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,

Farzad

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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...

BLOOMBERG TAKES A SWIPE

BUT, THEN...

www.healthcareitnews.com

...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...

SILENCE ON THE HITRC

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.
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More to come...

#HIMSS14 Day Four

Farzad's successor as ONC National Coordinator is the right person at the right place at the right time for Health IT, in my view. I wish her every success. The challenges are myriad and complex. She seems to have a good fix on them.

Maybe I should add this pic to my Facebook album "My Women." :)

I'm sure my largely rhetorical question is a non-starter, but I had to air it anyway, like I did repeatedly (exasperatingly) to Farzad. Were Congress to newly appropriate half of the initial REC grant expenditure to fund the 62 RECs through Stage 2, it would work out to about $65 per month per EP, based on the latest MU enrollment numbers. Commercial HIT consultants are will cost you $100 per hour at best (which is why the Privateers hated the REC initiative right out of the chute, particularly the vendor-neutral RECs like mine). It irks the crap out of me that HHS will let this hard-won new resource just fade away -- all the Happy Face talk about "no-cost extensions" and "sustainability" notwithstanding.

Federal Ag Extension Centers are now 100 years old since they were legislated into being. Given that the HIT effort will likely be 10 years in bearing visible Triple Aim outcomes and financial fruit, you would think that the feds would take a longer view. Maybe not a century, but, jeez, how about six years?

But, No.o.o.oo.OOOOh...

Having retired from the REC, I have no dawg in this fight, but, still, when I see ONC trying to spin how effective they've been for MU, it just begs a compelling question.

I'm in your corners, RECs. I lament that the REC "trade association" never got the first bit of traction.

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FINAL DAY PHOTO RAMBLE

Above, the tear-down continues apace.

Above and below, 7:20 a.m.; the final day early morning is always so ghostly quiet.

Above and below, 15 minutes out from closing Keyotes. Nothing like Hillary Day.

Above: these computer-controlled stage lights always remind me of the
egg pods in "Alien," lol.

CMS Administrator Marilyn Tavenner

Above and below, the HIMSS14 Press Availability. Dr. DeSalvo was gracious with her time.
I really appreciate her taking my question, my not being a "real" reporter.
I had to muscle my way in to get to ask it. The press would have kept at her for another hour,
her people had to finally insistently extract her from the room.

Below, final session, on the RECs. There were maybe three dozen people attending,
including my former HealthInsight colleague Wyatt Packer.

Another fine conference.

CODA

Brian Ahier's interview with Dr. DeSalvo.

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More to come...

Meaningful Use to become a "political football"?

From Government Health IT's

"5 nagging questions about meaningful use Stage 2"

3. Will MU become just another political football? Hatch and company being Republicans and the Obama administration being decidedly not, some observers are afraid that meaningful use may end up impeded by the gridlock that seems to define so many other debates in the nation’s capital these days. And yet the gridlock, one could say, only reflects the fact that there are no easy answers concerning how to move forward. “If the existing meaningful use deadlines and eventual outcome milestones get extended, critics of the Obama administration get to point to yet more healthcare dollars spent on Obama's watch with too little to show for it,” one observer noted. “If Meaningful Use doesn't get extended, hasty implementations could lead to a series of embarrassing headlines and, in a worst-case scenario, HIT-triggered preventable patient deaths.”

Well... got me reaching again for Photoshop.

Again, given the angry political fixation on "ObamaCare" (now in full throat at many congressional recess Town Halls), I'm just not seeing much significant headway across the next year or two for the anti-HIT crowd. There will, of course, be smoke (e.g., the rapidly molding "REBOOT" and its progeny), but no fire. NERF football, this is, IMO. If that. Maybe badminton would be a more pithy metaphor.

That's not to argue that there are no glaring problems with HITECH.
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FARZARD EXIT WATCH

Mostashari's departure creates concern among mHealth advocates
Eric Wicklund - Editor, mHealthNews

The impending departure of Farzad Mostashari, MD, the nation's National Coordinator for Health IT, caught everyone by surprise – none more so than mHealth advocates.

