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    Mostashari's biggest Meaningful Use regret and health IT's future


    … And basically the message we got [from FAH] was, "We're going to sue your butt if you do that." And we backed away from it. In retrospect, I would've said, "Sue me." And I would've kept that tight connection to the outcomes and working backwards from the outcomes.

    ME: How do you see IT and Internet applications changing how healthcare is delivered, especially when it comes to communication and sharing information?

    FM: Well clearly, they have. For all of its faults, one thing Meaningful Use did accomplish was that we moved off of paper. And as bad as some of the usability issues are with the [electronic health records (EHRs)] today, I don't see people going back to paper. And it is the foundation for doing more things.

    So the question is: How does this now become the infrastructure for doing more and in a more “Internet-y” way? The key here is going to be, “Can I use other tools on top of and around and attached to my EHR?” That's really the question. And for that, we need to open up those EHRs to third-party applications. The technology part of that is important—and there's good progress made on that with what are called application programing interfaces, [APIs,] and FHIR (Fast Healthcare Interoperability Resources), and all that kind of stuff.

    But more important than that are actually the business agreements. So again, when you're signing a contract, make sure that you know what your rights are to use your own data with another application and your rights to get your own data out … I think that's going to be the key.

    ME: What are the effects on a practice and patients when an EHR company closes and its system is removed from use?

    FM: One of the really worrisome things has been when practices couldn't get their own data in that situation, or the situation where a billing dispute [arises, or even where] a provider dies and the Office of Civil Rights that manages HIPAA actually is very aggressive about making sure that there's no loss of continuity in those situations. So practices should always be able to get their own data out of those systems, whether the vendor goes broke, whether they terminate their contract with them, the person who signed the contract dies, or whatever it is.

    You should always be able to get the patient data out. And anyone has problems doing that, they should call the Office of Civil Rights.

    …And if the EHR vendor says, "You have to pay extra," and they're holding you hostage, then you complain to the regulators that this EHR vendor is not fulfilling what they should be fulfilling as part of the certification rule, which is to let you have a batch download of all your data.  So be empowered in that. Be empowered in your contract.


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    • Anonymous
      This from a man who benefits directly from all of us 'paddling harder'. I'm done paddling harder. I'm paddling smarter, and it's called DIRECT PRIMARY CARE.
    • Anonymous
      This from a man who benefits directly from all of us 'paddling harder'. I'm done paddling harder. I'm paddling smarter, and it's called DIRECT PRIMARY CARE.

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