HIT Think

An Open Letter to National HIT Coordinator Farzad Mostashari

Dear Dr. Mostashari: Welcome to your new post! You were a good pick and you'll do a good job. But here's some unsolicited advice on how to do even better.

You and your predecessors are all physicians, very familiar with the industry yet very unfamiliar at the same time. No ONC head has lengthy experience in a standalone community hospital or small practice independent of academia or government. It's a different world and most of the industry lives in this different world. Your advisors on the HIT Policy and Standards Committees also don't live in this different world. It's long past time to shake up the committees and give the vast majority of the industry more representation.

On that note, it's also time to start seriously thinking of moving back the Stage 2 meaningful use timetable a little bit. Stage 2 is starting to look like it will be much more comprehensive than originally envisioned. And it's tough enough for much of the industry to reach Stage 1 compliance. ONC announced that 150 providers successfully attested to Medicare's Stage 1 meaningful use when attestation started on April 18, but I'm betting there's a lot of folks who, like me, were shocked that the number was so low. Those I've talked to sure were. Further, look at how far behind most states are in setting up Medicaid meaningful use programs where the bar for Stage 1 compliance is extremely low. There's no way Medicaid will be ready for Stage 2 in time.

Spend a day calling some of those who successfully attested on April 18. They'll tell you what's working and not working with the program. Call Mike Mistretta, CIO at MedCentral Health System in Ohio. He tried registering in early January and finally succeeded in mid-March. MedCentral's Medicare contractor for a decade has accepted a document listing the delivery system's direct deposit routing and account numbers. But the contractor for the registration system would not accept the document and demanded a copy of a cancelled paper check for an electronic account. CMS backed up the contractor, who finally agreed to accept a notarized letter from MedCentral's bank that included the same information as the document previously rejected. Seriously, there's silly stuff going on.

There's another group of folks you should be calling. The HIT workforce education programs at community colleges and universities are a wonderful idea but early anecdotal evidence suggests the graduates may not be as employable as envisioned. Talk to graduates as they seek employment and talk to hospitals and vendors to see what changes, if any, are needed for the programs.

Demand and ensure that Stage 2 requirements include the encryption of protected health information in transit and at rest. The government made a promise to Americans that electronic health information would be protected and it simply isn't. A promise is a promise.

On ONC's Web site is a page called Coordinator's Corner. It's your personal blog and it hasn't been updated in two months. It's a powerful communication tool if you write your own stuff and don't let the "messaging" folks near it.

Again, I wish you well.

Joe Goedert is News Editor at Health Data Management

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