It’s a corner of American society that’s been stubbornly resistant to the information technology revolution of the past few decades: health care. But the federal government is working to change that, using information technology to improve outcomes and relationships that patients have with their care givers. We chat with Farzad Mostashari, the national coordinator for health information technology.

Guests

  • Farzad Mostashari National Coordinator for Health Information Technology, U.S. Department of Health and Human Services

Transcript

  • 13:20:48

    MR. KOJO NNAMDITechnology likes to move at warp speed. Your shiny new iPhone will probably be a relic in about three years. But when it comes to your doctor's office, the information technology revolution seems to be moving at a glacial pace. By and large, our relationships with our doctors still revolve around paper charts stuffed in file cabinets and prescriptions jotted down in chicken scratch on tiny pieces of paper. But the federal government is taking the lead on an effort to encourage health care providers to embrace information technology.

  • 13:21:19

    MR. KOJO NNAMDIThe idea is that better access to information will lead to improved care, better decisions, lower costs and earlier detection of symptoms. We're joined this hour by the man spearheading the federal government's effort to bring health care into the information age. Farzad Mostashari is the National Coordinator for Health Information Technology, an office located within the U.S. Department of Health and Human Services. Farzad Mostashari, thank you so much for joining us.

  • 13:21:46

    MR. FARZAD MOSTASHARIThanks for having me. In a lot of ways, it seems like health information technology is like, remember, dipping dots which was advertised as the ice cream of the future for about 20 years, year after year. Well there've been a lot of promises about how health IT is going to change the experience for patients, for a very long time. But you wrote, recently, that the past year has marked a lot of progress in bringing health care into the information age. What happened?

  • 13:22:13

    MR. FARZAD MOSTASHARIWell, in the past two years we've made as much progress on health IT as was made in the past 20.

  • 13:22:21

    NNAMDIOkay.

  • 13:22:21

    MOSTASHARIPretty remarkable. So, well, it really goes back to the beginning of 2009 when, as part of the stimulus bill, Congress passed the Health IT incentive programs where the big problem before had been the doctors and hospitals were expected to put up the money and the effort to adopt these systems. But a lot of the benefits didn't go to them. So the incentive program says, we're going to help defray some of those costs. It also put in play support for us, for example, to give the doctors and primary care providers, in particular, a helping hand in making that transition. And it's been paying dividends over the past two years.

  • 13:22:59

    NNAMDIBefore we go much farther, I should like to invite our listeners to join this conversation. The number is 800-433-8850. How do you think technology could help to improve the relationship you have with your doctor? How do you think it could, on the other hand, make it not so much better? 800-433-8850, you can also go to our website kojoshow.org, join the conversation there.

  • 13:23:21

    NNAMDISend email to kojo@wamu.org or a tweet @kojoshow. Why do you think the health care sector has been resistant to change on this front? It's an eye opening experience to see just how much our medical experience still runs on paper. One study published a few years by the New England Journal of Medicine, found that less than 1/5 of doctors used electronic records.

  • 13:23:44

    MOSTASHARIWell, you know, what's exciting is that that now is 40 percent. So it doubled in the past two years. Next year, I think it's going to be 50 percent or more and pretty soon we're going to be at a place where the norm becomes like every other industry that we have. People use information systems, computers, to help them not just bill but doctors and hospitals will use computers to help them take better care of patients. So, yeah, it's coming, finally.

  • 13:24:15

    NNAMDII'm glad you talked about better care of patients. Because when we talk about meaningful use of electronic health records, how are you defining meaningful use?

  • 13:24:24

    MOSTASHARIThat's a great point. So in order to qualify for the payments, doctors and hospitals don't just get paid for buying the thing. They get paid for actually using it in certain ways. And the way we did it was, we said, let's work backward. What is it that we're trying to accomplish here? We're trying to have care that is safer. All right, we know that's a big problem and they just published a report saying that on -- in the outpatient side, there are still literally hundreds of thousands of medication related errors. All right, if we want to reduce that -- those chicken scratches you talked about...

  • 13:24:54

    NNAMDIOh, yeah.

  • 13:24:55

    MOSTASHARI...right, sometimes you look at that prescript paper prescription and you wonder, how can the pharmacist possibly make sense of what this is?

  • 13:25:02

    NNAMDIYou say, sometimes.

