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Tuesday, August 6, 2013

ONC Chief Dr. Mostashari calls it quits

One of my shots of Farzad at HIMSS13 in NOLA

From: Mostashari, Farzad (HHS/ONC)
Sent: Tuesday, August 06, 2013 10:23 AM
To: OS – ONC Feds

Subject: Announcement

My Dear ONC’ers,

On a pre-dawn morning in June 2009, I paced helplessly outside my Mom’s hospital room as alarms beeped and the monitor showed the most recent run of life-threatening heart arrhythmia. I had screwed up my courage to ask to see the paper chart, but I couldn’t even read the cardiology consult’s name. After her discharge it was also very difficult to get her records; she didn’t get needed follow-up and required emergency surgery. The complications, which weren’t supposed to happen, indecently increased the hospital’s revenue.

I joined ONC a week later. This office had a daunting task ahead of it. Working backwards from the outcomes we hoped to enable, we had to define ’Meaningful Use’ of electronic health records, establish a new certification program, endorse national standards, design and set up a slew of new grant programs to assist in health IT adoption, exchange, workforce, research, and privacy. There were 32 staff members.

You will remember the successive sprints ’ to recruit and establish the Regional Extension Centers and collaborate with newly appointed Health IT coordinators in every state. The ’Office of No Christmas’ moniker that we earned for yuletide rulemaking. Trudging 4 miles through the blizzard–to a hotel that still had power– for Beacon application reviews.

And then came an intense focus on implementation and integrity of our grant programs. Accelerating consensus around healthcare standards through an innovative new open source community paradigm in the Direct Project and its successor Standards and Interoperability Framework. Coordinating policy with our federal partners. Adding a new focus on consumer eHealth, and giving consumers access to their own data through the Blue Button. Creating a Health IT safety program.

We gradually assembled within ONC a microcosm of the diverse and passionate Health IT community itself. Implementers, doctors and nurses, software developers and project managers, privacy experts, proud standards geeks, patient advocates, public health workers, researchers and data analysts. And we added strength, integrity and resilience by recruiting a core of civil servants who are dedicated to lifelong public service.

You each brought to ONC your own personal commitments and your community’s perspectives, and we unified those divisions through our shared goals: A better health system– that truly knows and cares for all of its patients- through application of information and learning. You nurtured a culture of commitment to American innovation, and an essential optimism that healthcare’s best days are ahead of us.

Regional extension centers have assisted 140,000 providers- over 40% of all primary care providers in the country and over 80% of critical access hospitals- the largest medical technical assistance project in history. Nationwide, adoption of health records has tripled in doctor’s offices and increased five-fold or more in hospitals. Over half of prescriptions are now electronic. New functionalities essential for population health management are increasingly available and used. National standards and protocols for information exchange and interoperability are being implemented throughout the industry. Over the next 12 months we will see a great democratization of health information as individuals become empowered to download their own health information, and venture capital investment in new tools to help us manage our own health and healthcare are skyrocketing. Meanwhile, hospital readmissions are dropping, healthcare cost inflation is at historic lows, and the movement towards payment that rewards quality and value is gaining speed.

My mom has recovered now. Her hospital is working to implement new systems to provide accountable care. Her prescriptions and health records are electronic and can be shared across the state. Like 37 million other elderly Americans, we can access her medical history with her Medicare Blue Button records on her mobile phone.

There are formidable challenges still ahead for our community, and for ONC. But none more difficult than what we have already accomplished. In these difficult and challenging times, your work gives us hope that we can still do big things as a country. That government and the private sector working together can do what neither can do alone. We have been pioneers in a new landscape, but that landscape is one changed for ever, and for better.

It is difficult for me to announce that I am leaving. I don’t know what I will be doing after I leave public service, but be assured that I will be by your side as we continue to battle for healthcare transformation, cheering you on.

