Government expert encourages transition to electronic records

Internist Farzad Mostashari, MD, has tackled some intimidating tasks. He completed the CDC's rigorous Epidemic Intelligence Service program and, while working for the New York City Department of Health, he was one of the lead investigators in outbreaks of West Nile virus and anthrax.

But his latest assignment may be the toughest yet. In April, Kathleen Sebelius, secretary of the Department of Health and Human Services, named Dr. Mostashari the government's national coordinator for health information technology. The title puts him in charge of the massive conversion from paper charts to electronic records that U.S. physicians and hospitals are expected and financially incentivized under recent Medicare regulations to undertake over the next couple of years.

Dr. Mostashari recently spoke to ACP Internist about the challenges and progress of this transition, and how practicing internists can best serve their patients and take advantage of incentives.

Q: What would you say to physicians who are leery of switching to electronic records?

A: My main advice is that there's really no better time to jump in than now. There's the maximum funding available through the health IT incentive program in 2011 and 2012. The technology has improved. We have a good list of certified products that have much more in the way of interoperability and security and functionality built into them. And we have extension centers that are ready, willing and able to help primary care providers, particularly those in small practices in underserved areas. Change is going to be difficult, but it is ultimately going to be rewarding. I don't know that we know anyone who would go back to paper after they have made the switch to electronic. (A tool for finding your nearest extension centers is available. )

Q: How can practices ensure patient safety during the transition?

A: Like in every part of the implementation process, [my advice is] plan carefully, [and] get help in particular through the regional extension centers so that there is a level of readiness and a level of preparedness for the transition as it occurs. Folks who invest in that planning ahead of time find that it really pays off in minimizing the disruptions during the switchover process.

Q: What progress is being made toward interoperability of medical records?

A: There's been great progress made on interoperability. A lot more work yet to be done, but we now have electronic health records that all have been tested to be able to have some key abilities, in terms of how they code and export information about medications or problem lists or immunizations, how those messages are formatted. So when you are doing a lab report or a public health report or an immunization report or sending a referral, those are formatted in messages that can be understood most readily by the receiver. In the past year, there's been this incredible public-private partnership called The Direct Project to define a set of simple transport protocols of how to use the Internet to send secure patient information in a secure, encrypted fashion. Those protocols have been voluntarily committed to by 95% of the EHR market share.

Q: One specific problem mentioned by practices that are using electronic health records has been communication with laboratories. Do you have any advice or projects relating to that?

A: It's a basic expectation that if I order a lab, they should give me the results in the form that I want. That's not the case today. It starts with having the standards. We're creating a workgroup specifically on that issue. We're making great progress on that. It's been a cost-benefit issue. What we're doing is reducing the cost of stabilizing those interfaces, by simplifying. We also need to give providers a voice. Right now they have no leverage against the labs. The extension centers can pool them.

Q: New features are continually being added to the certified EHR products. How do you balance the desire to have the best possible systems with the practical challenges of repeated upgrades and changing standards?

A: Technology is always moving and always improving. We could think, “Let's just wait until the standards are all worked out and the perfect system is out there.” There's never going to be that time. I think the time is now for moving ahead and the vendors are committed. It's part of their commercial viability, their ability to manage those upgrades in a way that doesn't disrupt or destroy what has been done before. The fundamental foundations are in place with Stage I meaningful use. There's going to be constant improvements and incremental and evolutionary progress, but there is no reason to wait.