  • 13:25:04

    MOSTASHARIAnd the pharmacist do an incredible job, but all too often, there are mistyping, mis-readings and people get hurt. There's also people, drug interactions, people on -- particularly on a lot of medications. So what we said is, okay, if we want care that's safer, if we want to save those lives, there are certain things that people should do, like electronic prescribing.

  • 13:25:27

    MOSTASHARILike, checking for drug-drug interactions or drug allergies that have been proven to make care safer, that's part of meaningful use. So there's a whole set of things that providers should do. A lot of them go to speak right to the patient experience. And I think, increasingly, our listeners are going to be seeing this -- their interaction with the health care field.

  • 13:25:50

    NNAMDIIt's my understanding that one of the achievements that you are most proud of from the past year is the launch of a program called The Direct Project, something that you're advertising as health email. How does it work?

  • 13:26:01

    MOSTASHARIYou know, this current state of having doctors and hospitals talk to each other is pretty pathetic. So right now, the chances are that if you get discharged from a hospital, you're primary care provider is not going to get, in a timely way, information about your care. My mom, when she left the hospital, she showed up at the doctor's office and the doctor said, well, I hadn't heard you were even in the hospital, now you're out. Tell me what happened.

  • 13:26:40

    NNAMDIAmazing.

  • 13:26:41

    MOSTASHARIRight. And he hadn't gotten any papers on my mom's hospital stay. And it was up to her to tell him, all the complications that happened during her hospital course. You know, that's not fair. And what we said was we got to make it much easier and cheaper, much more standardized for that kind of basic communication that people expect their doctors and hospitals to have with each other. And so we got a -- and this is what's kind of cool about this, the process we followed.

  • 13:27:12

    MOSTASHARIWe said, let's get people together and agree on what that standard -- we're not -- we, the government, aren't going to set the standard out of the gate. We're going to invite people in and we're going to say, you pick, but after 90 days, all you industry people, you're going to pick one way of -- in which you're all going to embrace, that you can all live of talking to each other. And the protocols that they choose after 90 days was using the best of the internet, basically email protocols with security and encryption on top of it.

  • 13:27:42

    NNAMDIGoing to get to security and encryption in one second. But just to be clear here, is this a way, when we talk about the direct project for providers to communicate with each other or is it a way, also, for patients to communicate with their providers or both?

  • 13:27:56

    MOSTASHARIBoth.

  • 13:27:57

    NNAMDIOh.

  • 13:27:58

    MOSTASHARISo there are now people who are personally controlled health record vendors who will give you your very own direct email account. And increasingly, you can say to -- you will be able to say to your providers, send my information to me, securely, in my secure inbox at this location. And they can deposit it there and you can share it with whoever you want to share it with.

  • 13:28:24

    NNAMDII'm glad you used the word secure twice in your last response because you probably know that that is going to be the major concern of a lot of our listeners. Let's start with Robert who's calling all the way from Eastland, Texas. Robert, you're on the air. Go ahead, please.

  • 13:28:38

    ROBERTHi, good morning, glad to be on the line with you. I am a physician, practicing rural area and I have had EMR for over 11 or 12 years now. In fact, I'm getting ready to implement a new program starting next week. One of the features is that patients will be able to access their own records online. My question is, how do we protect HIPAA laws with the availability of people being able to seemingly break into computers elsewhere? What do we have, other than the encryption coding, to protect our files from people as they try to just to get to their file?

  • 13:29:21

    MOSTASHARIThat's a great question. I'm really glad that as a provider, you're asking that question because this is a shared responsibility. People trust their providers with keeping their records private and secure and one of the things that part of this meaningful use criteria is that providers do a security assessment and take steps to mitigate any insecurity, is this whole long checklist of things that providers really should be looking at. We've done some analysis, Robert, of where the breeches that have occurred, as part of the law, there was also a requirement on anyone who is responsible for the information.

  • 13:30:00

    MOSTASHARIIf it gets breeched, they have to report and they actually have to alert the media and alert the patients themselves. And we did an analysis where the Office of Civil Rights at HHS announces of the breeches that had occurred in the past since this law went into effect. And they found that the vast majority of breeches were not someone hacking in, you know, some nefarious person hacking in on the internet into the records. The vast majority of breeches occurred when a laptop was stolen, when portable media, when things were not secured, when the server room wasn't locked, when a USB drive is left on the subway.

