There's been a lot of press this past week about the resignation of National Coordinator for Health IT Farzad Mostashari--praise for his accomplishments, speculation regarding his replacement and concerns that the timing will adversely affect health IT progress. I'm struck, however, by the evident surprise in the industry of Mostashari's announcement after two years in the top job.
For one thing, he's following a pattern of previous leaders at the Office of the National Coordinator. His predecessor, David Blumenthal, stayed in the post for only two years; Robert Kolodner served as National Coordinator for nearly three years; and the very first head, David Brailer, held the job for slightly less than two years. Agency heads typically have moved in and out of these positions fairly quickly.
What's more, look what Mostashari has had to deal with in his two years as head of ONC. He's been in charge of one of the biggest game changers in the history of U.S. healthcare, spearheading the Meaningful Use program through untested waters, while facing a reluctant, sometimes hostile industry.
Think about what that entails. Mostashari has had to, among other things:
- Carry through on projects and programs he inherited from others
- Deal with a barrage of constant criticism from every corner
- Deal with the unintended consequences of EHR adoption (such as "right coding" and patient safety issues)
- Try to reconcile congressional mandates against the realities of technology (can EHRs adequately separate medical records that patients want to keep secret from their insurers, a new requirement of the HITECH Act?)
- Handle the aftermath of other agencies' proposals (can EHRs really create "access reports" as part of the HITECH Act's extension of the accounting for disclosures provision to EHRs?)
- Sit in the hearing hot seat and defend his work to Congress about programs created by, ahem, congress (even the Republicans themselves can't decide if they want to "freeze," "pause," or "reboot" the Meaningful Use program)
The list goes on and on.
Mostashari is leaving with his head held high and reputation intact, before he's so burnt out that he'd no longer be effective.
What I do find surprising--and inspiring--is the staying power of ONC's regular staff, whom Mostashari refers to as "my dear ONC'ers" in his resignation letter. These are mostly career government employees who, while they don't have to testify at congressional hearings, probably also feel the brunt of the criticism and the difficulty of their mission.
Mostashari told his staff in his resignation letter that "healthcare's best days are ahead of us," adding that, "[w]e have been pioneers in a new landscape."
"Your work gives us hope that we can still do big things as a country," he said.
Kudos to Mostashari for giving credit where credit is due--to these unnamed pioneers. No matter who will next fill his shoes, it's that staff that ultimately will be carrying the water buckets, tending the homesteads and tilling the field.
Mostashari concluded his letter by telling staffers that he'll be cheering them on after his departure. He won't be the only one. - Marla (@MarlaHirsch)