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.
(In related news, the Senate Commerce Committee on Tuesday approved President Barack Obama's nomination of Tom Wheeler to head the FCC, moving the mHealth Alliance member and former CTIA head one step closer to assuming the post. The Senate is expected to vote on Wheeler's nomination in tandem with an as-yet-unnamed Republican nominee for the last vacancy on the five-member FCC; both votes aren't expected to take place until after Congress returns to Washington from its August vacation.)
One of the more pressing issues facing the mHealth industry is the regulation of mobile medical applications. The FDA had issued a preliminary guidance document in 2011 outlining what types of apps it might regulate. The agency had been expected to issue its final guidance soon, but a coalition of healthcare groups has asked that it be delayed until the FDASIA study is complete, as some parties don't believe the FDA should have regulatory power over mHealth. Another faction, led by the mHealth Regulatory Coalition, has asked that the FDA release its final guidance to help the mHealth industry move forward and spur innovation.
As news of Mostashari's decision spread on Tuesday, healthcare leaders praised the outgoing ONC chief for his enthusiasm and accomplishments. Many remembered his appearances at the mHealth Summit in Washington, D.C., his development of app challenges to address population health issues and the story he told of using the iBlueButton app to help get his father emergency care while 500 miles away from home on the day after Thanksgiving.
"Dr. Farzad Moshtashari certainly recognized the adoption and increased use of mobile devices by everyone in our daily lives. Dr. Moshtashari was an ardent supporter of further integrating mobile devices into our meaningful interactions with healthcare providers," said Thomas Martin, manager of mHIMSS. "What lies ahead remains clarifying and articulating policies surrounding the use of mobile and wireless devices to aid existing polices, harness the vast power of this innovative technology, to ultimately improve the efficacy and efficiency of our healthcare system."
"Farzad's vision and commitment to the adoption of health IT has resulted in major improvements in care delivery, care coordination and patient outcomes, while saving our healthcare system time and money," added Chuck Parker, executive director of the Beaverton, Ore.-based Continua Health Alliance. "He has led the adoption of Meaningful Use from stage 1 to preparation for stage 3. These goals have led to a major model shift in adoption and are pacing the way for direct patient to provider interactions regarding their health."
"During his tenure, the ONC has worked to establish national standards and protocols for information exchange and interoperability," Parker continued. "As we at Continua work toward a global plug-and-play ecosystem for personal connected health, Farzad’s commitment to realizing interoperability of electronic health records has been enormously helpful."
"Farzad has been an excellent visionary and leader in taking the initial efforts of Dr. (David) Blumenthal and maintaining momentum and excitement regarding HIT," said Marc Probst, CIO of Salt Lake City-based Intermountain Healthcare and a member of the federal Health IT Policy Committee that advises the ONC. "I have been particularly impressed with Farzad’s attention to detail and focus on implementing HIT standards which can dramatically enhance interoperability and innovation in healthcare IT."
"I am sad to see Farzad move on, but I am confident that a transition can occur without disrupting the progress made to date," Probst added. "ONC has a strong, bright team, and although it may take a few months for a new national coordinator to gain traction, progress in HIT and meaningful use will go on. When Dr. Blumenthal moved on and Farzad took the role, it was a time of change and concern, but the transition went smoothly and progress continued. I wish Farzad great success – no doubt he will remain a key player in health IT."
Paul Tang, MD, vice president, chief innovation and technology officer at the Palo Alto Medical Foundation in Los Altos, Calif., and vice chairman of the federal Health IT Policy Committee, said working with Mostashari was "fabulous."
"He is a passionate visionary who never took his eye off the prize, while keeping his feet at least close to the ground," Tang said. "It's hard to fully comprehend what has been accomplished over the past four years under HITECH and meaningful use, but it has been nothing short of transformative. Having an EHR and PHR is not optional any longer – it's required to deliver the care Americans need and deserve. Especially in this industry, we owe Farzad a huge thanks for his leadership in getting us to this state."
"Working with Farzad has been an extraordinary experience," said John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston. "His focus on public health and patient/family engagement has had an enormous impact. My greatest lesson learned from Farzad is to choose policy goals first, then implement IT to support them, rather than implement technology for technology's sake."
Halamka described Mostashari as "a person who balanced policy imperitives and implementation reality."
"If you just look at the change that's happened in the four years that he's been deputy national coordinator and national coordinator, I think we've probably moved the needle more than in the previous 20."
"I appreciate Farzad for the passion he brought to the role, his efforts to engage stakeholders from across the healthcare spectrum and the many initiatives he inspired to promote IT adoption," said Bill Spooner, senior vice president and CIO at San Diego-based Sharp HealthCare. "He will be difficult to replace. Looking ahead, I can't immediately suggest a successor. I would like to see someone from community healthcare, where adoption and patient engagement are still challenging, lead ONC."
“Mostashari has long been committed to the value of health IT,” said Carla Smith, executive vice president of HIMSS. “At the New York City Department of Health and Mental Hygiene, he set a benchmark for how EHRs should be leveraged for public health and population health management, leading to the department’s Public Health Information Project being awarded the prestigious HIMSS Davies Public Health Award of Excellence in 2011.”
“Dr. Mostashari himself was presented with the 2011 HIMSS Federal Leadership Award during National Health IT Week, and thanks to his enthusiastic vision of our nation’s future health system, Dr. Mostashari routinely drew large audiences to his speeches at HIMSS events,” Smith added. “HIMSS appreciates Dr. Mostashari’s remarkable achievements as National Coordinator for Health IT and beyond.“
“Thanks to his energetic leadership, patient care is improving as providers and hospitals are implementing health IT, efficient information exchange is leading to better care coordination, and consumers are engaging as partners in their own health,” Smith said. “We wish Farzad success as he enters the next phase of his career and look forward to working with ONC to continue his vision.”
Russ Branzell, CEO, of CHIME, which represents more than 1,400 healthcare IT CIOs across the country, said he talked with Mostashari Tuesday morning and understood that the move would be a good one for him and his family – that he would be entertaining perhaps a less stressful position.
"He’s quite committed to doing the right things," Branzell said.
Branzell added that from a CIO perspective, he and CHIME members hope the next ONC chief will be able to build on Mostashari’s legacy. He hoped, he said, that it would be someone who works in the trenches (as Mostashari had in New York City), whether a doctor, nurse or CIO.
In a subsequent statement, Branzell said, "Any CIO will tell you that implementing technology in the face of cultural resistance and process redesign is a monumental challenge. 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."
(Contributing Editors Diana Manos and Bernie Monegain contributed to this story.)