Mostashari announced on Tuesday, August 6, that he will leave the ONC this fall after four years in the office and two as its leader. His departure comes at a time when the ONC is in the midst of a study of the nation's healthcare IT system, a crucial issue facing the mHealth industry as it awaits federal direction on the regulation of mobile medical apps.

"A leadership change at ONC will come at an awkward time for the timely completion of the FDASIA 618 committee work and sorting out the confusion over the regulation of mobile health and clinical decision support software," said Robert McCray, president and CEO of the San Diego-based Wireless Life Sciences Alliance.  "For the sake of consumers and patients we urge (Health and Human Services Secretary Kathleen Sebelius) to quickly identify a knowledgeable replacement with consensus-building skills and a desire to unleash the power of technology in healthcare, including self care."

The FDASIA 618 committee was created by the Food and Drug Administration Safety Innovation Act of 2012 and charged with reviewing the nation's HIT regulatory framework. The committee's study is expected sometime this fall, at which time the HHS will work with the ONC, FDA and Federal Communications Commission to draft a report for Congress that outlines a proposed strategy for regulating health IT, including mobile technology.

mHealth advocates say Mostashari's departure will create transition issues in the ONC that may affect its participation in the FDASIA study. In addition, it comes as another regulatory agency, the FCC, searches for a new leader to replace the departed Julius Genachowsky...

Mobile portends to be a huge component of Health IT going forward, one rife with special problems. We will need competent and steady hands at the helm here.
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ONC MEANINGFUL USE PROGRESS INFOGRAPHIC

Interesting.

But, looking ahead...

As if the turbulence of July 2013 on healthcare IT wasn't bad enough, last week things got arguably worse.

First, Farzad Mostashari, director of the Office of the National Coordinator (ONC) for Health IT at the Department of Health and Human Services, announced he is resigning, staying on just long enough for a replacement to be found.

Then, one of ONC's major projects of 2013, a strategy by CMS and ONC to promote interoperability in an industry that desperately needs it, made its underwhelming debut, overshadowed as it was by Mostashari's resignation, which hit during the same 24-hour news cycle.

How underwhelming was the ONC/CMS plan, itself a response to comments on an earlier request for information? Highlights of the initiative related to health information exchange tell the story:

• Accelerating Interoperability and Electronic HIE through Payment Models Require electronic HIE in all advanced payment models and Medicaid waivers
• Extend Center for Medicare & Medicaid Innovation (CMMI) efforts
• Include Long-term care and post-acute care (LTPAC) and Behavioral Health (BH) in State Innovation Models (SIM) grants
• Direct incentives for LTPAC and BH providers
• Explore additional reimbursement codes for care coordination via telehealth, e-visits, radiology queries, and Evaluation & Management
• Require electronic HIE standards as regulatory requirements for quality measurement and conditions of participation
• Extend Regional Extension Center (REC) support
• Extend Stark and Anti-kickback exceptions for donations of EHR software

The RECs are doing fine work, and it's all well and good for CMS and ONC to want to extend support for their work in the hopes of moving health IT interoperability forward and provide necessary training, but that will require Congress to act to extend that funding...

There will be no more REC funding. Period, IMO. I have opined at length across prior posts on the short-sightedness of this (and I no longer have no personal dog in that fight, having retired from my REC), but Congress is not going to appropriate any more REC money.

Scott continues, to conclude:

...the dog days of summer 2013, a good time for healthcare CIOs to take a break if they can, if they believe that things will turn around when they return in September. Meanwhile, I do wish ONC and HHS leadership all the luck in the world. Losing Mostashari now is the last thing they need.

ARCH-IT UPDATE

One of the more notable failures of the short-lived REC era. If they're doing anything of substance (or anything at all) in the Beltway on behalf of the ONC Regional Extension Centers, it must be a closely held secret.

The 10 RECs (out of 62) who bought into this scheme seem to have gotten played. Probably with taxpayer money.

UPDATE

"2014 brings a perfect storm of regulatory compliance issues for family physicians that, we fear, may derail health information technology (IT) adoption and substantially interfere with our shared progress toward achieving better care for patients, better health for communities and lower costs through improvements to the health care system."

