Mostashari: I think most people would agree that reform--no matter what their perspective is--needs to get the most value of healthcare spending, improve patient safety, reduce avoidable hospital admissions and readmissions, and none of that is possible without effective use of IT; what I really mean is better information.
You can't fix what you can't see. And I think IT is essential to that. Here's an example. If a provider or organization or ACO must identify their patients at greatest risk and want to reach out to them, such as send a reminder for missed follow-up care, they can't do that without electronic health records with registry functions.
If they want to measure the progress they're making in terms of controlling blood pressure over time, they can't do that without electronic health records. If they want to have reminders at point of care that someone needs a flu shot, they can't do that effectively without electronic health record systems. If they want to reach out to patients and educate them with a summary of their visit, and access to their records and the ability to ask questions and request refills online, you can't do that without electronic health records.
So, I think information technology is really is an integral part of being able to transform healthcare so that it is more coordinated, is more patient centric, is more efficient, and I think we're going to see those synergies more and more. Obviously, care coordination--and we know how hard that is in the current fragmented healthcare system, the hand offs, the discharges from hospitals, the people showing up in ERs and the admissions that take place because of missing information--those I think are all critically linked to the availability and use of health information technology.
McGee: How important are health information exchanges in all this?
Mostashari: We [at ONC] talk of health information exchange as a verb not as a noun. The goal is health information exchange, and there's not going be a one-size-fits-all solution to how health information exchange will happen. It's happening today. There is a variety of means, and needs will continue to be met by a variety of organizations and through a variety of technological approaches.
I think we've taken very concrete important steps forward in terms of assembling the building blocks for information exchange and interoperability. Whether it's the standards around vocabulary and terminology in our final rule for electronic health records for routing protocols for secure, private transmission of health messages over the Internet, or the governance rule around trusted intermediary that's going to be coming out later this year--those are the essential building blocks for information exchange and interoperability. And I think we'll see incremental but overall dramatic improvement in liquidity of data in the year to come.