NEW ORLEANS -- In his keynote address on the final day of HIMSS 2013, National Coordinator for Health IT Farzad Mostashari, M.D., said the health care system is fundamentally broken, and endemic problems
The problem that we have today isn't that there's too much standardization in health. We should be able to...have variation that is thoughtful. When you have variation for the sake of variation it is just bad medicine.
Farzad Mostashari, M.D.,
national coordinator for health IT
Mostashari pointed to a number of problems that exist within the health care system that could be solved relatively easily. Primary care physicians typically are not notified when their patients end up in emergency rooms; doctors rarely follow up with their patients to make sure orders are being followed; and there are barriers that keep patients from engaging in their own care. For Mostashari, these problems don't demand major technological innovation. In some cases, text messaging could suffice.
The broken health care system is personal for Mostashari. He discussed how his mother recently experienced surgical complications after she overlooked preoperative instructions and the hospital failed to follow up with her.
"That hospital is full of amazing doctors and the best nurses, and the system failed them as much as it failed my mom," Mostashari said. "That system is failing everyone in health care and everyone we love."
Increasing the amount of data available to physicians and other clinical staff may be one way to address these issues. The first stage of the meaningful use program was set up to get doctors to use systems that could generate and collect data. Stage 2 will focus more on what physicians do with that data.
Mostashari said that leveraging all this data should help health systems identify processes that have become ingrained parts of their culture, but that don't necessarily lead to improved care. It will be possible to create more evidence-based procedures.
"One of the most important functions of data is this: It's to help us move beyond our intuitive and wrong beliefs," Mostashari said. "So with data we can help understand our own behaviors, our patient behaviors, and put [to] the test our beliefs and intuitions."
Using more data to identify what works and what doesn't in health care inevitably leads to talk of seeking more standardized care. Mostashari acknowledged that some providers deride what they call "cookbook medicine." Providers feel all eventualities cannot be accounted for through standardization, and seeking to do so would squeeze innovation out of care. But he said more standardization would be helpful.
"The problem that we have today isn't that there's too much standardization in health. We should be able to squeeze down to standards and then, like an accordion, expand back out, and study and have variation that is thoughtful that we can learn from. When you have variation for the sake of variation, it is just bad medicine."
The keynote session also touched on payment reform. Many commentators see unsustainably high health care costs as a symptom of the broken system. Medicare and Medicaid, as well as many private payers, have launched new value-based payment models that could eventually replace the fee-for-service model in an effort to control costs.
Mostashari said that this approach does have value to it, but expressed skepticism that payment reform alone will lower costs and lead to better outcomes. He said that paying people for the outcomes you want makes sense, but eventually providers will figure out exactly what leads to the best reimbursements and do only what they have to in order to achieve that.
What he said makes more sense is to encourage a culture that values quality and encourages physicians to do what he called "the right thing." Mostashari said all people are not completely rational economic actors, so only applying economic pressure on physicians in pursuit of better outcomes may not deliver the best results.