- AAFP Board Chair Glen Stream, M.D., M.B.I., AAFP Proposes Revised Meaningful Use Stage Two Compliance Timeline

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OOPS


apropos of my August 4th post:

From Salon.com
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More to come...

Attestation money thus far

From an ONC / CMS "Meaningful Use Acceleration" webinar call.

Through Feb 29th, 2012, actually. I don't think I'd have used that particular graphic. The "HITstone Pipeline"? The 2012 GOP campaign attack ad lines just write themselves.

But, that $4.3 billion is roughly equivalent to 13 days of DoD in Afghanistan. And, the entire 4-year national REC Technical Assistance funding is TWO DAYS worth of Afghanistan action.

Be nice if they'd give the RECs another two days' worth (and make REC engagement mandatory). ONC keeps puffing up our Good Works (Farzad enthusiastically shouted out during a recent national call "REC People, my People!"). But, the REC funding reality is "Stage One And Done." Stage Two doesn't even now ensue until 2014, and providers who make it that far will be in the decreasing outer years of MU reimbursements, and you can bet that vendors are gonna charge them for upgrades.

So, where will EPs find the money to pay unsubsidized market rates for REC technical assistance, at a time when MU Incentive payments will be declining and care reimbursement rates may well be doing significantly likewise?

UPDATE

From another ONC web conference call slide:

What can I say? Seriously?
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ON EXTENDING THE LIFE OF THE RECS

via John Pulley at ModernHealthcare.com

It's a little-known fact, but the health information technology regional extension program was really my idea. 

I'm from Indiana, where we do corn and beans right. One reason is Purdue University, which runs our cooperative extension service. Purdue has helped farmers introduce new technology, best practices and workflow improvements for more than a century. Now, it's doing the same for healthcare providers, running Indiana's health IT extension service...

...Representatives from about half of the RECs met in St. Louis last week to discuss the program's future, Kendall said. Under the stimulus law, federal money for the program dries up in just four years. 

I asked Kendall whether HHS intends to ask Congress for ongoing funding of the REC program, since its model, the cooperative extension service, receives annual appropriations ($475 million this year). He said such a request was beyond his "scope." But it's not beyond mine. So, here goes: 

To HHS Secretary Kathleen Sebelius and ONC Chief Dr. Farzad Mostashari:

There are more than 500,000 physicians in office-based practice in the U.S. And there are many thousands of dentists, federally qualified health centers, critical-access hospitals, nursing homes and home health programs that also need trusted information brokers and experienced educators to help them install EHRs, connect to each other, link to health information exchange organizations, and gather, share and adopt best practices. This is all extension work.

You should put together the success story of the health IT extension program and take it to Congress. Tell its members the country needs this program and should fund it going forward.

Sincerely,

Joseph Conn, former extension agent

Indeed.

Relatedly, in the "Meaningful Use" news, from iHealthBeat.org:

Friday, April 06, 2012
MedPAC Raises Concern About Meaningful Use Attestation

During a meeting in Washington, D.C., on Thursday, several Medicare Payment Advisory Commission members raised concerns about the small number of eligible professionals and hospitals that have successfully attested to the Medicare portion of the meaningful use program, AHA News reports (AHA News, 4/5).

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments.

MedPAC Data

Commission members noted that health care provider participation in the meaningful use program is lower than the federal government projected...

Comments

Some hospital and physician advocates cited high EHR adoption costs and overly burdensome program requirements as reasons for the low adoption rates (Daly, Modern Healthcare, 4/6).

MedPAC members indicated an interest in monitoring the meaningful use program to determine if EHR adoption reduces costs and boosts efficiency (AHA News, 4/5).

That latter "ROI" thing remains a vigorous topic of contention -- in addition to "improving patient safety and patient and population health," which also remain in hot dispute. Many critics decry what they see as technology significantly adverse to productivity and ROI in the aggregate and inimical to patient safety and health.

It is the job of REC Technical Assistance staffs to help clinicians overcome and negate those concerns. 

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More to come...

Farzad's next chapter

Congratulations.

Monday morning Farzad gave me the nicest compliment I've ever had:

"I see all these comments on the blogs all the time with trolls bashing health IT, and you are often the only voice of reason, pushing back forcefully with facts and logic."