  • 13:30:37

    MOSTASHARIAnd I think it points to, you know, some very simple steps that those who are trusted with the information should take to secure it. So that there's a provider piece, there's a vendor piece, there is a government enforcement piece in our -- the Office of Civil Rights has now been pretty aggressive about taking a look at how the information is being secured and making sure people follow the HIPAA security laws.

  • 13:31:06

    NNAMDIAnd we all have a great fear about our private information being exposed and we're concerned about breeches, but given the fact that there have been breeches, particularly the one in the Bronx involving information about 1.7 million patients, have you had any access to whether there have been any adverse consequences of these breeches so far?

  • 13:31:29

    MOSTASHARIYou know, I think any...

  • 13:31:29

    NNAMDIHas anybody been scammed? Has anybody...

  • 13:31:30

    MOSTASHARIYeah.

  • 13:31:30

    NNAMDI...been denied insurance? Has anybody...

  • 13:31:33

    MOSTASHARIYeah, I think, the harm, it's unacceptable. Let me put it this way. It's unacceptable for the information to be breeched regardless of whether it ends up being used for nefarious purposes or not. And I think we can't have a standard that says let's evaluate and see if someone was actually hurt?

  • 13:31:56

    NNAMDII was just curious.

  • 13:31:57

    MOSTASHARIAnd, yeah, and I think our viewpoint on this is we don't want any breeches, whether or not anyone ends up being harmed as a result of it or not.

  • 13:32:07

    NNAMDIWell, to some extent, you're finding yourself working against goals that seem to be at odds with each other. On the one hand, you're trying to free up people's health information so that it can flow more freely which it can't do if it's locked away behind a Fort Knox kind of firewall. But on the other hand, the consequences, as we just mentioned, of not protecting that information, if we -- even if we haven't seen them yet, they're potentially pretty severe. And so you have to try to do both things at the same time.

  • 13:32:35

    MOSTASHARIYou do. You do and in some ways, it's a win-win. Because if people don't trust in the systems, if they don't trust that their information is at the utmost efforts are being made to keep their information private and secure, then we're not going to get the benefits of the technology either. So I actually think that we really do have to do both.

  • 13:32:58

    NNAMDIThank you very much for your call, Robert.

  • 13:33:00

    ROBERTThank you. Thank you for the answer. I appreciate that.

  • 13:33:03

    NNAMDIRobert mentioned HIPAA. Do you think HIPAA was designed well enough to be effective in a world where your medical information could be passed around electronically among so many people?

  • 13:33:12

    MOSTASHARIWell, there were some important modifications that were made to HIPAA as part of the high tech act. So on the one hand, there was the real push that was enabled and the systems and supports to get the information more electronic format. And as the other side, as I mentioned, for example, the breech requirements or access requirements that were expanded as part of that. So, yes, it's true that HIPAA was crafted at a time before we really had envisioned these widespread clinical information systems. On the other hand, there'd been some important kind of updatings that had been done to HIPAA. And there may be more that are needed as we go along.

  • 13:33:57

    NNAMDIIn case you're just joining us, we're talking with Farzad Mostashari. He is the National Coordinator for Health Information Technology. That office is located within the U.S. Department of Health and Human Services. If you'd like to join the conversation, go to our website, kojoshow.org, because the phone lines seem to be filled. What concerns do you have about the digitalization of medical information?

  • 13:34:18

    NNAMDIHave you had an experience where better access to information affected a decision you made about your health care? Where did you get that information? Was technology a part of the process? As I said, you can go to our website kojoshow.org, send us a tweet @kojoshow or email to kojo@wamu.org. Here is William in Tampa, Fla. William, your turn.

  • 13:34:40

    WILLIAMYes, thank -- first of all, Dr. Mostashari, I want to thank you for your leadership. Second is that from the standpoint of the inflection point when the practice of medicine is expected to use information technology versus where we are now, it requires the incentivization of a program like meaningful use. When do you think that that crossover will happen, that the medical profession will begin to understand that this is really the instrument that needs to be used in the practice of medicine? And when might that occur?

  • 13:35:16

    MOSTASHARIWell, I think that it's going to occur when we get providers talking to each other. And as part of their professional standards, that this is the modern practice of medicine now, that these are some expectations that you would have, that if you really want to provide modern health care, you're going to need to have the best tools.

  • 13:35:39

    MOSTASHARIAnd that medicine is getting -- the knowledge that we have is getting so complex and, frankly, the expectations that patients have are getting to the point where we expect, now, to be able to, you know, go online to our bank and go online and ask -- you know, email people, if -- for everything, every part of our interactions except for health care. And I think it's really going to be that societal tipping point. But it's coming, I think, with a speed that will surprise people.

