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SCOTTSDALE, Ariz. -- During Farzad Mostashari, M.D.'s last hours as a government employee he got a taste of what his first days as a civilian would be like.
"I was in the office in D.C. on Friday, cleaning things out, and leaving little notes for whoever the next national coordinator would be," said the former National Coordinator for Health IT. But something was holding him back and preventing him from leaving: "There was no one to turn in my badge to."
The awkwardness of the federal shutdown notwithstanding, Mostashari left office feeling pretty good about having served the effort to transform health information technology for the past four plus years.
Speaking for the first time since leaving the ONC in front of several hundred healthcare CIOs at the CHIME13 Fall CIO Forum in Scottsdale, Ariz., Mostashari said that "despite all of the difficulty of working within the government, I wouldn't have exchanged it for anything. It's really an unusual honor to be able to work on behalf of a nation as diverse, as varied, as creative, and as large as ours. All of us serve in one way or another, in whatever way we can serve. And sometimes the more immediate your service is, the more you see the lives you touch. But when you are able to serve, and to feel however small that you were part of a movement, it's a very special thing and I'll cherish that for the rest of my life."
Our certification process is furloughed right now. The ONC standards work has stopped. The policy work has stopped.
Former National Coordinator for Health IT Farzad Mostashari, M.D.
Good feelings aside, Mostashari, whose next role is as visiting fellow at the Brookings Institution's Engelberg Center for Healthcare Reform, presented the audience with some frank assessments of the state of the process of transformation, meaningful use and the government shutdown.
"Technology provides the opportunity to change the slope, not just incremental progress, but change the slope, so that's pretty cool to be in a position where we can do that," he said. "But we've been shackled. Trying to change a system like healthcare is really hard, and when there are forces that mitigate against the change in so many different ways that are keeping the status quo in place, it becomes nearly impossible."
Many of his "worries and concerns," not surprisingly, focus not on the technology involved in healthcare transformation, but on the people and practices that run healthcare. He used that issue as a challenge to the CIOs in the audience.
"We can talk about population health management all day long. We can even buy population health management software, but flipping the practice, flipping the hospital … that's a cultural challenge. That's not an IT challenge. That's a business practice challenge," he said. "One thing you all have going for you is that a being CIO is as much about change management and governance as it is about electrons."
Mostashari was asked by Russell Branzell, President and CEO of the College of Healthcare Information Management Executives (CHIME), to comment on the proposed delay of meaningful use stage two deadlines, regarding which CHIME issued a public statement of support last month. The delay, Mostashari said, isn't a bad idea, but wouldn't work, for several reasons.
"There's no legal way to change a final rule without doing a pretty long process; it takes about nine to 12 months of proposing the new rule," he said. "It would be total chaos because no one would know what the final rule is going to be."
Also, all of the work toward interoperability would be interrupted. "We can't wait for interoperability. It's past time. We have a whole series of really, really important standards, that we got consensus from everyone, we put them in the final rule, everyone has had plenty of warning, and we need everyone to step up to those standards," he said. "So one of the policymakers' concerns is going to be, if we delay this what's going to be the impact on the number one job we have to do now. I think folks should assume that the timelines stick."
Mostashari saved his strongest rant of the night on the state of the government and the size of the budget the ONC has to manage healthcare transformation.
"Can I talk about ONC's budget?" he interjected. "Maybe you've noticed, but there's no updates to the certified health IT product list happening. Our certification process is furloughed right now. The ONC standards work has stopped. The policy work has stopped. Not having a budget, people don't see it. There's so much other work of government that people don't see, and you only see when failures occur. And then you are like, so where's the government?"
"The budgets are not only capped, they're frozen. It's like having a household budget for diapers and your kid is in grade school now but you still have to have a diaper budget and you can't have a school book budget," he went on.
"Year after year the ONC budget has been $60 million, $60 million. That's the entire ONC budget to do all of the standards work, all of the coordination work, the certification work, all of it. And the thought of a $3 trillion healthcare industry, a $30 billion health IT industry, and you can't get funding for the government agency that's responsible for that, is really problematic. I guess I would say, because I'm no longer with the government and I can be pretty blunt about this. This really is a partnership now between the government and the private sector and I really worry about this continuing budget by crisis. It's no way to run a railroad."
Earlier in the day CHIME announced that Mostashari’s replacement, Acting National Coordinator for Health IT Jacob Reider M.D., would not be appearing due to the government shutdown. The irony was not lost on anyone in attendance.