Support of incremental change and improvement is one of the guiding principles of the federal effort to promote the use of health information technology, a top federal IT official said at a tech conference in Washington on Tuesday.
But Farzad Mostashari, senior adviser for policy and programs with the Office of the National Coordinator for Health Information Technology at HHS, said during his keynote speech to open the Government Health IT 2010 Conference & Exhibition that he was looking for “bold incrementalism.”
The day-and-a-half conference is sponsored by the Chicago-based Healthcare Information and Management Systems Society as part of its National Health IT Week activities.
“A lot of what we do can be thought of in that vein,” said Mostashari, a physician who as assistant commissioner of the New York City Department of Health and Mental Hygiene headed a task force to bring health IT to the city's primary-care physicians.
An example, Mostashari said, is ONC's dual approach to health information exchange. The ONC still maintains its commitment to a proposed national health information network based on the “query-and-response health information exchange model,” Mostashari said. And yet, federal officials realized many providers won't be ready in time to use such a full-bodied exchange to qualify for Medicare and Medicaid IT subsidy payments under the American Recovery and Reinvestment Act of 2009, also known as the stimulus law. So, ONC developed NHIN Direct, a lighter-weight exchange platform.
“There can't be one-size-fits-all for information exchange,” he said. “We've recognized we need to use the market, using what's already happening and improve it.”
Another potential example of bold incrementalism, Mostashari said, would be the expanded use of metadata, whereby providers would “tag” medical records to add information about records' clinical contexts.
In an interview after his speech, Mostashari said he thought it might be feasible to use metadata tagging, as some privacy advocates have suggested, to track patient data as it moves from healthcare providers through multiple layers of business associates. Under federal law, patient consent is required in the movement of medical records of individuals who have received care from federally funded substance-abuse and mental-health treatment programs. Again, Mostashari suggested, an incremental approach to that use might be best.
“These are thorny issues, but important issues, and we're working to address them,” he said. “I think mental health is a good place to start.”