David Brailer And Farzad Mostashari:
Two National Health IT Czars Compare Notes
he Office of the National Coordinator for Health Information Technology (ONC) was established in May 2004 through an executive order issued by President George W. Bush. David J. Brailer was appointed the nation’s first national coordinator for health information technology and served in the post from 2004 to 2006. Since then, three others have occupied the position: Robert Kolodner, David Blumenthal, and Farzad Mostashari, who was appointed to the post when Blumenthal returned to Harvard in April 2011.
Brailer, a health information technology entrepreneur who holds doctoral degrees in both medicine and economics, was charged with launching a new push to bring America’s hospitals and physicians into the digital era. Much has changed since then.
Substantial federal funding was allocated to expand the adoption of health information technology in the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the 2009 American Reinvestment and Recovery Act. Subsequently, federal regulations for stage 1 of “meaningful use” were issued, governing standards that physicians and hospitals would have to meet beginning in 2011 to receive extra payments under Medicare and Medicaid for adoption and use of health information technology (IT). In February 2012 the federal government released proposed regulations for stage 2 of meaningful use, raising the bar for providers in such areas as health information exchange and giving patients access online to their electronic health records.
With the HITECH payments flowing, there has been a sharp expansion nationwide in the use of technologies such as eprescribing and electronic health records. In mid-February 2002, Secretary of Health and Human Services Kathleen Sebelius announced that nearly 2,000 US hospitals and more than 41,000 doctors have now met the standards for achieving meaningful use of health information technology and have received $3.1 billion in federal incentive payments as a result.
But substantial questions remain about the degree to which use of health IT will foster quality improvement and cost reduction in health care. And recently, new questions have arisen as to whether use of health IT will spark a new set of safety-related issues, such as treatment delays due to poor human-computer interactions or loss of data.
In 2010 Health Affairs published an interview that Brailer conducted with then–national coordinator David Blumenthal. The journal recently asked him to reprise his role as interrogator by interviewing Mostashari.
A physician and public health specialist, Mostashari joined ONC in 2009 as deputy national coordinator under Blumenthal. He had previously served at the New York City Department of Health and Mental Hygiene, where, as assistant commissioner for the Primary Care Information Project, he facilitated the adoption of health IT by more than 1,500 providers in underserved communities. He also led a center in public health informatics funded by the Centers for Disease Control and Prevention (CDC). A graduate of Yale Medical School who has a master’s degree in public health from Harvard, Mostashari also served in the CDC’s Epidemic Intelligence Service, including as a lead investigator in outbreaks of West Nile virus and anthrax in New York City.
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