Farzad Mostashari, MD, ScM, is the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.
Before his appointment as National Coordinator, Mostashari was the Assistant Commissioner for the Primary Care Information Project at the New York City Department of Health and Mental Hygiene. During his tenure he facilitated the adoption of prevention-oriented health information technology by over 1,500 providers in underserved communities. Mostashari also served as the head of the NYC Center of Excellence in Public Health Informatics, with funding from the Centers for Disease Control and Prevention and created the Bureau of Epidemiology Services at the NYC Department of Health. The Bureau provided epidemiologic and statistical expertise and data to the city’s health department.
We spoke with Mostashari about prospects for better data to inform better population health.
What changes in the field of data are helping to improve population health?
The new ways we collect, store and analyze data are all critical for having the information we need to identify problems and create solutions. Our goal is not to have dead data that sits on shelves but to make it come alive by using it to improve the public’s health. Once you close a paper file it's dead. You’re not able to move it or learn from it. As I’ve said previously, unlike in the world of Harry Potter, a physician can’t wave a wand and have the paper charts that list the diabetes patients line up, and then wave the wand again, for, say, the patients who didn’t come back for a follow-up visit. That can’t be done on paper, but it can be down with electronic records which capture that data and allow providers to interact with the data. It provides a much stronger basis for population health management.
Other examples of electronic health record data that’s changing us to be proactive rather than retrospective include using patients’ records to remind those with allergies to begin to use their allergy medications before allergy season begins and avoid some asthma emergencies. We can look at nursing home vaccine records after a flu outbreak to break down not just how many got a flu shot but what the patterns were among those who did get the shot and those who didn’t. The goal should be not to review death rates, but to be proactive for the next season to expand flu immunizations.
What are important points in using data most effectively to improve public health?
As Thomas Frieden, director of the Centers for Disease Control and Prevention has said,” the denominator is so important” —not just data on the people who are in front of you, but to also know how many overall are impacted and how many we can help. It’s not just about the patient who is in front of you.
One thing we have going for us that we didn’t have 20 years ago is being able to manage information in ways we simply could not do before. We have the advantage now of being able to compile and assess data so much more easily. My phone isn’t a phone, it’s a communications platform, and gives us access to more critical data today than anyone had ten years ago.
Having data for decision making, and the simple act of a clinician looking at data on their collective of patients, not just individuals, is the foundation of population health management and the fundamental difference between paper charts and electronic health records.
How does leadership play a role in the intersection of data and public health?
Public health leaders must be willing to work with others to share the data they have rather than to keep it to themselves. They need to rely on the expertise of others—statisticians, for example, to help them assess the data, and then work with community leaders to help share the lessons the data shows. It’s about bringing together the collective health care team to bring the data alive, to view it prospectively rather than retrospectively to improve the health and care of each and every patient.