  • 13:36:12

    NNAMDIAnd William, here's an example. I'd like to bring up a blog post that your office, Farzad Mostashari, posted recently about an Army veteran who's using health IT to better manage his diabetes. Using him as an example, how can these technologies change the way we interact with our doctors and manage treatments for something as serious as diabetes?

  • 13:36:35

    MOSTASHARIYou know...

  • 13:36:35

    NNAMDITell us his story, Donald.

  • 13:36:37

    MOSTASHARI...you know, there's actually this incredible study that happened earlier this year in Cleveland. And it points right at the heart of the question you asked. There were -- it was a study of 20,000 people with diabetes and they looked at those who got care in using paper records and looked at those who got care using electronic records. These were both part of a community improvement project -- health improvement project.

  • 13:37:05

    MOSTASHARIAnd they looked at the basic stuff that someone with diabetes should get, right, stuff that a third year medical student has learned. They should get a pneumonia shot, they should get their sugars checked, their eyes checked, those kinds of things. And they found, and this is shocking, that among people cared for on paper, they got those things consistently seven percent of the time, seven percent of the time.

  • 13:37:29

    NNAMDIYeah, you see me opening my eyes here. I can't believe that. But obviously, it's true.

  • 13:37:34

    MOSTASHARIAnd in practices that had electronic health records, it still wasn't good enough, but it was 51 percent got the right care. And what was more amazing was the practices with the electronic health records were improving faster. So that's the difference. And the difference for it -- you know, people don't really see -- aren't able to see this in the large scale. But in an individual person's experience, it's going to be things like getting a reminder from the doctor. If you didn't show up -- and look, we're all guilty of this. You know, I need to refill my prescription. I've let my prescription, personally, lap -- I'm sorry...

  • 13:38:15

    NNAMDIExpire.

  • 13:38:16

    MOSTASHARI...Dr. Boyhan (sp?) , I'm sorry if you're hearing this. You know, I'm late in getting my prescription refilled for my cholesterol medication, right? We get reminders from our mechanic when we need an oil change. We need to get a reminder from our pet. It's great if you're a cat. But we don’t get reminders for our own health care.

  • 13:38:35

    MOSTASHARIBut in this context, you will be able to get that reminder to come in and refill that prescription, for example, or come in and get that flu shot that you need or come in and get that blood sugar check. It's also, I think, much easier to communicate when you're both -- not only as the patient on the internet, but the provider can also take advantage of that.

  • 13:39:02

    NNAMDIWilliam, thank you very much for your call. Onto Harvey in Baltimore, Md. Harvey, you're on the air. Go ahead, please.

  • 13:39:10

    HARVEYGood afternoon. Thanks for taking my call. I have a question and, you know, I hear all of this internet use and using computers when, in my mind, there's a simple solution. And that is to be able to adapt mobile phones that can send you reminders using simple software applications and then tracking that data. And when people's sugar, as you were just talking about, exceed a certain threshold, it automatically notifies their doctor. Yet, we don't see Verizon or any of the large telephone companies getting into this arena and tracking this kind of information when pretty much everybody's walking around with a cell phone in their pocket. Can you comment on that?

  • 13:39:57

    NNAMDIHe can more than comment on that because it's my understanding that his office has challenged developers to create mobile apps that can help people make their health care decisions and apps that specifically target heart disease.

  • 13:40:10

    MOSTASHARIExactly right. Exactly right. So great point, that we walk around town in our pockets with more computing power than, you know, than the biggest hospital or center could boast two decades ago, and it's an amazing opportunity to bring that mobile revolution to health care. And one of the ways that we're doing this is by, as Kojo said, we're challenging app developers to develop apps, and we're seeing some fantastic examples of that that can help improve people's management of their own health and their connection to doctors.

  • 13:40:49

    MOSTASHARIAnd we're starting with -- one of things we're starting with is the thing that kills the most Americans, which is heart disease. And there's some very simple things, aspirin use in people who are at high risk. Only about a third of people who should be on aspirin are on aspirin, getting their blood pressure and lipids under control, about half of people who have that should -- have that under control, and getting help to quit smoking. And there's just on the texting thing, the example you gave, there's incredible evidence around simple text-based solutions for helping people quit smoking, and it's the -- and the text for baby program.