Wow. :)

'An EHR should not be a federally-subsidized “hardship”.'

AthenaHealth's Dan Haley writes at THCB

Pursuant to the American Recovery and Reinvestment Act of 2009 (the “stimulus”—remember that?), the federal government certified Electronic Health Records (EHRs) for “Meaningful Use,” thereby stamping a government seal of approval on scores of software products.

Across the country doctors quite reasonably assumed that seal carried some meaning, and resolved to spend significant money, time, and effort to both purchase and implement MU-certified EHRs—many of them for the first time—and then to make “Meaningful Use” of them (as defined by the government).

For their pains, the doctors who succeeded in meeting MU metrics received a federal subsidy check. At last report nearly $21 billion in such subsidies have been paid.

Unfortunately, the ROI on that significant federal investment has been mixed to say the least. High numbers of providers on cutting edge health IT platforms who participate in the MU program successfully attest and receive a check. But the overall attestation rate nationally is woefully low (fewer than half)...

Now the federal government is defining as a “hardship” the use of many of the very systems that the federal government subsidized in the first place. Oy. No wonder the Government Accountability Office (GAO) recently issued a report eviscerating the MU program...

Interesting. Haley's boss Jonathan Bush once said of the HITECH initiative during a HIMSS video interview "you're just gonna schtimulate a bunch of losers."

Some effects of the "schtimulus."

He also recommended that the RECs get "a quick bullet... No one will even notice. Nobody's home."

Yeah, he actually said that.

Another of athenahealth's anti-REC practices: they entice their clients to buy into E-Z "Proxy Attestations" done on their behalf by athena, which cuts the RECs out of their Milestone 3 payments otherwise due the REC when an athena-using REC client attests.

I'm loving Dan Haley's use of the hyperbolic phrase "eviscerating the MU program." I'm reading the GAO report at the moment. Not finding any bloody entrails thus far, just some legitimate criticisms of the CQMs, which I regard as to a great degree simply time-wasting "Quadrant Three" stuff.

Mr. Haley graciously replied to one of my comment questions.

Well, OK, so MU attestation is a direct proxy for quality of clinical outcomes and patient satisfaction? Seriously, dude? How about answering the question?

Well, this article seemed equal parts blog post and press release (by a major THCB patron?). While you indeed cannot argue that EHR vendors failing to make the Stage 2 cut on time should get a pass via their customers, it's just a tad disingenuous that a vendor whose CEO crassly bashed the MU program while benefiting from it massively now proposes that the feds step on the air hoses of his competition.

Orange is the new black? Jonathan Bush is the new Judy Faulkner?
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Another question I have with respect to the GAO report:

40% of the MU incentive payments have gone to the Medicaid side. What proportion of that is A/I/U "free money"? "A/I/U," recall, is "Adopt, Implement, or Upgrade." From the GAO report:

In addition to meeting program eligibility requirements, to receive incentive payments or avoid penalties, eligible providers must also satisfy reporting requirements by submitting information to CMS for the Medicare EHR program, to the states for the Medicaid EHR program, or to both. The reporting requirements generally incorporate the three statutory criteria for “meaningful use” established in HITECH—(1) demonstrate use of certified EHR technology in a meaningful manner; (2) demonstrate that certified EHR technology is connected in a manner that provides for the electronic exchange of health information; and (3) submit information on CQMs using certified EHR technology. To receive incentive payments from the Medicare EHR program, the information reported by providers must satisfy all three statutory criteria; that is, providers must “demonstrate meaningful use.” However, to receive incentive payments from the Medicaid EHR program in their first year of participation, providers need not satisfy the three statutory criteria. Instead, they must only report that they adopted, implemented, or upgraded to certified EHR technology [emphasis mine]. In subsequent years, though, they must demonstrate meaningful use to receive incentive payments.

Those incentive funds data may well be available, somewhere. It's alluded to tangentially in footnote 50:

Only a subset of providers that participated in the Medicaid EHR programs for 2011 and 2012 demonstrated meaningful use. For the Medicaid EHR program, providers are not required to demonstrate meaningful use for their first year of participation; they need only report that they adopted, implemented, or upgraded to EHRs. Of the providers that participated in the Medicaid EHR program in 2011, 27 percent of hospitals and less than 1 percent of professionals demonstrated meaningful use. Of the providers that participated in the Medicaid EHR program in 2012, 73 percent of hospitals and 29 percent of professionals demonstrated meaningful use.

