WASHINGTON, D.C. -- To a room full of freaks and geeks, outgoing National Coordinator for Health IT Farzad Mostashari's, M.D., final message to the movers and shakers of health IT was serious, yet affectionate: You're all a bunch of misfits.
That's good, he went on to say, because currently patients are usually afterthoughts in the U.S. healthcare system, especially when it comes to leveraging their own health data to actively participate in their care. They too are misfits in this giant machine -- even though they should be the first priority.
The programmers, developers, vendors, policy wonks and patient advocates in attendance at the 2013 Consumer Health IT Summit can empathize with patients, Mostashari concluded, and therefore are in a prime position to create technologies to drive patient engagement.
Ever sympathetic to his audience, he cast himself as a misfit, too: "I certainly know what that feels like, growing up feeling American in Iran, Iranian in America, feeling like a geek among the jocks, a bicyclist in a world of cars, a public health advocate in the world of healthcare," Mostashari said to the crowd assembled in the great hall at HHS' Hubert H. Humphrey building, which for many attendees would likely be the last time they'd hear him speak publicly before he leaves his post Oct. 5. "I don't need to tell you I'm a misfit; I'm wearing a bowtie."
The biggest concern I have with 'misfits' is not the nerds and geeks, of which I am one. It's the patients who are mis-fit into a healthcare system.
Farzad Mostashari, M.D., national coordinator for health IT
It was an apt bumper-stickering of his life and times at the ONC, beginning four years ago as then-coordinator David Blumenthal's, M.D., understudy and then taking over after Blumenthal stepped down in 2011. While Mostashari stuck out in a crowd of otherwise business-as-usual bureaucrats, his frenetic approach energized not only his staff, but the ecosystem of U.S. health IT software developers and (albeit sometimes reluctantly) the healthcare providers who reaped the meaningful use incentives his office administered.
Mostashari put the pedal to the metal. He made everything sound urgent, whether it was negotiating a minor adjustment to some obscure data standard or announcing a sweeping policy initiative published in the Federal Register. He could make the deep, in-the-weeds technical geekery of health information exchange sound like a life-and-death matter. He could see the potential in every health IT advancement -- however incremental -- to save lives and help patients live more healthily and happily. As well he should have; that was his job.
The question is: What will all Mostashari's efforts add up to? What will be his long-term contribution to the country's health IT infrastructure? It will probably take a decade to know for sure, but patient engagement -- motivating them to take charge of their health through taking charge of their health data -- will certainly be his touchstone policy idea.
But can patients take over the healthcare system, no longer cast as misfits and afterthoughts swimming in a wake of diagnoses codes, billing transactions, spreadsheet cells, quality reporting measures, stock dividends and profit sharing? And, once empowered, will we actually take charge of our health? Whether or not he inspired us all to do that will be the yardstick by which we measure his effectiveness.
The ONC has another barrier to overcome in U.S. healthcare, already acknowledged by Mostashari's lieutenant and veteran Chief Information Officer David Muntz, principal deputy national health IT coordinator: the evolving, or perhaps declining, nature of the CIO position among hospital executives.
Mostashari's successor will have to help hospital IT departments operationalize the last two stages of meaningful use, as the provider CIOs we interviewed leading up to National Health IT Week pointed out. He sold the public health benefits on the incentive program so well, 90% of hospitals and 78% of eligible physicians signed up so far.
How can the healthcare CIO prove the rest of meaningful use will pay off and get the CEO's attention to fund the rest of it? What's it going to take to get the other executives to see that this amorphous, hard-to-explain technology initiative is just as important as the very visible, concrete investments of cutting-edge diagnostic imaging machines, breaking ground for new hospital wings and giant billboard ads? After all, the CIOs are misfits too, at least in the C-suite.
"IT leaders who wish to receive the respect they believe they're entitled to should see their roles as not just managers of the switches, but actually as enablers of healthcare transformation -- and [should] reflect that in their prioritization and strategies," Mostashari told SearchHealthIT "The biggest concern I have with 'misfits' is not the nerds and geeks, of which I am one. It's the patients who are mis-fit into a healthcare system that doesn't see a good fit between patient preferences and what [providers] want to do to make money. … If we can align, re-engineer, redesign the healthcare system around the patient and the patient's health, the pieces will fit together."
This was first published in September 2013