  • 13:41:23

    MOSTASHARISo there's some really wonderful examples of that, and this is the exact reason why we're seeing, Harvey, that the medical world and the health world can't resist the opportunities that we have here to use the technology, use the incredible innovation that's coming out to help address some of our most important challenges.

  • 13:41:47

    NNAMDII know that people have until the end of the year to submit their entries in these mobile app competitions, and I discern from your response that you've had time to start evaluating a few of them yet and that you've been impressed by some of them.

  • 13:42:00

    MOSTASHARIYeah. We -- this is actually not our first -- this whole concept of doing a challenge is something that's kind of new to government, right? We know how to do contracts and we know how to do grants, but under the America Competes Act give us the ability to do a challenge, and to do rewards, so we've started doing that at the Office of National Coordinator. And we did one for transitions of care where -- to address that issue of when people leave the hospital, for example, very often there's -- people fall through the cracks of the health care system. So we've got some terrific apps around that and we evaluated them and they're doing some wonderful things there.

  • 13:42:44

    MOSTASHARIThe other challenge I want to mention for people, if you're not an app developer, but you're using some sort of technology to improve your health, maybe to keep a new year resolution, we've announced a challenge for you. It's called healthynewyear.challenge.gov, and if you go to that site, healthynewyear.challenge.gov, it asks you if you're using technology to keep your new year's resolution around your health, post a little video of it and we're gonna do a challenge, and we're gonna pick the most compelling stories to highlight.

  • 13:43:20

    NNAMDIExploiting our competitive urges. Farzad Mostashari is the national coordinator for Health Information Technology. He joins us in studio. Harvey, thank you very much for your call. We're gonna have to take a short break. If you have called, stay on the line. We'll try to get to your call. If the lines are busy, go to our website, kojoshow.org, or send us a tweet @kojoshow. I'm Kojo Nnamdi.

  • 13:45:32

    NNAMDIWelcome back. We're talking with Farzad Mostashari. He is the national coordinator for Health Information Technology, and his office is located within the U.S. Department of Health and Human Services. Before we get back to the phones, I'd like to combine an email and a question here. The email comes from Constance in Silver Spring. "I'm concerned that this digital medicine records keeping and communication is basically for the rich and the few remaining members of the middle class. It assumes that every patient can afford broadband access, DSL or cable, and isn't stuck with dial-up or phone-only access or no online access at all.

  • 13:46:05

    NNAMDIMany people in the Washington area have to go to the public library to use a computer if they have time to get there when the library's open, and many formerly middle class people find that, thanks to job losses and the great recession, they can't afford the up-to-date computers and broadband access that you really need to use the Internet these days for medical purposes or anything else." How do you respond to somebody like Constance?

  • 13:46:27

    MOSTASHARIWe take that very seriously. I think as government, you know, we love to use the market for what the market does best, which is innovate. But one thing where we still believe there's a role for government is to make sure that the benefits of this accrue to everybody, and we're taking steps to make sure that whether it's physicians and those who are taking care of Medicaid patients, those who are lower income areas, that those providers in particular can get access to the technology.

  • 13:46:52

    MOSTASHARISo we focused a lot of our resources on making sure that a digital divide does not emerge on the physician side. And in terms of on patients, I think one of the really interesting possibilities is, as the previous caller talked about, cell phone based approaches. We're seeing that there actually is a very high penetration of cell phone use and increasingly smart phone use in all communities, including underserved communities.

  • 13:47:22

    MOSTASHARISo this is something we have to be very aware of. We have to monitor it, but so far so good. We have not, because of, I think, efforts that we're doing and the states are doing, community health centers and like, the libraries that you mentioned are doing, we have not seen that emerge to date, but we're vigilant about it.

  • 13:47:39

    NNAMDIWell, it won't be a problem for digital natives, but how about a lot of older patients who may not be exactly up to mastering a new gadget or learning a new software program? What are you concerns about whether embracing health IT is going to require too many people to learn too many new tricks, if you will.

  • 13:47:56

    MOSTASHARIWell, two points to that. One is people use things that make their life better and more convenient and those who are older tend to have more interactions with health care, and frankly, more frustrations about, you know, for example, getting their lab results back, or getting an appointment, or getting a refill. And so I think they do engage. They have a reason to engage with the technology, and they do do it. The other is that people get help.

  • 13:48:28

    MOSTASHARIPeople get help. I know that I'm certainly on the receiving end of a lot of that, and I think it's not unique. People do get the help that they need to be able to access that, including those who are less comfortable with it.

