Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


Mostashari: It's Crunch Time for Health IT Adoption

By John Reichard, CQ HealthBeat Editor

July 9, 2013 -- Farzad Mostashari, the nation's top health IT official, recently said that policymakers, doctors and hospitals should take a bit of a victory lap because of the widespread adoption of electronic medical records that has occurred in their industry since the 2009 economic stimulus law.

But he warned that even though they are passing significant milestones, they have a long way to go.

"It may be a marathon, but it sure feels like a series of consecutive sprints," Mostashari, National Coordinator for Health Information Technology at the Department of Health and Human Services (HHS), said at a National Press Club event sponsored by the policy journal, Health Affairs.

Mostashari said 2014 would be a challenging year for providers. That's because many still haven't adopted the technology. Even those who have need to use it more effectively to keep from seeing their Medicare payments cut in 2015.

The stimulus law (PL 111-5) included an estimated $30 billion in Medicare and Medicaid bonus payments for health IT adoption. But it also called for reduced payments starting in 2015 for those who do not adopt IT or fail to conform to a set of expanding requirements for "meaningful use" of the technology.

Whether providers see cuts hinges on whether they make meaningful use of health IT in 2014. Next year marks the start of "stage two" of the meaningful use program in which doctors and hospitals must be able to begin electronically exchanging medical information about a given patient and provide it directly to patients over the Internet in a way they've never done before.

Mostashari noted the strides that have been made in adoption, a point backed up by the findings of a recent study posted online by Health Affairs.

"The nation's health care system is in the midst of an enormous change as hospitals and ambulatory care providers transition from paper-based to electronic record keeping systems," said the study, led by Catherine DesRoches, a senior scientist at Mathematica Policy Research in Cambridge, Mass.

The percentage of hospitals with a basic electronic health record system has climbed from 9 percent in 2008 to 44 percent in 2012, the study said.

And another new study posted by the journal found that the percentage of office-based physicians with a basic electronic health record system grew to 40 percent last year, up from 25 percent in 2010. That study was led by Chun-Ju Hsiao, a researcher with the National Center for Health Statistics at the Centers for Disease Control and Prevention.

"Behind every one of those hundreds of thousands of practices there's someone who stayed up late, someone who worked through the night, someone who did something in addition to their regular jobs to be able to accomplish this across the country," Mostashari said.

"The stimulus bill said this is a long term opportunity for investment in infrastructure, not just runways and railways and roadways, but in an information infrastructure," Mostashari noted. "And it worked. It worked!"

Sixty-two regional extension centers for health IT established under the stimulus law are helping 140,000 primary care providers install electronic medical records. "You policy people out there, that's pretty remarkable," he said.

Now, 79 percent of hospitals have gotten health IT bonus payments under the stimulus law, either from Medicare or Medicaid, up from 40 percent in 2012. In the case of Medicaid, some hospitals are getting the payments on the promise that they will install electronic health records systems.

Segue to Stage Two

But stage two is just around the corner—October for hospitals, January for outpatient providers. Then, "every electronic health record system will have to have some building blocks of interoperability standards," Mostashari said.

In stage two "we're able to have for the first time in our nation's history a single set of standards and vocabularies and terminologies for expressing medical terms that would be applied to medications and diagnoses and procedures and immunizations, so that information from one system doesn't have to be translated into math before it can be used by another system."

"There will be ubiquitous availability of secure exchange messaging so that every electronic health record can catch and throw those documents with every other one,'' he added. "It's right around the corner."

But at the same time, he said, "where we are today is not acceptable. And we're going to have to move just as hard as we did to get adoption, we're going to have to work just as hard, just as creatively, just as diligently, to get that secure exchange of information."

Another element of stage two "is called 'view, download and transmit,'" Mostashari said. And it's one of the measures that hospitals and doctors are going to have the greatest difficulty with because it's new. "It's not what we've been doing, we haven't been giving patients easy online electronic access to download their own clinical information and use it however they choose to use it. We've been saying '75 cents a page and 30 days' to copy records for patients."

The coming months are going to see "a rush to the wire" among the late adopters, he said.

Mostashari said his office plans to work particularly with the providers in small practices to say "don't miss the boat on this guys, you will get the penalties, we don't want you to get the penalties, we want everyone to succeed on this."

Publication Details