Harnessing the Power of Health IT

Farzad Mostashari is a health IT scholar at the Brookings Institution. November 2013.  
National Journal
Clara Ritger
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Clara Ritger
Nov. 6, 2013, 3:28 p.m.

It was early in Far­z­ad Mo­stashari’s pub­lic-health ca­reer when he real­ized the power of health-in­form­a­tion tech­no­logy. He went to a Medi­caid prac­tice in New York City and asked the doc­tor how many flu shots she ad­min­istered that sea­son. She es­tim­ated 80 per­cent of her pa­tients re­ceived the vac­cine. When they re­viewed the re­cords, only 22 per­cent had been vac­cin­ated.

“That was the ‘aha!’ mo­ment,” Mo­stashari said. “I began to see the pos­sib­il­it­ies “¦ how we can use the routine data that gets col­lec­ted in the pro­cess of de­liv­er­ing care to im­prove the health of pop­u­la­tions.”

Mo­stashari joined the Brook­ings In­sti­tu­tion last month, leav­ing his post as na­tion­al co­ordin­at­or for health IT at the Health and Hu­man Ser­vices De­part­ment. Now a vis­it­ing fel­low at the En­gel­berg Cen­ter for Health Care Re­form at Brook­ings, he plans to fo­cus on trans­form­ing small prac­tices by in­tro­du­cing health IT and im­prov­ing over­all pop­u­la­tion health.

“It may be the most ex­cit­ing thing that’s happened in health care in the last 50 years,” Mo­stashari said, “the idea that the doc­tors and hos­pit­als have an in­cent­ive to keep you healthy, and they can make more money if they keep you healthy.”

The idea of a health care sys­tem fo­cus­ing on the healthy as much as the sick has been on his mind for a long time, he said. Mo­stashari began his ca­reer at the Cen­ters for Dis­ease Con­trol and Pre­ven­tion as a fel­low with the Epi­dem­ic In­tel­li­gence Ser­vice and saw how small data — Su­dafed sales at loc­al phar­ma­cies, for in­stance — could in­dic­ate the ex­tent of ill­ness with­in a com­munity.

But with data col­lec­tion come con­cerns about se­cur­ity in a di­git­al age, es­pe­cially giv­en the on­go­ing pri­vacy de­bate fueled by the Na­tion­al Se­cur­ity Agency’s col­lec­tion of phone re­cords. Mo­stashari said it has al­ways been a primary con­cern in his work.

“Don’t col­lect the in­form­a­tion in the first place if you don’t have to,” he said. “Get the min­im­um data ne­ces­sary to do the job, study the pat­terns, and be trans­par­ent about what you are col­lect­ing.”

He worked in New York City from 1998 to 2009, where he wit­nessed the im­pact of 9/11 and in­vest­ig­ated the an­thrax let­ter at­tacks that fol­lowed.

“Our of­fices were down­town,” Mo­stashari said. “I came out of the Cham­bers World Trade Cen­ter sub­way stop at 9:04 that morn­ing. We were all af­fected “¦ by our friends, fire­fight­ers, the whole down­town area which was covered in the white powder, and people com­ing in­to the health de­part­ment for shel­ter while we’re try­ing to fig­ure out, is this the be­gin­ning of “¦ well, we were very con­cerned about bi­o­ter­ror­ism at­tacks be­ing linked to this hor­rible event. And then, ex­actly, it ap­peared like we had feared — the an­thrax let­ter at­tacks came the fol­low­ing month.”

His role as one of the lead in­vest­ig­at­ors of the at­tacks fueled his in­terest in real-time track­ing of pub­lic-health prob­lems and promp­ted him to help es­tab­lish the In­ter­na­tion­al So­ci­ety for Dis­ease Sur­veil­lance, serving as its first chair.

In 2009, after years of work­ing at the New York City Health De­part­ment, Mo­stashari moved with his wife and three kids to Wash­ing­ton, where he as­sumed his po­s­i­tion with HHS.

“It felt, and it feels, like a once-in-a-life­time op­por­tun­ity to do something big,” Mo­stashari said of his work at HHS to bring health care in­to the di­git­al age. “We talk about big things we do in this coun­try, like build­ing a high­way sys­tem, mo­bil­iz­ing for war ef­forts, and Medi­care, and this, I think, is up there.”

In 2009, only 9 per­cent of hos­pit­als had ba­sic elec­tron­ic health re­cords, Mo­stashari said, but he es­tim­ates in 2013 the num­bers will show 60 per­cent or more.

With that ex­pan­sion well un­der­way, Mo­stashari has turned his fo­cus to re­im­burse­ment sys­tems in health care and to ac­count­able-care or­gan­iz­a­tions — groups of pro­viders that co­ordin­ate ser­vices to max­im­ize be­ne­fits to the pa­tient. It’s fig­ur­ing out the in­cent­ives for primary-care doc­tors to provide pre­vent­ive health care that is the trick to re­du­cing over­all health spend­ing, Mo­stashari said.

Al­though he left HHS to be­gin the work on the health sec­tor’s pay­ment struc­ture, he also left for per­son­al reas­ons.

“It’s an in­tense job and be­ing there for four years takes its toll,” he said. “I say, I listen to my heart when it said it’s time to go, and that hap­pens to be my wife.”

Dur­ing the job trans­ition Mo­stashari has main­tained his trade­mark look that star­ted when he bought a box of bow ties at a yard sale in Brook­lyn, N.Y. He still wears them — @Far­z­ads­Bowtie is even a re­gistered Twit­ter ac­count — al­though the fash­ion state­ment star­ted be­cause he didn’t want a tie to get con­tam­in­ated if it got in a pa­tient’s face or dragged on hos­pit­al sur­faces.

“I think bow ties are mak­ing a comeback now,” he said.

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