Health IT Czar on Making Meaningful Use 'Meaningful'

Editor's Note: In this installment of Medscape One-on-One, the outgoing National Coordinator for Health Information Technology, Farzad Mostashari, MD, talks with Medscape Editor-in-Chief Eric J. Topol, MD, about his accomplishments at the Department of Health and Human Services, offers advice to clinicians, and discusses his plans for the future.

Introduction

Dr. Topol: Hello, and welcome to Medscape One-on-One. I am Dr. Eric Topol, Editor-in-Chief of Medscape and Director of the Scripps Translational Science Institute. I am thrilled to be joined today by Dr. Farzad Mostashari, National Coordinator for Health Information Technology, aka the Health IT Czar at the US Department of Health and Human Services, aka HHS. Farzad, it is really great to have you here. Welcome.

Dr. Mostashari: Thanks. It's great to be here.

Looking Back: 4 Years at the ONC

Dr. Topol: This is a unique time because you have been at the Office of the National Coordinator (ONC) for 4 years, and for the past 2 years you have been the czar, but you recently have decided to move on.

Can you tell us a bit about your experience over the past 4 years in this remarkable organization?

Dr. Mostashari: I can start off by remembering back to June 2009. I was a week late joining the ONC because my mom had gone into the hospital for routine, elective knee replacement. She was at one of the best hospitals in the country, but what ensued was a series of complications -- vascular complications, infectious complications, cardiac complications. I remember being outside her room in the predawn hours. She was having runs of ventricular tachycardia on the monitors; all the alarms are going off. I am a physician and still I didn't feel like I could ask to see the chart.

Dr. Topol: There's something wrong with that.

Dr. Mostashari: Yes, there's something wrong with that. When I got the chart, I couldn't read the cardiology attending's name and I couldn't figure out how to reach that person. Neither could the nurse. When my mother left the hospital it turned out that there was a lot of follow-up that never happened, and she had to have emergency surgery a year later. A lot of this can be traced back to the lack of systems every step of the way. It is not that the doctors weren't amazing, the surgeons weren't skilled, the nurses weren't caring, the medical students weren't brilliant; everyone was trying their best, but the systems failed my mom. They fail too many people every day.

So, part of my passion and mission, and the reason why I have been doing what I have been doing the past 4 years, is to try to make that better. And the way that I feel I can contribute to that is by helping people have the tools they need to be able to change the system in a way that lets ordinary people do extraordinary things instead of taking extraordinary people and getting very ordinary results from it.

From Iran to New York City

Dr. Topol: Speaking of extraordinary, you have an amazing background. You came to Albany, New York, from Iran at age 14, and then you went to Harvard and got a master's degree in population science. Then you went to Yale Medical School and later spent 10 years in New York City at the New York City Department of Health and Mental Hygiene, as well as the CDC-funded NYC Center of Excellence in Public Health Informatics and an Agency for Healthcare Research and Quality-funded project focused on quality measurement at the point of care.

Dr. Mostashari: Yes. My career really has been about asking how we use data to make better decisions. I kind of think of it as if I started off thinking "10 to the 6th or 10 to the 7th": How are we going to make better decisions for 10 million people? Then I narrowed the scope a little bit and said, "How do we make better decisions for 10 to the 3rd and 10 to the 4th for a doctor's office?" And now what I am getting really interested in is 10 to the zero, if you remember your math there. I am sure you do -- it is 1.

Dr. Topol: The N of 1. We like that.

Dr. Mostashari: The N of 1. How do we make better decisions for an individual person using all of the information -- and information and visualization tools -- to understand human behavior? How do we bring all of that together to make better decisions [for the individual]?

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