I'd like to know to date (effectively through 2013) how many MU dollars went to A/I/U, prehaps stratified by EHR?

MARCH 14TH UPDATE

Great THCB comment by Dr. Rob:

...The real flaws rest not in the EMR products, or even the implementation of MU, but in the central task of health care in the US: to identify problems (diagnoses, ICD codes) and apply a procedure to them (CPT, E/M). EMR systems are not designed with doctors or patients as their main target audience for their data; it is for the government agencies and insurance companies this [sic] data is being collected. For physicians, the EMR products are often, therefore, not very usable for true clinical purposes.

This is a window into so much of what is wrong on a bigger scale, in that it shows how the patient has moved far from the center of care, and now is more of a commodity from which to get data and justify billing. Patient outcomes have little to do with this, a reality that most patients in the system realize pretty quickly.

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PROPS TO MAT KENDALL

Farzad sent me a direct tweet message asking that I give a shout-out ONC's Mat Kendall for his tireless REC efforts, especially regarding workforce and the rurals. Done.

Mr. Kendall is one tireless, extremely smart person who could be making serious Bank in the private sector. Dude is a walking encyclopaedia of Health IT knowledge.

UPDATE

Oh, now I understand the context of Farzard's request.

Champion of IT extension centers leaving HHS
By Joseph Conn

This month, someone you probably don't know, but who had a major impact on healthcare IT, will be leaving your employ. And as he leaves office, the major project he built is in danger of disappearing as well.

Mat Kendall steps down March 21 from the Office of the National Coordinator for Health Information Technology at HHS. There he has quietly headed the department that created a nationwide network of regional health IT extension centers known as RECs. The RECs are creatures of the American Recovery and Reinvestment Act.

Kendall has been ONC's director of the Office of Provider Adoption Support for 4½ years. Since their inception, the 62 RECs have been Kendall's babies.

The RECs have proven to be quite popular with Modern Healthcare readers, according to our latest health IT survey in which 71% of respondents indicated they wanted to see federal support for the REC program extended.

A key goal set for the RECs by the ONC was that they help 100,000 providers enroll in the ARRA's electronic health-record incentive payment program. Adding to the challenge, RECs would focus on smaller, primary-care physician practices and on smaller, rural clinics and critical-access hospitals, many of which were health IT neophytes before the RECs arrived.

To date, the RECs have worked with more than 150,000 providers. About 134,000 of them now have EHRs. Nearly 94,000 of them have achieved meaningful use...

Yeah. Continuing,

Dr. Farzad Mostashari, the former ONC chief and Kendall's one-time boss, in commenting on the Modern Healthcare survey results, said it would be “a great investment” for the feds to continue funding the RECs, adding, “We would be crazy to let this slip out of our hands.”

So far, though, federal funds on the RECs are running out and no one in either the executive or the legislative branch has made an effort to support them.

What have I been saying? Arguing for? Recall what I wrote in my post #HIMSS14 Day Four?

Were Congress to newly appropriate half of the initial REC grant expenditure to fund the 62 RECs through Stage 2, it would work out to about $65 per month per EP, based on the latest MU enrollment numbers. Commercial HIT consultants are will cost you $100 per hour at best (which is why the Privateers hated the REC initiative right out of the chute, particularly the vendor-neutral RECs like mine). It irks the crap out of me that HHS will let this hard-won new resource just fade away -- all the Happy Face talk about "no-cost extensions" and "sustainability" notwithstanding.

Federal Ag Extension Centers are now 100 years old since they were legislated into being. Given that the HIT effort will likely be 10 years in bearing visible Triple Aim outcomes and financial fruit, you would think that the feds would take a longer view. Maybe not a century, but, jeez, how about six years?

But, No.o.o.oo.OOOOh...

Having retired from the REC, I have no dawg in this fight, but, still, when I see ONC trying to spin how effective they've been for MU, it just begs a compelling question.

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More to come...