Mostashari: Paper records are great ... if you're Harry Potter

Health IT coordinator talks to CHIME members about accountable care, national patient identifiers, EMR certification and more
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Farzad Mostashari, M.D., always speaks with enthusiasm about health IT, and his address yesterday afternoon to members of the College of Healthcare Information Management Executives was no exception. Peppered with references to Harry Potter and magical thinking, the National Coordinator for Health IT covered topics ranging from patient safety to accountable care to national patient identifiers.

Here are some of the highlights from his speech, delivered at CHIME's Fall CIO forum in Indian Wells, Calif.:

On the drive for better healthcare at lower cost

"I'm optimistic. I think we're going to do it by tapping into innovation. We're going to create disruptive innovation … evolutionary innovation. And we're going to do it through the one thing known to create reliably faster, better and cheaper [healthcare], which is technology," he said. "The idea that we would bring the same brilliance, the same power, that has transformed everything else and bring that to healthcare."

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"Data. Wow! I love data."
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Technology is just a tool, he said, but what a tool it is, he added. "Data," he said. "Wow! I Love data."

On paper records

Once you close a paper file it's dead. "You can't use it for anything. You can't move it, you can't learn from it," Mostashari said.

"In a Muggle world, the world we live in, the provider can't go into the room of paper charts and flourish their wand and say 'All the patients with diabetes!' and the charts fly out and hover in the air. 'All those who didn't come back to see me, over here!' Send in an owl. We can't do that on paper. But that is the essence of population health management."

On chronic disease management

"We already know that if you can control somebody's blood pressure, they're much less likely to have a stroke. We have medicines that work. Statins work for lipid-lowering." But current systems only ensure that happens about half the time, he said.

"You add up those faulty processes and you get to a point where a patient with diabetes has a 7 percent chance in a paper-based world of having the five no-brainer things they need to have done. They need to have their sugar checked or their lipids checked or a pneumonia shot. No doctor said 'Oh, in my incredible diagnostic wisdom, this patient with diabetes doesn't need a pneumonia shot.' No, they forgot. They don't have a system."

The lack of systems, incentives and information is killing people today, he said.

On accountable care organizations

How is accountable care different than managed care efforts of 20 years ago? ACOs must not only control costs but also improve quality. And because an ACO cannot control where a patient gets care, they must do so over networks that include their competitors. And they have to engage patients so that they continue to use the ACOs services.

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"Meaningful use is a tool. You can do it, check the box and get the check. That will have been an inept use of that tool."
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So what makes ACO pilot leaders think they can succeed? "We have tools we didn't dream of 20 years ago. That's what we've got going for us," Mostashari said. "We've got to get the most juice out of every tool we have--every resource we have."

On Meaningful Use

"Meaningful use is a tool. You can do it, check the box and get the check. That will have been an inept use of that tool. I'm sorry. It will have been a tremendous waste of your time and your staff's time and the clinician's time if you don't use it as a tool to get to what you need to get to, which is population health management, information exchange and patient engagement," he said.

On EMR certification

Vendors do want standards, Mostashari said. But there's still a lot of work to do to ensure that when a product is certified to do something that it actually does it. "This is where making it meaningful, the circle widens. It's not just the hospitals, the docs who have an opportunity to make it meaningful … but also the vendors," he said. "Make the certification meaningful. Don't just take the shortest route to certification."

Providers have to help improve the certification process and speak up when a product is not interoperable, for example, he added.

On national patient identifiers

In response to a question from the audience--when will we have a mandated national medical record?--Mostashari posed a question of his own.

"So let me ask you guys a question. The problem we're trying to solve is patient management. It's a safety issue, a quality issue--making sure we have the right patient. Have our patient matching problems gone away for all of our elderly patients on Medicare? They all have a number. It's the same number. It's a national number," he said.

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"Let's make progress on what we can make progress on today."
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There's "a little bit of magical thinking" around the idea of creating a national patient ID for people under 65, too and that by doing so "poof--all of our patient matching problems will go away," he said. The quality and completeness of the attributes and consistency of matching information is a bigger priority.  

"Let's make progress on what we can make progress on today and not pin our hopes on a distant future when Congress will somehow authorize a universal patient ID," he said.

On what will happen to healthcare reform if Mitt Romney wins the Presidential election

"That's above my pay grade," he said with a laugh. "You have any more questions about the national patient ID?"