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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