  • 13:48:45

    NNAMDIHere is David in Sandy Spring, Md. David, you're on the air. Go ahead, please.

  • 13:48:50

    DAVIDHello there.

  • 13:48:51

    NNAMDIHi there.

  • 13:48:51

    DAVIDFirst of all, having grown up in a medical family, I'm aware of the fact that there never were any good old days, okay. So we'll say that is the case. But recently, my health providers have been going over to electronic recordkeeping and a couple of things have come up which I'm very familiar with, my background in computers. One is that on two occasions now I have received large bundles of paper, one from an emergency room in Sylmar, California, and another from an emergency here in Montgomery County.

  • 13:49:29

    DAVIDLarge bundles of paper reflecting what they thought went on while I was there, and I've discovered that many of the pages, for one, have nothing on them, but they have to be printed out, and number two, that a number of them have boxes were are simply wrong. That's spelled W-R-O-N-G, wrong. And they -- also in both cases, they said, please come back and pick up your records because we're not allowed to share them with anybody. And one emergency room was out there in California, and the other's one here, and I can't go there because I can't drive. And then they say, and you'll have to come back another time to pick up the x-rays.

  • 13:50:07

    MOSTASHARIOh.

  • 13:50:08

    DAVIDSo now, in the meantime, my cardiologist was able to walk over to the emergency room here in Montgomery County and basically break in and yell at some people and carted the stuff off and called me up and said, do you know this stuff is wrong? And I said, well, how you gonna undo it, and he said, damned if I know. That's how far I am right now.

  • 13:50:27

    MOSTASHARIYeah.

  • 13:50:29

    NNAMDICare to respond to that?

  • 13:50:30

    MOSTASHARIIsn't it frustrating? You know, two things. One is that this is a key problem, is the -- one of the providers, Dr. Tastian (sp?) who runs a small practice in Wisconsin, who has really embraced this, said, I love having a thousand fact checkers.

  • 13:50:53

    NNAMDIMm-hmm.

  • 13:50:53

    MOSTASHARIHe gives every patient -- it's part of the Meaningful Use requirements. He gives every patient an after-visit summary that has printed on it the medications he thinks you're on, the diagnosis he thinks you have, the appointment that he -- right, and he says not a week goes by when my patients or their families don't correct my records, and I love it, right? And that's the difference, I think, between providers that really see it as an opportunity to engage with patients and their families and use them to improve their data that they need to take better care of the patient.

  • 13:51:32

    MOSTASHARIAnd I think that's a key part of this, is let the patients help. Let the patients help improve the quality of the data by sharing the information with the patients, and as per HIPAA requirements, giving them an opportunity to submit corrections as required. So good luck.

  • 13:51:55

    NNAMDIDavid, thank you very much for your call. Onto Lisa in Hillsboro, Va. Lisa, your turn. Go ahead, please.

  • 13:52:02

    LISAHi. I had kind of a weird experience where I was doing two things at the same time. I was discussing with a vet putting a chip in my pet so that Animal Control could return to them to me, at the same time that I putting in case of emergency numbers into a Smartphone. And I thought, why don't we have -- at least an in case of emergency with our devices that most of us carry around so that at least if you were admitted into a hospital in an emergency room where you have nothing and nobody knows anything about you, or you're with an EMT in a whatever, in an ambulance, they're able to at least access this critical information about us through a secure line and it could be, you know, NSA secure.

  • 13:52:45

    LISABut at this point, we should be able to have at least the basic information about the last time you were in a hospital and what your blood type is and things like that. A lot of these complications happen because the quality of the information that even the patient takes in, or the patient's family take in isn't correct or isn't up-to-date or whatever, and I don't -- that's the kind of technology that I think makes the most (unintelligible) at this point.

  • 13:53:11

    LISAAnd then, from there, you know, all the records in the world, and all the standardization and everybody using standardization, that would be great. But...

  • 13:53:19

    NNAMDIYou got all your contacts in your phone, you've all your reminders in your phone, why can't you also have a basic health report in your phone?

  • 13:53:27

    MOSTASHARIWhy isn't there an app for that?

  • 13:53:29

    NNAMDIExactly.

  • 13:53:31

    LISAEven if they say emergency, one of those numbers should be, you dial this number and those people are able to access through their remote, you know, security, okay, we get into my file in a secure site, a secure network, and it tells them, you know, hey, I'm AB negative...

