Though he no longer has authority over meaningful use regulations, former ONC chief Farzad Mostashari, MD, warned the audience at the CHIME Fall CIO Forum not to expect a delay in Stage 2 of the government’s EHR Incentive Program. He also took issue with the pace of EHR usability, interoperability and health data exchange.

"I think folks should assume that the timelines stick," Mostashari said Oct. 9 in a keynote address. It was his first public speech since stepping down as national coordinator for health IT less than a week ago.

Due to the nature of the federal regulatory process, he said, it would be difficult to introduce more flexibility for complying with the Stage 2 rules, as Ann Arbor, Mich.-based CHIME, which represents 1,400 CIOs, has requested. "To change anything that's in the regulation, you need to do a rulemaking," he said. It would take nine months to a year before CMS could finalize any modifications, he noted.

Also, Mostashari said, if CMS suddenly announced that it were to make a change to meaningful use Stage 2 through a new rulemaking, there would be "total chaos" since nobody would know what was going on while regulators worked through it. However, he offered a bit of consolation to the audience of hospital CIOs by suggesting CMS could take "sub-regulatory" steps such as providing new guidance on hardship exemptions to existing rules.

Unencumbered from political and procedural restraints about what he can say, Mostashari, newly appointed visiting fellow of the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, was more critical than he typically had been during his two years as coordinator. "I'm no longer in the government and I can be pretty blunt about this," Mostashari said, before critiquing EHR usability and the slow pace of health information exchange.

"We can't wait for interoperability," he said. "It's past time."

As he sees it, the expectations for how EHRs should work are rising faster than vendors are improving their systems. "I do worry about the usability of the products.” He questioned whether the market might not be incentivizing usability as much as it should.

"Those of us in healthcare know almost too well that those systems are sometimes lacking," Mostashari said. "Lack of rational, engineered processes and protocols."

Still, technology by definition gets better over time, but some things in medicine haven't changed in many years, Mostashari said. "We've been shackled. Trying to change a system like healthcare is very hard," he said. But with forces jealously guarding the status quo, it becomes "nearly impossible."

Mostashari praised the work of his former colleagues in the Office of the National Coordinator for Health Information Technology and the work of his three predecessors. By now, he said, IT-enabled health reform has become a "partnership" between government and the private sector.

The current government shutdown has stalled progress, however, as ONC reportedly is down to four "essential" staffers from its normal 60-person workforce. (Mostashari joked that there was nobody around to turn in his ID badge to when he departed last Friday.) He said that EHR certification is "furloughed" right now even as vendors and providers gear up for meaningful use Stage 2, and work on health IT standards and policy has stopped.