Mostashari: 'Usability,' better decision-making, key EHR success

"The goal is clear...there should be a greater emphasis on usability" for EHRs, Mostashari tells FierceHealthIT.
The Office of the National Coordinator of Health IT (ONC) must balance the competing concerns of a wide range of stakeholder groups, including patients, providers, health plans, vendors and government agencies. Because of the pervasive effects of health IT and Meaningful Use on these stakeholders, some of them regard government regulations as heavy-handed and excessive. Newly appointed National Coordinator of Health IT Farzad Mostashari, MD, however, is committed to keeping the government's role in check.

In a recent interview with FierceHealthIT, I asked Mostashari how ONC will work with the National Institute of Standards and Technology (NIST) to develop usability standards for electronic health records, and whether that might lead to certification of EHRs for usability.

"The goal is clear...there should be a greater emphasis on usability, a better science around how to measure usability, and an improved ability of providers to use usability in their purchasing decisions," Mostashari said. "So transparency is the goal here, not regulation, per se."

When pressed further, Mostashari deferred to the Health IT Policy Committee, a government advisory body that makes recommendations to ONC about meaningful use and the certification of EHRs.

"I'd be very surprised if the result of their process was something that said, 'If you score 71 [on a usability test], you have permission to market EHRs in this country, and if you score 70, you do not,'" he said. "I can't see that as what comes out of this policy process. Our goal is for vendors to have guidance in terms of what to focus on in improving the usability of products, and for providers to have more transparency [to aid them] in their selection of those products."

Mostashari has said that the achievement of meaningful use provides a pathway toward accountable care organizations and that the proposed ACO regulations on health IT are aligned with meaningful use requirements. Observers though, have noted that some of the ACO criteria go well beyond Stage 1 of meaningful use. For example, ACOs will have to be able to provide advanced decision support, and may also have to provide predictive modeling of patient health risks, as well as telemedicine and comparative benchmarking.

Asked if that means that ONC's expectations for ACOs with regard to adopting health IT are higher, Mostashari did not hesitate. "To be successful as a patient-centered medical home, an ACO or any sort of provider of seamless, accountable care, you need to have a very strong foundation in information technology," he said. "You have to be able to identify the patients who are most at risk for having an avoidable complication or admission, and you have to be able to reach out to them. And you have to be able to provide more adherence to protocols and best practices at the point of care.

"You have to make sure that information moves when the patient is being discharged or is referred from a primary care doctor to a specialist," Mostashari continued. "So there's no question that the ability to use data for better decision making--having the data be liquid in an electronic format, and having the ability to move and manipulate that information--those are key parts of both meaningful use and what you need to be successful as an ACO."

Today, large healthcare enterprises are taking the lead in building the kind of health information exchanges (HIEs) to which Mostashari alluded. Still, many of these organizations remain competitors that don't show much interest in cooperating with one another. So what's the federal government's role in ensuring that this cooperation takes place in state and regional HIEs?

In Mostashari's view, the spread of HIEs within healthcare systems and their medical staffs is a positive trend. "It's exactly what we want," he said. "It's fantastic that there's an emerging business case for improved care coordination and information exchange. Our guidance to our state HIE grantees and our state-designated entities and health IT coordinators is to foster those networks of information-sharing across affiliated providers."

However, Mostashari added , the government needs to ensure there isn't a "lock-in of data within the larger healthcare enterprise." He also pointed out that the ACO regulations contain language that would discourage ACOs from erecting barriers to hinder the ability of patients to get care elsewhere by limiting the flow of information outside the ACO.

"The government has a duty to protect the public," he said. "One of the aspects of that is to make sure their information can follow them wherever they go, whether that's inside or outside the network." - Ken