  • 13:53:48

    MOSTASHARIYeah.

  • 13:53:48

    LISA...and I'm diabetic, and da da da.

  • 13:53:50

    MOSTASHARIYeah.

  • 13:53:50

    LISAAnd it saves lives...

  • 13:53:51

    MOSTASHARIYeah.

  • 13:53:51

    LISA...and it's like one phone call away.

  • 13:53:54

    MOSTASHARIYeah. It's interesting. We actually...

  • 13:53:57

    NNAMDII'm glad you're so dispassionate about this, Lisa.

  • 13:54:01

    MOSTASHARIActually, we're not the only ones who do app challenges at Health and Human Services. The assistant secretary for preparedness and response put out an app challenge, too, for apps that will help you in an emergency identify your key information, like your blood type and medications and so forth, as well as your emergency contacts. They did an app challenge around that. It's up on challenge.gov, and they got some great, again, great apps that people can use today to do this.

  • 13:54:30

    MOSTASHARIThe other thing that people can use is, I'm not gonna name any particular technologies or companies here, but there is a venerable manufacturer of medical bracelets and so forth who is now doing -- enabling exactly this, where instead of the information being printed on the bracelet or whatever, it gives whatever emergency room the opportunity to call or go online...

  • 13:55:00

    NNAMDIIt's in the Cloud.

  • 13:55:01

    MOSTASHARIAnd -- it's in the Cloud, and pull down your information.

  • 13:55:04

    NNAMDILisa, thank you very much for your call. On now to Curtis in Elk Ridge, Md. Curtis, your turn.

  • 13:55:12

    CURTISHi, how are you doing? I have a quick question about -- regarding how this would play any kind of role in people that what they call doctor shop, meaning they might have a real back problem, but they go to multiple doctors and get a little too many pills for them, and maybe sell some of the on the street. Would that put a stop to this at all? And I'll take the comments off air.

  • 13:55:38

    NNAMDICurtis also wanted to know about people who get meds that they need, say, through Canada. How would it affect those people?

  • 13:55:44

    MOSTASHARIMm-hmm. You know, this is for the most part, the ability to look up someone's records is gonna be based on their consent. So I think there's not gonna be this, you know, centralized database in the Cloud where any, you know, any doctor can go and look up a patient and get the totality of their information, whether, you know, whether or not the patient wants it or not. This is really going to follow a lot of what we currently have, which is if you go to a doctor and you say, you know, get my records from the other place, right, and we're gonna make it easier for you to do that, and easier for them to receive that information.

  • 13:56:32

    MOSTASHARIThere are, in very limited circumstances, laws that are in place in many states around the particular issue you raised around opioid prescriptions and abuse of those, and there are state laws that require pharmacies to report to these prescription monitoring programs to address those, and we are looking to link those existing state law and existing state monitoring programs into emergency rooms and pharmacies and so forth, to help address this real public health epidemic.

  • 13:57:12

    NNAMDIWe're almost out of time, but Steven in Clarksburg, Md., I can't get to your call, but I can tell what you want to ask about. He says that electronic information for health records is very influenced by the insurance companies. What role do insurance companies play in this at all?

  • 13:57:28

    MOSTASHARIInsurance companies have supported this transition in the past, and I think they too are going to be the beneficiaries, but also the sources of a lot of the electronic information. So patients should be able to go not just to their doctors, but to the health plans and say, give me my data.

  • 13:57:45

    NNAMDIAnd I'm sure that we would -- Steven is concerned about is whether they can get denied insurance on the basis of this.

  • 13:57:51

    MOSTASHARINo.

  • 13:57:52

    NNAMDIOkay. And I'm afraid that's all the time we have. Farzad Mostashari is the national coordinator for Health Information Technology, an office located within the U.S. Department of Health and Human Services. Thank you so much for joining us.

  • 13:58:04

    MOSTASHARIThank you, Kojo.

  • 13:58:05

    NNAMDI"The Kojo Nnamdi Show" is produced by Brendan Sweeney, Michael Martinez, Ingalisa Schrobsdorff, and Tayla Burney with assistance from Kathy Goldgeier and Elizabeth Weinstein. The managing producer is Diane Vogel. The engineer today, Kellan Quigley. A.C. Valdez is on the phones. Podcasts of all shows, audio archives, CDs and free transcripts are available at our website kojoshow.org. Thank you all for listening. I'm Kojo Nnamdi.

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