What is the government's role in developing new technology? Some would say to stay out of the way. Dr. Farzad Mostashari, the national coordinator for health information technology, said that's overly cynical.
But, Mostashari said in an interview, government is no longer the major producer of innovative products and services that it once was, creating things for military purposes or space exploration that work their way into the consumer market.
"That's not the model anymore," he said. "The investments in research and development that are going on in the consumer technology space are now dwarfing the investment and innovation that are happening in, say, the military."
Mostashari was in Boston yesterday to speak at the Health 2.0 conference about his vision for what the government can do today to pave the way for new technologies in health care. He laid out his main points, five things government can do to foster innovation, just before he took the stage:
1) The old-fashioned way, by investing in academic research and development. He cited, as an example, the SMART project (a catchy acronym for a clumsy name: Substitutable Medical Apps, Reusable Technology) at Children's Hospital Boston, where Zak Kohane and Ken Mandl are developing a system of "iPhone-like" medical apps designed so that they can be easily swapped out when better ones are developed but that allow for easy saving and transfer of data to a new program.
2) Create a space for identifying new ideas. Mostashari pointed to the 17 Beacon communities designated by his office as places to try out new technologies, such as sending text messages to people with diabetes in New Orleans or providing people in Tulsa, Okla., personalized assessments of their heart attack risk.
3) Provide data. The government collects a lot of health care data on a regular basis. Mostashari said his office is working to make more of that available to developers who can "crunch and slice and dice and make use of in apps and services that people might enjoy." An example: What if when you looked up the name of a hospital in a search engine, it automatically pulled up quality of care data that the government already collects, in an easy-to-read fashion.
4) "Smart regulation can unleash innovation, if we think about the little guy, if we don't make the regulation so that it gives an advantage to the biggest players, to the ones with the ability to navigate the greatest complexity," Mostashari said.
There are more than 700 certified vendors of electronic health records. More than 60 percent of them have 50 or fewer employees, Mostashari said.
One way to help the smaller developer is to create industry standards for the development of electronic health records to make the process simpler, he said. His office has been using online communities and wiki forums to get input on what those standards should be and to build consensus. (See them here and here.)
5) Promote competition. The Office of the National Coordinator has supported a product developer competition run by Health 2.0. Competitors are given a challenge to tackle a tough issue in medicine and technology, such as how to improve communication when a patient is discharged from a hospital to a rehab facility or nursing home. Yesterday, it announced the latest challenge, to connect opthamologists' many imaging tools and databases with an electronic health record.
Mostashari also talked about the successes and challenges the government has faced in creating a national system of electronic health records in which hospitals and doctors can easily share information with each other.
A big hurdle has been in agreeing on how the data should look, what format should it be in, and will it be readable by the next program it's sent to.
"You have kind of your Betamax, VHS wars," he said. "We've really accelerated consensus."
In the next phase of the electronic health records roll-out, his office has proposed that all systems must use the same medical vocabulary -- for things like medications, health problems, and procedures -- and must use a standardized format for creating a patient care summary.
"We're proposing significant steps in standards-based information exchange as part of stage two," he said. "There's still a lot of work to be done, but I think we are poised to have some of the building blocks in place to have the same kind of hockey stick curve … for information exchange as we've seen for electronic health record adoption in the last two or three years."
Changes to how doctors and hospitals are paid will help too, he said. Payment methods that reward doctors that communicate with each other in order to better coordinate care "are creating a business case for people to want to exchange information across the street, from Beth Israel to the Brigham," he said. "Once you get the cost and benefit ratio right, then you start to see information flowing at the speed of trust."
Trust requires rules, he said. How will the data be handled? Who will have access to it? And what can they do with it? Mostashari said his office is working to develop standards on that, too.
Chelsea Conaboy can be reached at firstname.lastname@example.org. Follow her on Twitter @cconaboy.