Intelligent use of data can fix a broken healthcare system, said Dr. Farzad Mostashari, national coordinator for health IT within the U.S. Office of the National Coordinator (ONC). Mostashari delivered the final keynote address of the Healthcare Information and Management Systems Society (HIMSS) meeting last week in New Orleans.
Electronic data acquisition has the power to make the invisible visible by collecting and analyzing information at a scale and speed impossible with a paper-based system. It replaces assumptions with facts, and facts allow intelligent workflows to be developed, inefficiencies to be corrected, and default standards with measurable outcomes to be established, according to Mostashari.
He described how fragmented data could fail to alert patients and healthcare providers about basic treatment that could greatly improve patient outcomes and cost savings due to preventive care. He cited a study of 24,000 patients with diabetes, in which only 7% of the patients received the right care in a timely manner. Mostashari also mentioned the serious and expensive complications his mother experienced by overlooking a warning to stop taking aspirin seven days before surgery.
Dr. Farzad Mostashari from the ONC discussed the power of data at HIMSS 2013. Image courtesy of HIMSS."When data and information make the invisible visible, we can do something about it," he said. "We can do quality improvement instead of retrospective accounting. Data is not enough; it's what you do with it."
But he also expressed frustration with the length of time it takes to publish research on healthcare IT.
"I'm sick of seeing results of studies that ended in 2009," he said. "We can't wait five years. Little data in a clinic can be as powerful as big data in a cloud."
Mostashari also stressed that establishing standards of care based on data analysis is critical to healthcare reform. He criticized clinicians who say that standards stifle innovation and represent cookie-cutter medicine. The Kaiser Permanente healthcare system uses team-based standards of care for patients who have heart failure, he pointed out. The 10-year survival rate of Kaiser's cardiac patients is 80%, compared with the national average of 10%.
When Marilyn Tavenner, acting administrator of the U.S. Centers for Medicare and Medicaid Services (CMS), says that CMS is committed to IT because without it, new payment and delivery models can't succeed, the healthcare system listens, Mostashari noted. To fix the system, payment rules make a big difference. Incentives matter, and healthcare providers shouldn't be asked to do extra work they aren't paid for.
"In a fee-for-service world, a lot of work that is being done isn't reimbursed -- yet," he said. "Fee for service isn't dead yet, but there are a lot of plans for its demise. We are now seeing from all points of view a recognition that we can't just keep paying for widgets, regardless of the necessity of them."
Defending meaningful use
The head of the ONC also used the keynote podium to address critics and defend what has and has not been accomplished by the meaningful use (MU) electronic health record (EHR) incentive program created by the American Recovery and Reinvestment Act of 2009.
The federal government's investment in this program, almost $12 billion as of February 2013, hasn't produced changes in outcomes yet, but that shouldn't be expected at this stage of implementation, according to Mostashari. Healthcare providers are either still installing systems or are building up stores of data in them, he said.
In 2010, only 5% of healthcare organizations had met the stage 1 MU requirement to adopt computerized physician order entry (CPOE). By 2011, this increased to 21%, and by 2012 it reached 50%. There were almost no electronic prescribers of medication in 2006, but by the end of 2012, there were more than 500,000, according to statistics he presented.
ONC perceives the exchange of information and interoperability as a big challenge for 2013. Only 24% of U.S. hospitals are electronically exchanging data.
"This is not where we want to be," he said. "Twenty-four percent is nothing to crow about, but it is triple what it was two years ago. I want to convey our policy intent. We are going to use every tool at our disposal -- payment, policy, technology regulation, and bully pulpit -- to get this to the top of the curve, rather than where it is at the bottom."
Mostashari also made a point of stating that both CMS and ONC intend to make sure it's more profitable for healthcare providers to share information than to hoard it.
"No one should make a profit holding patient data hostage," he said to extended audience applause.
He also told the audience that healthcare providers need to wake up to cyberthreats, and he emphasized that CMS and ONC would be "forward leaning" with respect to maintaining privacy and security of medical records.
To critics of the cost of the MU program, Mostashari said that its participants were earning the financial incentives they received.
"This is not a giveaway; they are earning it," he said. It's a culture change, he noted, driven in part by the professional ethos of doing the right thing.
It's also the result of hard work. "You know what scales? Hard work. Grit scales," he said.
