rule, clearing it through OMB [the federal Office of Management and the Budget], and all the other stages to get to a final rule. And just think about the impact that all of that would have on all of you to say, OK, there’s going to be a proposed rule for a new end date for Stage 2. So that’s something that would cause policymakers to pause. Now, policymakers have all kinds of tools in their toolbox, and one is called subregulatory guidance. And that’s where I would advise CHIME to look: don’t make requests or suggestions that will be difficult to meet, think about the subregulatory space.”

In other words, he said very frankly to Branzell in response to an immediate follow-up question, healthcare IT leaders, and CHIME leaders in particular, should not consider a timetable relaxation to Stage 2 of meaningful use a realistic possibility. The former National Coordinator’s response was far more blunt than any he had delivered while in the role, even weeks ago, and seem to startle both Branzell and some in the audience in its candor.

Mostashari did say that one possible way that the future National Coordinator might possibly address the continued pleas of CHIME leaders and other healthcare IT leaders might be to create a set of hardship exceptions that would be allowed for noncompliance with the deadlines of Stage 2, but such exceptions, he noted, would not allow for meaningful use incentive payments.

Mostashari was also uncharacteristically blunt about funding issues, both related to the current federal government shutdown (which has both essentially shuttered ONC itself, and also has disallowed Jacob Reider, M.D., the Acting National Coordinator for Health IT, from fulfilling his agreement to appear on Friday morning, Oct. 11, at CHIME13. Proactively broaching the topic of the federal government’s ongoing budgeting process, he said of the ONC budget, “You should care about it, because of the examples I’ve just mentioned around the need for work around standards and around the certification of EHRs [electronic health records]. I think you’ve noticed that there have been no updates lately to the EHR certification list; ONC certification work has stopped. And one of the things that’s happened for the past three or four years in Washington is that the budgets are not only capped, they’re frozen. Year after year, the Department [of Health and Human Services] has said, we want to reduce other departments’ funding and increase ONC’s funding, and year after year, it’s been at $60 million,” which he described as wholly inadequate to fund the necessary work of the agency.

In order to try to get around the ongoing budget freeze, Mostashari noted, the agency’s leaders have attempted creative solutions. “We tried to propose a user’s fee: $1 million for vendors to support the certification program and shield it from budgetary uncertainty—and what happened it was totally shot down. So I guess I would say, and I’m no longer in the government, and I can be pretty blunt about this, [that] this stuff really matters, and this really is a partnership now between the federal government and the private sector. And I really worry about this continuing budget-by-crisis, continuing sequester, and so on. It’s no way to run a railroad.”

Despite the blunt talk, the session ended on a laudatory note, with Branzell calling members of the CHIME board to the stage (with the men wearing bow ties, a Mostashari style signature), to present him with an exceptional award, the CHIME Board of Trustees Legacy Award for leadership and dedication to healthcare IT. Dr. Mostashari accepted the statuette from the board with gratitude, ending the session with final words of encouragement to the audience. “The road ahead is hard, and the challenges are immense for our industry and our country. This is a big thing we need to do, we have to do, and we can do it,” he said to applause.

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