Being honored at a dinner that ended the 12th Annual HIMSS Policy Summit in Washington on Sept. 18, Dr. Farzad Mostashari finally explained why he is leaving as national coordinator for health information technology on October 5. Looking toward his wife, he said, “I listened to my heart and there she is standing in the front row.”

He’s also worried that his daughter, 11 years old now, will be 14 when the Obama Administration ends and won’t want to hang around her father. Asked what his next career step is, Mostashari said, “I honest-to-goodness do not know what I’m going to be doing in my career.” He figures taking a day or two off after Oct. 5 and then start beating the bushes and finding out what opportunities are available.

In recent months there have been significant calls from industry stakeholders to delay Stage 2 of the electronic meaningful use program, and maybe Stage 3 as well. Asked if such requests are being considered, Mostashari said ONC is always listening and understands that Stage 2 is much tougher than the first Stage, “but people wanted that, they asked for that.” There is an urgency that cannot wait for interoperability, but also a realization that there is so much work to be done for Stage 2 compliance, he acknowledged. But for Mostashari, the idea of a delay comes down to this: “It would be a lost opportunity for interoperability if we took our foot off the gas pedal in 2014.”

Asked what he is most proud of during his 4+ years at ONC as a deputy coordinator and then the national coordinator, Mostashari noted that no leader accomplishes things alone. “We have moved health care. We have made more progress every year in hospitals than in the previous 20 years combined.” He expressed dismay at critics who carp that Washington bureaucrats who don’t know anything are making poor decisions for the industry. At a time when there is not a lot of praise for government, the ONC staff have walked the walk in the industry and have made sacrifices to serve, he said. “I want others to know how smart, dedicated and professional these people are.”

Asked about a sought-after achievement that got away, Mostashari wishes he had pushed harder for opening application programming interfaces. That would have accelerated interoperability by enabling providers to avoid a lot of work to use a third-party software module, such as a patient portal or registry, with their electronic health records systems. There wasn’t consensus on what open API should look like, and security concerns and other considerations caused ONC to back down for now, but maybe it shouldn’t have, he said. Maybe the agency should have pushed for publishing APIs anyway to accelerate innovation, he added.

If Mostashari has suggested a candidate to succeed him he’s not sharing that information. But he does have one core piece of advice for the new national coordinator: “Take the long view, it’s a marathon not a sprint.”

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