Mostashari to step down; health IT leaders hail ONC chief's efforts

Dr. Farzad Mostashari will step down this fall as head of the Office of the National Coordinator for Health Information Technology at HHS, where he's had a big hand in guiding federal health IT policy for the past four years, including the challenging rollout of meaningful-use rules for electronic health-record systems.

The announcement came in an e-mail to staff from HHS Secretary Kathleen Sebelius.

“During this time of great accomplishment, Farzad has been an important advisor to me and many of us across the department,” Sebelius said. “His expertise, enthusiasm and commitment to innovation and health IT will surely be missed. In the short term, he will continue to serve in this role while a search is underway for a replacement. Please join me in wishing Farzad all the best in his future endeavors.”

Mostashari, who has a background in public health, is the fourth ONC chief since the position was created by an executive order of President George W. Bush in April 2004. He has been with the ONC since July 2009, when he joined as deputy national coordinator after serving as New York City's assistant health commissioner in charge of a health IT extension program for 1,500 healthcare providers in underserved communities. He was named to the top job at ONC in April 2011, succeeding Dr. David Blumenthal.

“During his tenure, ONC has been at the forefront of designing and implementing a number of initiatives to promote the adoption of health IT among healthcare providers,” Sebelius said. “Farzad has seen through the successful design and implementation of ONC's HITECH programs, which provide health IT training and guidance to communities and providers; linked the meaningful use of electronic health records to population health goals; and laid a strong foundation for increasing the interoperability of health records—all while ensuring the ultimate focus remains on patients and their families. This critical work has not only brought about important improvements in the business of healthcare, but also has helped providers better coordinate care, which can improve patients' health while saving money at the same time.”

Mostashari confirmed an early report of the announcement on Twitter with a post, “It's true,” but declined otherwise to comment.

Under Mostashari's watch at the ONC, “meaningful use” became common parlance in the healthcare industry, referring to criteria for qualification in the federal electronic health record incentive-payment program under the American Recovery and Reinvestment Act of 2009. The program has thus far doled out $15.5 billion to hospitals, office-based physicians and other eligible professionals. More than 80% of hospitals and 58% of physicians and other professionals have received payments under the program for adopting, implementing, upgrading or meaningfully using a federally certified EHR system.

Reactions from Mostashari's peers in the physician informatics community combined gratitude and concern about the future of the federal HIT program.

“It's bad news,” said Dr. William Bria, president of the Association of Medical Directors of Information Systems, a professional association for physician informaticists. “It never would be a good time for Farzad to step down over the next 10 years.”

Each of Mostashari's three predecessors at ONC brought unique combinations of skills to the job, and Mostashari was no exception, according to Bria.

“He was a physician who translated the spirit of the profession into public health in one of the most challenging environments in the country,” Bria said. “He knew how to absorb the blows of furious colleagues and could smile and shake their hands and win them over with his good spirit and his good soul. You didn't believe he was trying to push you over as a government official. He knew that the outcome was worth the suffering. I think we owe him a tremendous debt of gratitude. It's going to be a hell of a job trying to find someone that good to replace him.”

“I think Farzad has done a very good job,” said Dr. Kevin Fickenscher, president and CEO of the American Medical Informatics Association. “He's taken us through this initial period of meaningful use, which has been controversial. There have been lots of discussions around the direction we were taking. I think Farzad has done a good job of listening and setting a sense of direction. Fifteen years ago, a lot of this was theory and ideas. The systems weren't at a point that we could affectively deploy them in the way we are today. He's taken it from sort of the bench to the application.”

Fickenscher said he's thankful that Mostashari is announcing his departure in advance, giving the ONC and the industry time for a smooth transition, which also occurred with previous ONC leaders.

“There are some big issues in front of us,” Fickenscher said. “We absolutely need to pursue effective interoperability. We need to pursue standards—not new standards but standards that we have—so that they're consistent across organizations. Another big issue is usability.”

“What a remarkable guy he's been in both his public health perspective and his tireless pursuit of patient and family engagement,” said Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center in Boston, who has served as vice-chairman of the federally Health Information Technology Standards Committee, which has reported to Mostashari throughout his tenure. “Working with Farzad has been an extraordinary experience. His contribution has certainly been vast. He will be missed.”

Like Halamka, Dr. Paul Tang, chief innovation and technology officer at the Palo Alto (Calif.) Medical Foundation, has worked with Mostashari at close quarters, serving as vice chairman of the federal HIT Policy Committee, which Mostashari chairs. Tang chairs the HIT Policy Committee's meaningful use workgroup. Both panels advise the ONC.

“Farzad has brought tremendous leadership, experience, and energy to this important position,” Tang said. “The accomplishments he led in the office and in partnership with CMS (which runs the EHR incentive payment program) during these past two years of HITECH implementation are setting up the needed information infrastructure that is so important for delivering patient-centered, coordinated, team-based care. We all owe him a debt of gratitude.”

In a March 4 video interview at the Healthcare Information and Management Systems Society convention in New Orleans, Mostashari was asked about his tenure.

“I'm going to keep doing what I'm doing, as long as I'm having fun, and I'm having a lot of fun,” Mostashari said.

Mostashari has not announced his plans after leaving ONC service.

Follow Joseph Conn on Twitter: @MHJConn