Best wishes to you all,


Aug 7th: Well, what are we to make of this? Resigning without a new gig in hand? If he is to be taken at his word, what does that say of the situation at ONC? Who of equivalent stature is around to succeed him and take in the increasing political anti- Health IT pushback? Who of such clinical and political cred would even want to?

Below, no mention of any of this today on the ONC blog site.

The Health IT press this morning is dripping with fulsome praise for Dr. Mostashari personally, and for the progress ONC has ostensibly made during his tenure, but little in the way of departure analysis above the fold just yet. The only thing I can find is in the Healthcare Informatics article linked here:
Upon the announcement by Health and Human Services Secretary Kathleen Sebelius on August 6 that Farzad Mostashari, M.D. was planning to leave his post as National Coordinator for Health Information Technology, Russell P. Branzell and George T. Hickman issued a joint statement regarding the departure, representing the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME), the nation’s CIO association. Branzell is president and CEO of CHIME, and Hickman, excecutive vice president and CIO of Albany (N.Y.) Medical Center, is CHIME’s  board chair.

“Through Dr. Farzad Mostashari’s leadership, we saw the Office of the National Coordinator lead our nation’s providers through the first gates of measured, meaningful use of electronic health records, and address in reality those initial standards that make our health information portable across the U.S. healthcare system,” the statement said.

“Any CIO will tell you that implementing technology in the face of cultural resistance and process redesign is a monumental challenge,” Branzell and Hickman continued. “ONC’s task was to help guide such implementations in over 5,000 hospital settings and with nearly 400,000 physicians and clinicians.  Today’s health delivery system is fundamentally different than it was five years ago when HITECH was passed, but it’s not because Congress simply passed a law.  It’s because ONC and CMS, in partnership with the private sector, designed an implementation strategy that tried to align various stakeholders and make the spirit of HITECH a reality.”

And, they concluded, “CHIME appreciates the partnership forged under Dr. Mostashari’s tenure and his commitment in furthering the development of widespread health IT adoption. We wish him continued success in his future endeavors...”
[Russell P. Branzell]
Why do you think Dr. Mostashari is leaving right now?

He told me that he thought this was the time for him; he’s been there since 2009, and he just thought this was a logical and appropriate time for him to transition. And I’ll tell you, we’re very appreciative of everything he’s done. One of things he’s done is to bring in the voice of the community—CIOs, physicians, and nurses—to be part of the process. And one of the things I asked him was what he’d like to see in his successor; because we’d like to see a CIO or physician or nurse, someone who’s worked with some of the requirements of Stage 2 meaningful use, placed into that office.

So you’re not necessary arguing for David Muntz or Judy Murphy [Judy Murphy, R.N., Deputy National Coordinator for Programs and Policy] to succeed Dr. Mostashari?

Oh, absolutely, either David or Judy could succeed him; both of them do have that provider-organization experience, and both would be logical and highly qualified candidates. Now whether or not they’re interested, is a different question. This is very highly stressful work. If either of them would throw their hat into the ring, we would be very strong supporters...


...As National Coordinator he brought energy, enthusiasm, and momentum to healthcare IT. He inspired, challenged, and influenced with informal authority, never a heavy hand. Hundreds of people volunteered to support his vision out of respect for his ideas and a sense that it was the right thing to do.

Some people seek fame and fortune. Some just want to make the world a better place. In all the years I've worked with Farzad, I've never sensed any self-interest. He has been mission driven.

Washington is a hard place to work. Some say that no one is your friend (except your dog). Hours are long, pay is poor, and travel is overwhelming. Burn out is hard to avoid when you've cleaned the Augean Stables and your only feedback is that you missed a spot...


Real beehive of up-to-date activity and information, that ONC HITRC (Health Information Technology Resource Center).

Nothing about Dr. Mostashari's departure. Nothing else much of recent dates, either, though.

More to come...

1 comment:

  1. Looks like a classic case of getting out while the getting is good.