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Farzad Mostashari explains the path for federal health IT regulations caught up with national coordinator Farzad Mostashari for an update on meaningful use and information exchange rulemaking.

Farzad Mostashari, M.D., national coordinator for health IT, wants interoperability now, but recognizes the role of regulations in this area may need to remain limited. He explained his thoughts on the subject in an exclusive interview with SearchHealthIT.

Tabling future information exchange regulations is part of a broader regulatory pullback he said will enable government and industry to focus on making sure providers have properly implemented stage 1 meaningful use and are prepared to move forward with stage 2. In other words, don't expect too much information this year about future stages -- whether it be stage 3, set to go into effect in 2016 --- or the increasingly discussed (but still hypothetical) stage 4.

Far harder is to recognize when we can make more progress by holding back. And in particular that was the message we heard when it came to regulations that would govern the nationwide health information exchange.

Farzad Mostashari, M.D.,
national coordinator for health IT

On a lighter note, Mostashari expressed amusement with the Twitter handle @FarzadsBowtie, a parody account written from the perspective of his trademark bowties. But as for who is behind the account, that mystery only deepens.

In her address at HIMSS, Centers for Medicare and Medicaid Acting Administrator Marilyn Tavenner said there will be no new health IT regulations coming in 2013. Knowing how long the regulatory process takes, are we still on track to get stage 3 up and running by 2016?

Farzad Mostashari: Well it's certainly too soon to express an opinion about that. 2016; come on. And I think that was the point. Marilyn's point, and one that I will reiterate, is we want to finish stage 1 strong. We want to get people in 2013 to focus on the step up to stage 2. I think some folks got panicked when they saw discussions of stage 3, and holy moly, we're not even to stage 2 yet, and I think some people misunderstood and thought we were already doing rulemaking when the policy committee asked for comment.

So I think what's she's saying is let's focus on implementation this year and stage 2, and let's get that done. It's going to be a lot of hard work, in particular to push forward on the interoperability and exchange issues, which are critical for us to make progress on. Let's see what happens with stage 2, let's learn from that, and let's give the policy and standards committees a little more time to make sure we can make additional step ups in terms of the standards and implementation guidelines, and the policy committee to think about different options for what stage 3 might look like. So that's the idea here and the whole point is not to prejudge and not prematurely draw conclusions about what stage 3 is going to be and when stage 3 is going to be. We're focused on stage 2.

Over the past few years you've spoken very emphatically about the need for data liquidity and how we need health information exchange (HIE) now. At the same time, it seems your office is taking a more hands-off approach. From a personal perspective do you ever get frustrated at the pace of things? Do you ever wish you could snap your fingers and make universal standards happen?

Mostashari: Someone called this "Zen and the art of government." We are by nature forward-leaning and action-oriented at ONC, so of course we want to help. We see a problem, we want to solve it. Far harder is to recognize when we can make more progress by holding back. And in particular that was the message we heard when it came to regulations that would govern the nationwide health information exchange. We have the authority to do it. But was it the best thing to do right now? What we heard was, "Guys, if you start doing rulemaking you're going to freeze everything while people wait, and right now there are a lot of things that are in flux, there's a lot of things that are dynamic, there's a lot of private sector activities that are going on -- give it a chance and don't solve problems before they emerge. Wait to see what happens."

I think that doesn't mean that we don't continue to be forward-leaning. So if you see last week -- the RFI we released -- that's sending as clear a signal as we can send that we are committed to pulling every policy and payment lever to make sure people have an incentive to share information and not hoard information. That's action; that's probably one of the most significant things we can do that's not regulation. We could say, even on governance, we're going to put out there what we believe is right. A lot of the private-public governance entities are looking to us to provide that guidance and clarity. We will do that, it's just not going to be in the form of regulation. We heard it would be helpful if you recognized one or more of these private-public entities so people would know ONC is a part of this one, so we put out a funding opportunity. So there's a lot that we can do. Really sometimes letting other people help is the most important thing you can do. We're seeing the industry is stepping up in part because the market is demanding interoperability.

You've also spoken about how vendors need to get it together and get on board with interoperability and standards. Is the CommonWellinitiative that was announced at HIMSS what you had in mind?

Mostashari: I think overall, if you pull back and look at the big picture, the mass movement of the industry is toward stepping up and saying, "Pretending that we can have a business case that locks people into our proprietary interfaces ain't going to work. And for us to succeed as an individual, we need to be able to talk to other vendors." We're seeing this in every vendor strategic plan and statement and action.

The specifics of CommonWell are interesting because it is the first time I've seen a number of vendors come together and say we want to have an open platform for information sharing. But the specifics have not been entirely clear to me. Yesterday at the Health IT Policy Committee meeting I asked the policy committee to delve into it a little bit and report back.

Do you think it's significant that Epic was not included in the announcement?

Mostashari: I think it is very tempting to write this story about the conflict. Is it this vendor versus that vendor, and what does it mean? But I don't think that's the story here.

Members of the HIT Policy Committee are increasingly talking about stage 4 meaningful use in their meetings. What's the talk that you hear around that?

Mostashari: I think we should recognize that meaningful use is going to continue to evolve, but let's not get ahead of ourselves here. Let's focus on getting stage 2 successful, and we're not going to do rulemaking on stage 3 in 2013. Stage 4 -- let's not get ahead of ourselves.

Who is behind the Twitter account, Farzad's Bowtie?

Mostashari: Well it's not me, that's for sure. I think we need some investigative reporting on that matter. They didn't ask me for permission, either.

Let us know what you think about the story; email Ed Burns, news writer, or contact @EdBurnsTT on Twitter.

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